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Clinical and Laboratory Factors Related to Seizure and Serotonin Toxicity in Tramadol Intoxication: An Egyptian Study

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Abstract

Background and Objectives

Tramadol is a centrally acting analgesic with a lower risk of addiction compared to opioids. Tramadol overdose is becoming a health crisis in Egypt and is associated with serious and severe adverse effects. This study aims to identify clinical and laboratory findings associated with tramadol-induced seizure and serotonin toxicity in adult Egyptian patients with tramadol overdose.

Methods

This prospective study included adult patients admitted for tramadol overdose with or without symptoms of seizure or serotonin toxicity. Basic demographic information, clinical symptoms, laboratory measurements, and plasma tramadol concentrations were collected.

Results

A total of 71 patients (79% males) were included in the study. Seizure occurred in 38% of the subjects and was prevalent in male patients with metabolic acidosis or high tramadol concentrations. Serotonin toxicity occurred in 41% of the subjects and was prevalent in patients with hyperthermia, high pulse rate, and high tramadol levels.

Conclusion

Seizure and serotonin toxicity are severe adverse effects of tramadol overdose that occur in high frequency among young Egyptians. High tramadol concentrations in plasma seem to play a key role in prevalence of seizure and serotonin syndrome in tramadol-intoxicated adult Egyptians.

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Acknowledgment

The authors would like to thank the nursing and technical team at Ain Shams Poison Control Center for their assistance in conducting this study.

Author information

Authors and Affiliations

  1. Faculty of Pharmacy, Kafrelsheikh University, Kafrelsheikh, Egypt

    Ahmed Amin Ali & Khaled Abdelkawy

  2. Department of Emergency Medicine, Faculty of Medicine, Ain Shams University, Cairo, Egypt

    Mahmoud Mohamed Abdeshafy

  3. Faculty of Pharmacy, Menoufia University, Menoufia, Egypt

    Ramy M. Elsabaa

  4. School of Pharmacy, Pacific University, 222 SE 8th Ave., Hillsboro, OR, 97123, USA

    Fawzy Elbarbry

Authors
  1. Ahmed Amin Ali
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  2. Mahmoud Mohamed Abdeshafy
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  3. Khaled Abdelkawy
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  4. Ramy M. Elsabaa
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  5. Fawzy Elbarbry
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Corresponding author

Correspondence to Fawzy Elbarbry.

Ethics declarations

Conflict of Interest

All authors declare no financial or non-financial conflict of interest, and confirm that the study was approved by the appropriate ethics committee for research involving humans.

Ethics Approval

All procedures in this study were in accordance with the 1964 Helsinki declaration (and its amendments). An official permission to conduct the study was obtained from the Research Ethics Committee at Kafrelsheikh University (Ethical Approval Number: KFSIRB200-40; date: October 14, 2021).

Consent to Participate

Written informed consent was obtained from all patients in this study or from their relatives if they are not capable of giving consent.

Consent for Publication

Not applicable.

Code Availability

Not applicable.

Availability of Data and Materials

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

Author Contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were done by Mahmoud MA; protocol development and topic selection by Ahmed A; statistical monitoring/analyses by Khaled A and Ramy ME; manuscript reconstruction, language improvement and statistical monitoring/analyses by Fawzy E. The first draft of the manuscript was written by Fawzy Elbarbry and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript. All authors agreed on the following statements: (1) made substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data; (2) drafted the work or revised it critically for important intellectual content; (3) approved the version to be published; and (4) agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

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Ali, A.A., Abdeshafy, M.M., Abdelkawy, K. et al. Clinical and Laboratory Factors Related to Seizure and Serotonin Toxicity in Tramadol Intoxication: An Egyptian Study. Clin Drug Investig 43, 963–971 (2023). https://doi.org/10.1007/s40261-023-01326-y

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  • DOI: https://doi.org/10.1007/s40261-023-01326-y

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