Abstract
Tramadol is commonly prescribed for pain control because it presents a lower risk
for addiction and respiratory depression compared to other opioids. However, tramadol's
serotonin and norepinephrine reuptake inhibitory effects result in a unique adverse
effect profile. Two such adverse events are serotonin syndrome and seizures. The prevalence
of tramadol-induced serotonin syndrome and seizures is modest in the general population,
but if left untreated, the morbidity and mortality can be high; therefore, prompt
recognition and management is essential. Various risk factors such as medical comorbidities,
use or abuse of supratherapeutic doses of tramadol, and concomitant administration
of proconvulsant serotonergic cytochrome P-450 inhibitors will help clinicians identify
individuals at an elevated risk for serotonin toxicity and seizures. Serotonin syndrome
and seizures can be effectively treated by administering benzodiazepines, providing
supportive care, and discontinuing tramadol and other contributing agents. Cyproheptadine
should be administered in moderate to severe cases of serotonin syndrome. Our objective
is to summarize the literature on the pharmacology, epidemiology, risk factors, clinical
presentations, and evidence-based management of tramadol-related seizures and serotonin
syndrome.
Keywords
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Article Info
Publication History
Published online: May 10, 2018
Accepted:
April 2,
2018
Received in revised form:
April 2,
2018
Received:
March 28,
2018
Footnotes
Funding: None.
Conflicts of Interest: None.
Authorship: The authors take full responsibility for the content of the article. All authors participated in the research and preparation of the manuscript.
Identification
Copyright
© 2018 Elsevier Inc. All rights reserved.
