Q: 54-year-old male with past medical history (PMH) of depression is recovering in ICU after his cardiac bypass surgery. As part of multi-model pain regimen, he received tramadol. The patient progressively developed agitation, tachycardia, hallucinations, increased body temperature, and abnormal eye movements. What is your concern?
Answer: Serotonin syndrome
Tramadol has been inducted in many multi-model pain regimens at various institutions to decrease the use of narcotics. Although tramadol is an opioid agonist, it has lower risk of dependence on short-term use. Also, in comparison to narcotics, it causes a lower level of constipation. It works by blocking the reuptake of serotonin and norepinephrine and so may cause serotonin syndrome, particularly in patients who are already on serotonergic agents.
(The clue in the question is the patient's PMH of depression - who has a high chance of being on SSRI).
#toxicity
#drug-interactions
#neurology
References:
1. Grond S, Sablotzki A. Clinical pharmacology of tramadol. Clin Pharmacokinet 2004; 43:879.
2. Beakley BD, Kaye AM, Kaye AD. Tramadol, Pharmacology, Side Effects, and Serotonin Syndrome: A Review. Pain Physician 2015; 18:395.
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