Tramadol induced convulsions

[skymedic]

A south African colleague of mine, recently conveyed her concern regarging the safety of Tramal (Tramadol hydrochloride, a synthetic narcotic). This follows several incedents experienced by her colleagus, plus two of which she bore the brunt.

In all cases, the patients concerned were either initially hypovolemic, hypotensive, or both. Following the administration of Tamadol at the recommednded dosages of 2mg/kg slow IVI, these patients (most of whom were GCS 15/15 initially) experienced grand mal seizures within ten minutes of receiving Tramal. Most of these had to be intubated and ventilated after Diazepam administration, and some required further sedation for adequate management.

I suspect that the above is caused by one or more of the following:
1. Low hematocrit
2. Altered diffusion gradients and pressure gradients on the brain due to hypotension.
2. Cerebral hypoxia (though most patients were 15/15 at time of administration)
3. Electrolyte imbalances
4. Altered neurotransmitter enhanced/impaired
5. Pharmacokinetics of the drug are altered and/or affected by one of the above scenarios.

If anyone has experienced a similar case or can provide any insight to into the matter, please advise.

Thanks

Michael Dollenberg
N.Dip AET, ACLS PALS

PS. I've since found out that in clinical trials of Tramadol on lab rats (apparently their neuro structure and response is similar to ours), convulsions were induced after dosages of 25mg/kg.

Here's a theory:

If the patient is compensating by means of vasoconstriction (fit, young and healthy), then he would effectively have an increased concentration of tramadol in cerebral circulation (due to decreased peripheral circ.). thus increased risk of high cerbral doses???

Any thoughts??
[This message has been edited by skymedic (edited February 02, 2000).]

[This message has been edited by skymedic (edited February 03, 2000).]

[Trauma_Dog]

You might want to go back and look deeper in the charts and see If there is a corlation between your pt's past medical Hx's and see if there is a common denominator.

Next, I will ask why the medication was given? Pain relief or sedation?

Most Opioids have a S/E of hypotension,which in this case may have lowered the B/P even further,possibly causing anoxia to the brain and therefore inducing the seizure...Pure speaculation. It would be some good data to look for..Pre-administation and Post-aministration blood pressures.

I would then look for PMH simulaties in the following;

* Serotonin reuptake inhibitors (SSRI),ie.Zoloft.
* Tricyclic antidepressants and other tricyclic compounds.
* Other Opiois
* MAO inhibitors,ie.the popular OTC St.Johns'Wart.
* neuroleptics.
* alcohol ingestion

An increased sezure risk has been report in all the above case when just one dose of Tramadol has been administered.

This drug is not widely used in EMS here in the states is popular where you are? We are using several different methods for pain management. Fentanyl,Stadol, Morphine and Nitus Oxide.

Let me know what you come up with, may be an interesting topic for reserch and a paper to publish.
The Dog

------------------
Kent Simon
Paramedic Incharge
MCHD EMS,
Montgomery Co.,TX


[This message has been edited by Trauma_Dog (edited February 07, 2000).]

[This message has been edited by Trauma_Dog (edited February 07, 2000).]