Fatal overdose of tramadol and alprazolam

Michaud, Katarzyna; Augsburger, Marc; Romain, Nathalie; Giroud, Christian; Mangin, Patrice

doi:10.1016/s0379-0738(99)00118-8

Cited by 71 publications

(59 citation statements)

References 5 publications

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“…In previously reported tramadol fatalities (3)(4)(5)(6)(7)(8)(9)(10)(11) in combination with other drugs, death occurred when tramadol blood concentrations ranged from 0.03 to 134 mg/L. In cases where authors ascribed the death to tramadol, blood concentrations ranged from 9.6 to 134 mg/L.…”

Section: Discussionmentioning

confidence: 99%

“…Some non-lethal cases of respiratory depression, seizures, and serotonin syndrome have been reported with tramadol (1)(2). Several deaths have also been reported when tramadol was ingested alone in overdose (3)(4)(5), or when it was ingested with others drugs (6)(7)(8), particularly with central nervous system (CNS) depressants like benzodiazepine (9)(10)(11). We report a case of a tramadol overdose in combination with other CNS depressants, leading to refractory shock and asystole requiring extracorporeal life support (ECLS).…”

Section: Introductionmentioning

confidence: 99%

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Refractory shock and asystole related to tramadol overdose

Daubin

Quentin

Goullé

et al. 2007

Clinical Toxicology

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Introduction. Tramadol use is largely considered safe. However, several lethal cases of tramadol intoxication were reported, suggesting an underestimated toxicity. We report for a tramadol overdose case in combination with other central nervous system depressants, leading to refractory shock requiring extracorporeal life support. Case report. A 33-year-old man was admitted in our intensive care unit for drug intoxication with coma, seizures, and hypotension without signs of heart failure. A few hours later, he developed a ventricular tachycardia, followed by a brief cardiac arrest in asystole with refractory shock requiring an extracorporeal life support, vasopressors, and hemofiltration. With this aggressive support, his overall status gradually improved. Repeated echocardiography showed an improvement in the cardiac function. The patient was weaned off extracorporeal life support on day eight and discharged on day 12. On admission, a urine analysis, using gas chromatography-mass spectrometry, showed high peaks of tramadol and desmethyltramadol with the presence of hydroxyzine, gabapentine, and clonazepam. The tramadol blood concentration measured by the high-performance liquid chromatography method-diode array detector was 23.9 mg/L, much higher than many previously reported fatal overdoses. No other drugs with potential cardiac toxicity, such as beta-blockers, calcium antagonists, antiarrythmic, antidepressants, meprobamate, or other xenobiotics were detected. Conclusion. This case illustrates that tramadol overdose may cause refractory shock and asystole when taken in combination with CNS depressants, and reminds all physicians to be vigilant with regard to the potential toxic effects of tramadol.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Refractory shock and asystole related to tramadol overdose

Daubin

Quentin

Goullé

et al. 2007

Clinical Toxicology

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“…It has been approved in some countries since 1980 and become the most prescribed opioid worldwide [3,4]. Tramadol was authorized by the Iran Drug Selecting Committee in 2002 as an analgesic.…”

Section: Introductionmentioning

confidence: 99%

“…Tramadol binds weakly to the μ-opioid receptor and also inhibits reuptake of monoamines such as serotonin and norepinephrine [2][3][4][5]. Most of the analgesic effect of tramadol may be secondary to non-opioid properties, via the central monoaminergic pathways.…”

Section: Introductionmentioning

confidence: 99%

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Factors Related to Seizure in Tramadol Poisoning and Its Blood Concentration

et al. 2011

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Drug concentrations in post‐mortem specimens

Ketola

Kriikku

2019

Drug Testing and Analysis

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A meta‐analysis of drug concentrations in post‐mortem specimens is presented. The analysis involved 50 commonly used drugs and their concentrations in femoral blood, other blood (such as cardiac blood), vitreous humor, muscle, liver, kidney, brain, heart, lung, spleen, and bile. A total of 10 993 analytical results from 5375 post‐mortem cases in 388 studies were gathered and the ratios of drug concentrations in tissue material to median femoral blood concentrations were calculated. Analytical results from the laboratory's own database (years 2000–2018) were also included. The results show that the variation of ratios between post‐mortem specimens and femoral blood is highly compound dependent. This database can be utilized in interpretation of toxicological results in cases where femoral blood is not available. The specimens with similar concentrations as in femoral blood were vitreous humor, muscle, and other blood, such as cardiac blood, and the highest concentrations were generally measured from liver and bile. For these reasons we suggest the following order for biological specimens to be used for a quantitative toxicological analysis in cases where femoral blood is not available: 1. other blood, 2. muscle, 3. vitreous humor, 4. brain, 5. heart, 6. spleen, 7. kidney, 8. liver, and 9. bile.

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Fatal overdose of tramadol and alprazolam

Cited by 71 publications

References 5 publications

Refractory shock and asystole related to tramadol overdose

Refractory shock and asystole related to tramadol overdose

Factors Related to Seizure in Tramadol Poisoning and Its Blood Concentration

Drug concentrations in post‐mortem specimens

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