Tramadol Toxicity - Etiology, Adverse Effects and Treatment

What Is Tramadol?

Tramadol is an analgesic drug and belongs to a group or class of drugs called opioids, which are commonly used for pain management by acting on the central nervous system. Tramadol is available as an oral, immediate-release, and extended-release tablet. Tramadol also comes as an oral extended-release capsule. Immediate-release drugs are released and show their effects on the body. Extended-release drugs are released slowly into the body.

What Is Tramadol Toxicity?

Excessive or overuse of Tramadol can result in tramadol toxicity. Tramadol abuse is problematic in several countries, according to a review by the International Narcotics Control Board. However, many studies have reported the increased misuse of Tramadol as a drug with intentional overdoses or intoxications. While many facts about Tramadol's efficacy for pain are unknown, there is increasing evidence from post-marketing surveillance indicating significant side effects. Tramadol can be considered responsible for severe intoxications leading to consciousness disorder, seizures, agitation, and respiratory depression. The easy availability of opioids for treatment or prescribed for pain management in some countries may be contributing to increased drug-related health problems, hospitalizations, and life-threatening conditions.

What Is the Etiology of Tramadol Toxicity?

The major cause of Tramadol toxicity is drug dependence for an overdose. While it is believed that Tramadol has a much lower potential for causing drug abuse and dependence than more opioids available, for example, Codeine or Hydrocodone, recently Tramadol abuse rate has been increasing. The National Survey on Drug Use and Health (NSDUH) states that about 3.2 million people used Tramadol for non-medical purposes in 2013, up from 2.7 million in 2012.

Drug dependence is mostly associated with tolerance, meaning the patient requires higher and higher doses of the medication to achieve the same effects. This can be associated with an increased risk of overdose.

Some factors may also present the possibility of Tramadol toxicity. According to The National Survey on Drug Use and Health (NSDUH) survey, the majority of people who got addicted to Tramadol were over the age of 26. The U.S. Drug Enforcement Administration (DEA) states that Tramadol abuse by people who are:

• Already suffering from narcotic addiction.

• Patients are suffering from chronic pain.

• Health professionals can also get affected.

Also, the Centers for Disease Control and Prevention says that, in general, men are more likely to overdose on prescription painkillers. However, overdose rates in women have been reported rapidly in recent years. Prescription painkiller dependence generally can also be associated with dependence on other abusive substances, like alcohol. If a person who has struggled with other substance addictions in the past may be more prone to dependence on opioids, putting them at higher risk of an overdose.

What Are the Signs and Symptoms?

Tramadol may cause drowsiness. It is suggested that a person should avoid driving, using heavy machinery, or performing any dangerous activity. Tramadol may also cause other side effects.

The more common signs and symptoms of tramadol toxicity:

• Dizziness.

• Headache.

• Drowsiness.

• Nausea and vomiting.

• Constipation.

• Lack of energy.

• Sweating.

• Dry mouth.

• Itching.

These effects may subside in a few days or a couple of weeks if they are mild. If they are more severe or do not subside on their own, consult the doctor.

Adverse Effects of Tramadol Toxicity

The followings are the serious side effects and their symptoms:

Serotonin syndrome

• Fast heart rate.

• High blood pressure.

• Body temperature that is higher than normal.

• Reflexes that are stronger than normal.

• Lack of coordination (control of the movements).

• Nausea and vomiting.

• Diarrhea.

• Agitation.

• Hallucinations.

• Coma.

Serious breathing problems

• Slow breathing rate.

• Shallow breathing.

• Fainting,

• Dizziness.

• Confusion.

Physical dependence when stopping the drug

• Feeling irritable, anxious, or restless.

• Trouble sleeping.

• Increased blood pressure.

• Fast breathing rate.

• Fast heart rate.

• Dilated (large) pupils.

• Teary eyes.

• Runny nose.

• Yawning.

• Nausea, vomiting, and a loss of appetite.

• Diarrhea and stomach cramps.

• Sweating.

• Chills.

• Muscle aches, back pain, or joint pain.

Adrenal Insufficiency

• Long-lasting tiredness.

• Muscle weakness.

• Pain in the abdomen.

Androgen Deficiency

• Tiredness.

• Trouble sleeping.

• Decreased energy.

• Seizures.

• Addiction or misuse of this drug.

What Drugs Interact With Tramadol and Result in Poisoning?

If a person is having breathing problems or withdrawal symptoms, the person may start or stop taking certain other medicines. Inform the doctor if a person is on drugs like an antibiotic, antifungal medication, heart or blood pressure medication, seizure medication, or taking treatment for HIV (human immunodeficiency virus) or hepatitis C. Many other drugs can be seriously dangerous when used along with Tramadol. Tell the doctor if they also use:

• Medicines to treat allergies, asthma, blood pressure, motion sickness, irritable bowel, or overactive bladder.

• Other opioid medicines.

• Benzodiazepine sedative drugs like Klonopin, Valium, or Xanax.

• Muscle relaxers, sleep medicine, other drugs that make the patient drowsy, or medicines that affect serotonin, for example, antidepressants, stimulants, or medicine for treating migraines or Parkinson's disease.

Other drugs can also interact with Tramadol and result in serious conditions, including prescribed medicines and over-the-counter medicines, multi-vitamins, and B-complex or herbal products.

How to Avoid Tramadol Toxicity?

The toxicity is most likely when the drug is being abused or overused, so the best way to avoid Tramadol toxicity is to use the drug in an appropriate amount and correctly.

• A patient should start the intake of Tramadol only if prescribed by a doctor.

• Follow the doctor's dosage instructions.

• Take Tramadol as it is prescribed, usually orally.

• Snorting or injecting crushed Tramadol can be dangerous, especially at high doses, and lead to serious conditions.

• Avoid mixing Tramadol with other substances, such as alcohol, other opioids, or central nervous system (CNS) depressants (e.g., Valium, Xanax, Ambien).

How to Treat Tramadol Toxicity?

The following are the points to keep in mind while treating Tramadol Toxicity.

• The Federal Food and Drug Administration (FDA) states that the treatment of a Tramadol overdose or toxicity should focus on maintaining adequate ventilation, which can help the patient to breathe properly.

• Naloxone is a type of narcotic that is mostly used to reverse the effects of Tramadol toxicity. It works by attaching its molecule to the same receptors present in the brain that Tramadol and other opioids affect, preventing the binding of opioids at those particular sites and producing their usual effects.

• As Tramadol has an atypical mechanism of action, Naloxone administration can only partially reverse some of the dangers in an overdose situation.

• Moreover, Naloxone can help by reducing respiratory and central nervous system depression. The FDA suggests that it can also increase the patient's risk of seizure. Therefore Naloxone should be used very carefully.

• Administration of oxygen is indicated if a patient is experiencing severe respiratory difficulties.

• Patients may also experience irregular heartbeat, cardiac arrest, or defibrillation in serious conditions.

Conclusion:

Tramadol is a common analgesic drug used for pain management. It is a type of addictive drug and can lead to drug abuse causing life-threatening conditions. It is recommended to use only the required amount of drug, and if a person experiences any of the signs and symptoms, they should immediately consult the doctor to avoid any unfortunate circumstances.