Tramadol side effects: Seizure and hypoglycemia

Sir,

We read a case report regarding seizures being a side effect of low dose tramadol by Beyaz et al.[1] We would like to share our views and the recent literature.

In a very recent study on the first seizure, the tramadol has been implicated as a causative agent in about one-fifth of the patients and the low dose of the drug is also not safe from this point of view.[2] Hence, as the authors have written that seizures are a rare side effect of tramadol[1] is not so. A very important observation in the study by Asadi et al. is that it is more common in first 6 h of consumption and in first 10 days.[2] Hence, it is a point worthy that one who tolerates early the later chances of developing seizures are less likely.

At times, the seizures are so deleterious that they are being implicated in about one-fifth of the cases of recurrent shoulder dislocation.[3]

Hypo- and hyper-glycemia are also of concern in patients using tramadol[4] which further complicate the side effect profile.

Hyponatremia is again a complication of concern complicating the tramadol therapy.[5]

We have personally seen the patient of osteomalacic myopathy who otherwise was doing very well got deteriorated with seizure in a setting of fever and hypocalcemia.

Hence, as we see that tramadol is implicated in hypoglycemia, hyperglycemia, hyponatremia, we recommend its restricted use and as and when required rather than continuous one and for a short time. Furthermore, as the other opioids are being withdrawn from the market because of addiction liability so is the case with tramadol that public and even de-addiction centers are now using in lieu of opioids, so the time is not far away when tramadol will also be disappearing. Hence, as to avoid the abstinence syndrome better we use it as judicious as possible.

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Conflicts of interest

There are no conflicts of interest.