Tramadol overdose as a cause of serotonin syndrome: a case series

Tashakori, Ahmad; Afshari, Reza

doi:10.3109/15563651003709427

Cited by 82 publications

(72 citation statements)

References 21 publications

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“…Central nervous system complications are the most frequently reported manifestations ranging from agitation to deep coma 5 . Seizure has been considered to have an important role in tramadol toxicity as declared by studies and the literature 5, 7, 8, 9, 10, 11. Nausea/vomiting and respiratory depression have also been reported 5, 7, 8.…”

Section: Introductionmentioning

confidence: 99%

“…Seizure has been considered to have an important role in tramadol toxicity as declared by studies and the literature 5, 7, 8, 9, 10, 11. Nausea/vomiting and respiratory depression have also been reported 5, 7, 8. Of cardiac issues, hypotension, especially affecting systolic blood pressure (SBP) and sinus tachycardia have been listed as tramadol toxicity complications 5, 7, 8, 12, 13, 14…”

Section: Introductionmentioning

confidence: 99%

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Electrocardiographic changes in patients with tramadol-induced idiosyncratic seizures

Moghadam

Zarei

Farsi

et al. 2016

Turkish Journal of Emergency Medicine

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ObjectivesTo assess ECG changes in patients with tramadol-induced seizure(s) and compare these changes in lower and higher than 500 mg tramadol doses as a main goal.Material and methodsIn an analytical-cross sectional manner over 1 year, 170 patients with idiosyncratic seizure(s) after using tramadol, were studied. Full data were recorded for each patient. ECGs were taken from all the patients on admission and 1 h later and were assessed for findings.Results70 of 170 patients (41.2%) had used lower than 500 mg doses of tramadol while 90 patients (52.9%) were included in the high dose group. Rate of female patients in the high dose group was significantly higher. The average age of patients in the high dose group was significantly lower (22.04 vs 25.76). The high dose group had significantly higher heart rates. There was no history of cardiovascular diseases; two patients had previous history of seizure. No significant difference was shown between low dose and high dose groups from the point of ECG changes.Discussion and conclusionUsing doses higher than 500 mg is more frequently seen in women, young people and those who have not experienced previous use of tramadol. Terminal S wave, sinus tachycardia, and terminal R wave in the lead aVR are among the most common ECG changes in tramadol users.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Electrocardiographic changes in patients with tramadol-induced idiosyncratic seizures

Moghadam

Zarei

Farsi

et al. 2016

Turkish Journal of Emergency Medicine

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“…3,10 Synthetic piperidine opioids are considered proserotonergic and include fentanyl, 17 methadone, 18 meperidine, 19 propoxyphene, dextromethorphan, 20 and tramadol. 21 The phenantherene morphine analogues, i.e., oxycodone, 22 hydromorphone, oxymorphone, and buprenorphine 23 do not act as serotonin uptake inhibitors, 24 but may increase the intrasynaptic serotonin levels either through increased release of neurotransmitter or some unknown mechanism. 4,6,14 The list of opioids implicated in causing serotonin syndrome with other serotonergic agents is growing (table 2).…”

Section: Serotonergic Opioidsmentioning

confidence: 99%

Case Scenario: Opioid Association with Serotonin Syndrome

2011

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“…Tramadol is a commonly prescribed opioid used in severe pain. Tramadol can cause miosis through stimulation of opioid receptors [9] or mydriasis through stimulation of the adrenergic receptors [10]. In fact, it inhibits serotonin and noradrenaline reuptake from the synaptic cleft, and stimulates pre-synaptic release of serotonin [11].…”

Section: Discussionmentioning

confidence: 99%

Bilateral acute angle-closure glaucoma following tramadol subcutaneous administration

et al. 2018

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BackgroundTo report a case of bilateral acute angle closure-glaucoma following the use of subcutaneous Tramadol.Case presentationA 42-year-old healthy man with unremarkable past medical and ocular history, was admitted to the Orthopedic Department for surgical treatment of a bilateral open fracture of the femur following a road accident. Three hoursafterTramadolsubcutaneous injection, the patient complained of a bilateral acute painful visual loss with persistent vomiting. An ocular examination showed bilateral acute angle-closure-glaucoma. The patient was treated with topical anti-glaucoma therapy and intravenous Mannitol 20%.After resolution of ocular hypertension attack, NdYag laser peripheral iridotomy was performed on both eyes. After a follow-up period of 7 days visual acuity improved to 20/20 in both eyes and intraocular pressure returned to normal levels.ConclusionsThis case highlights the risk of developing bilateral acute angle-closure glaucoma after Tramadol administration.KeywordsAngle closure glaucomaMydriasisTramadolAnterior segment OCT

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Tramadol overdose as a cause of serotonin syndrome: a case series

Abstract: In tramadol overdose, mydriasis or tachycardia appears to indicate a higher risk for seizure. Management may need to be focused on both mu-opioid agonism and potential mild serotonin syndrome.

Cited by 82 publications

References 21 publications

Electrocardiographic changes in patients with tramadol-induced idiosyncratic seizures

Electrocardiographic changes in patients with tramadol-induced idiosyncratic seizures

Case Scenario: Opioid Association with Serotonin Syndrome

Bilateral acute angle-closure glaucoma following tramadol subcutaneous administration

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