Tramadol was approved in 1995 by the FDA. Indicated to treat pain, it was classified as a “nonscheduled opioid” until 2014, when it became a schedule IV drug.
Tramadol quickly gained popularity possibly due to the belief that tramadol poses a lower risk of adverse effects than general opioids such as dependence. It became the second most-commonly opioid in 2013. It is important to highlight risks related to the prescription of tramadol. This review focuses on seizures as 1 of the drug’s adverse effects.
Tramadol is a synthetic codeine analog. Tramadol and its active metabolite provide analgesic effects by binding to opioid receptors and inhibiting gamma-amino butyric acid. In addition, it inhibits nor-epinephrine and serotonin re-uptake. The therapeutic dose is 50mg daily and the maximum daily dose should not exceed 400mg. There are several adverse effects related to tramadol overdose including seizure, agitation, tachycardia, and hypertension. It may also cause coma and respiratory depression. Of the aforementioned side effects, seizure is the most common.
Cases of seizure have been reported as “brief, tonic-clonic seizures” and usually self-limited. Seizures triggered by tramadol have been observed with higher and lower doses, and co-ingestion of alcohol, tricyclic antidepressants, antipsychotics, and selective serotonin reuptake inhibitors. However, seizures have also been reported with doses as low as 75mg.
In conclusion, tramadol is a commonly prescribed opioid agonist. It has been associated with seizure—even in cases of patients receiving doses as low as 75mg. In cases of Asian patients, younger patients with a history of alcohol and/or drug abuse, or patients who have suffered a cancer, renal failure head injury, or stroke, medical professionals must take caution and perhaps consider alternative medication.