Tramadol and serotonin toxicity

 Q: Tramadol is an opiod?

A) True

B) False

Answer: A

Tramadol is increasingly becoming a part of multi-model analgesia protocols, particularly in post-surgical ICU patients. Tramadol is called a mixed mechanism opioid because it has weak affinity for mu-opioid receptors. It is also serotonin and norepinephrine reuptake inhibitor. 

The objective of this question is to highlight the risk of serotonin syndrome due to wide use of serotonin reuptake inhibitors in the population. A combination of tramadol and serotonin reuptake inhibitors may cause life-threatening serotonin toxicity and seizures.

#toxicology

#pharmacology

References:

1. Nelson EM, Philbrick AM. Avoiding serotonin syndrome: the nature of the interaction between tramadol and selective serotonin reuptake inhibitors. Ann Pharmacother. 2012 Dec;46(12):1712-6. doi: 10.1345/aph.1Q748. Epub 2012 Dec 4. PMID: 23212934.

2. Beakley BD, Kaye AM, Kaye AD. Tramadol, Pharmacology, Side Effects, and Serotonin Syndrome: A Review. Pain Physician. 2015 Jul-Aug;18(4):395-400. PMID: 26218943. 

3. Hassamal S, Miotto K, Dale W, Danovitch I. Tramadol: Understanding the Risk of Serotonin Syndrome and Seizures. Am J Med. 2018 Nov;131(11):1382.e1-1382.e6. doi: 10.1016/j.amjmed.2018.04.025. Epub 2018 May 10. PMID: 29752906.