The side effects of chronic exposure to synthetic drugs such as tramadol have become a concern for the health system. Medicinal plants can be used as rich sources of natural compounds with therapeutic properties to reduce the side effects of synthetic drugs such as tramadol. Hence, this study sought to review the published research concerning the protective role of medicinal plants against tramadol toxicity. This systematic review was conducted according to the preferred reporting items for systematic reviews and meta-analyses (PRISMA) statement. This study included all published articles evaluating the efficacy of the medicinal plants against tramadol toxicity until December, 2021. For this systematic review, search was performed using keywords including tramadol, toxicity, poisoning, overdose, medicinal plants, and herbal medicines from reliable databases such as PubMed, Google Scholar, Web of Science, Wiley, Elsevier, and Science Direct. The risk of bias tool for animal intervention studies (SYRCLE’s RoB tool) criteria and the OECD guidelines and the WHO Good Laboratory Practice (GLP) handbook were used for quality assessment of animal and in vitro studies, respectively. This review determined 18 medicinal plants and one multi herbal formulation against tramadol toxicity. Plants such as Nigella sativa (Black Seed), Moringa Oleifera (Drumstick tree), and Aloe Vera, pomegranate, wheat, barely, pumpkin, walnut, kiwi fruit, turmeric, apple, fennel, and garlic also displayed therapeutic effects against tramadol toxicity. This review exhibits a wide range of medicinal plants with therapeutic effects such as antioxidant, anti-inflammatory and anti-apoptotic properties which could protect the organs of the body against toxicity caused by tramadol. Hence, the use of these plants or their compounds can be effective in reducing the complications caused by many diseases.

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.

This case report describes a rare occurrence of tramadol misuse resulting in a manic episode in a patient without a history of psychiatric disorders. The patient had used tramadol off-label for premature ejaculation. Following discontinuation of tramadol and initiation of mood stabilizer treatment, the manic symptoms resolved. Tramadol, despite its potential antidepressant properties, also poses a risk of inducing psychiatric disturbances. Diagnosis can be challenging and necessitates a thorough examination. Management involves immediate cessation of tramadol and administration of mood stabilizers. Clinicians should exercise caution and closely monitor patients when prescribing tramadol, particularly for off-label indications.