Low-Dose Tramadol-Induced Seizure: A Case Report

Abstract

Tramadol is a weak mu (µ) opioid receptor agonist that acts by inhibiting serotonin and norepinephrine uptake. Tramadol undergoes extensive hepatic metabolism by a number of pathways, including CYP2D6 and CYP3A4, and by conjugation with subsequent renal excretion. The maximum recommended dose is 400 mg/day. One of the most important adverse effects of tramadol is a seizure, which usually occurs at high doses and is often generalized tonic–clonic type and self-limiting. Here, we present a case of a patient with inflammatory low backache who developed seizures while on low-dose oral tramadol. After 1 h of taking the first tablet of tramadol, he developed morbilliform rashes all over the body. One day later, he developed generalized tonic–clonic seizures followed by a loss of consciousness for 5 min. The patient was admitted to the hospital and managed conservatively with injection lorazepam and tramadol was stopped. In general, if applied in overdose, tramadol can only incite seizures in patients already suffering from some sort of disorder related to seizures or if it is administered along with antidepressants, alcohol, etc. But here, only with the use of 37.5 mg oral application, the incidence of seizure happened.

The Protection by Vitamin E Against Tramadol-Induced Proconvulsant Effects and Brain Damage in Pentylenetetrazole-Induced Status Epilepticus in Rats

“…Tramadol can increase a patient's likelihood for developing seizures through lowering of the seizure threshold [12]. Occurrence of generalized tonic-clonic seizures has been reported with high doses of tramadol [13] but may also develop after such low doses as 37.5 mg twice daily [14]. Seizures may occur within the first 24 hours of tramadol administration.…”