TRAMADOL is a narcotic-like pain reliever. It is a synthetic, centrally acting analgesic drug with two distinct, synergistic mechanisms of action. Usually, TRAMADOL is used to manage moderate to severe surgical pain but it has shown anti-shivering effect in some setting. TRAMADOL is a weak opioid agonist and an inhibitor of monoamine neurotransmitter reuptake. It could inhibit the reuptake of 5-hydroxy tryptamin, Norepinephrine, and Dopamine [1]. . .

Background: TRAMADOL is a widely prescribed analgesic and due to its opioid-like effects, the potential for abuse of TRAMADOL is noticeable. Besides, the complications of TRAMADOL abuse have become a public health concern. This study aimed to investigate the affecting factors on the seizure, as one of the most common complications of TRAMADOL consumption. Methods: A total number of 64 patients from 315 patients who were referred to Sina Hospital, Tabriz, Iran because of TRAMADOL toxicity were included in this 9 months cross-sectional retrospective study. Results: There were 52 males and 12 females in the study. The seizure happened in 53. 1% of the subjects and the Mean± SD time between TRAMADOL consumption and seizure was 5. 9± 7. 36 hours. There was no significant association between seizure and sex, age, the dose of TRAMADOL, and previous TRAMADOL consumption history. A significant association was seen between the dose of TRAMADOL and the time of seizure. Conclusion: Seizure that happens due to TRAMADOL overdose is not dependent on sex, age, and previous history of TRAMADOL consumption. As the dose of TRAMADOL is higher, the seizure happens later. More research is needed to understand why the seizure occurs later in higher doses.

This study aimed to evaluate the shoulder dislocation following TRAMADOL-induced seizure and its potential difference with other shoulder dislocations. We evaluated six cases that used TRAMADOL tablets and some of them had a history of seizure. All of the cases had shoulder dislocation. According to the findings, TRAMADOL use and TRAMADOL-induced seizure may increase the risk of shoulder dislocation.

Background: TRAMADOL is an analgesic medication. High prevalence of TRAMADOL abuse has beenfrequently reported. This study was aimed to evaluate the common and serious complications and deathcases due to TRAMADOL intoxication. Methods: A cross-sectional study was performed on 420 patients hospitalized in poisoning ward ofTehran Loghman Hospital for four months period. Patient’ s characteristics and medical complications wererecorded during hospitalization and subsequent visits. Results: Convulsion (31. 3%) and apnea (6. 2%) were the most serious side effects in patients using withTRAMADOL intoxication. The incidence of apnea was correlated with the drug doses (P<0/5%). However, theincidence of other complications was not significantly related with the drug dose. Conclusions: The high prevalence of TRAMADOL abuse, and its high and dangerous complications in ourcountry that requires careful vigilance of physicians and pharmacists in prescribing and selling TRAMADOL, andfamilies’ awareness about the arbitrary use of his youth.

Background: TRAMADOL is a centrally acting opioid analgesic used to treat moderate to sever pain. It has more advantage and less opioid adverse effects than conventional opioid analgesia.Case Report: This article reports a patient with TRAMADOL dependency that had psychosis after TRAMADOL withdrawal.Conclusion: By the increase of TRAMADOL usage for relief of chronic pain, TRAMADOL abuse and dependency is increased. Some of TRAMADOL withdrawal symptoms are not related to opioid, for example when the effectiveness is not only on opioid receptors, but on catecholamine and serotonin receptors. So, together with typical symptoms of withdrawal, atypical symptomes had been reported.Psychosis is one of TRAMADOL atypical withdrawal symptoms which subsided a few days after suppression of withdrawal symptoms. In such cases, the diagnosis is substance withdrawal instead of psychotic disorder due to substance withdrawal and treatment is based on this diagnosis.

There are a few reports of seizure induced by TRAMADOL at therapeutic dose. Two case reports of repeated seizures with following agitation due to treatment with TRAMADOL are presented here. Both of them have similar presentation and TRAMADOL was injected intravenously at therapeutic doses. TRAMADOL prescription especially intravenously can evoke seizure with agitation or even status epilepticus. TRAMADOL should be cautiously prescribed especially for patients with history of epilepsy, addiction and old ages.