Epidemiol Health.  2019;41:e2019026. 10.4178/epih.e2019026.

Severe complications of tramadol overdose in Iran

• Habibollahi P
• Garjani A
• Shams Vahdati S
• Sadat-Ebrahimi SR
• Parnianfard N

• KMID: 2469428
• DOI: http://doi.org/10.4178/epih.e2019026

Abstract

OBJECTIVES
Severe complications of tramadol overdose have been reported; however, few large-scale studies have investigated this issue. Therefore, this study aimed to explore the presentation and complications of tramadol overdose in patients admitted to an intoxication referral center in northwestern Iran.
METHODS
Patients with tramadol overdose admitted to Sina Teaching Hospital in Tabriz, Iran during 2013-2017 were included. For each patient, the following data were collected: demographics, previous drug or medication overdose, whether the patient was in the process of quitting drug use, ingested dose of tramadol and co-ingestants, Glasgow Coma Scale (GCS) score, clinical symptoms at the time of admission, and admission characteristics. Serotonin toxicity was diagnosed in patients who fit the Hunter criteria. Multiple logistic regression was performed to identify variables associated with the incidence of severe complications of tramadol overdose.
RESULTS
In total, 512 cases of tramadol overdose were evaluated, of which 359 patients were included, with a median age of 41 years (range, 16-69) and a median tramadol dose of 1,500 mg (range, 500-4,000). The most frequent complications associated with tramadol overdose were hypertension (38.4%), tachycardia (24.8%), and seizure (14.5%). No serotonin toxicity was detected in patients. Having a GCS score <15, having taken a tramadol dose of >1,000 mg, being in the process of quitting drug use, being 30-49 years old, and male sex were significantly related to the incidence of severe complications of tramadol overdose.
CONCLUSIONS
Although seizure was prevalent among Iranian patients with tramadol poisoning, serotonin toxicity and cardiogenic shock were rare findings.

Keyword

Tramadol; Serotonin syndrome; Overdose; Complications; Iran

MeSH Terms

Demography
Glasgow Coma Scale
Hospitals, Teaching
Humans
Hypertension
Incidence
Iran*
Logistic Models
Male
Poisoning
Referral and Consultation
Seizures
Serotonin
Serotonin Syndrome
Shock, Cardiogenic
Tachycardia
Tramadol*
Serotonin
Tramadol