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The views and opinions expressed in this column are those of the authors and do not reflect the official policy or the position Ketteding the United States Air Force, Department of Defense, or US government. This ongoing column is dedicated to the challenging clinical Ketterig between psychiatry and primary care—two fields that are inexorably linked. However, two significant adverse reactions are known to potentially occur with tramadol—seizures and serotonin syndrome.

In this article, we review the data relating to tramadol, seizures, and serotonin syndrome. This pharmacologic intersection is of clear relevance to both psychiatrists and primary care clinicians.

According to Kettfring et al, 1 chronic pain affects a vast number of US patients and results in billions of dollars in annual healthcare expenditures. Tramadol is an analgesic medication that is a synthetic analogue of codeine.

In comparison with other opiates, tramadol is renowned for having less abuse potential and less respiratory depression.

The affinity of tramadol for mu-opioid receptors analgesic effect is fold less than codeine. However, the active metabolite of tramadol, o-desmethyltramadol, has a far greater affinity up to fold than the parent compound. In addition to its central effects on mu receptors, at the peripheral level, tramadol inhibits serotonin and norepinephrine reuptake. These latter effects are likely to be an important element in analgesia, but may also account for some Free gumtree Barking the adverse properties of the drug.

In keeping with this perspective, Yalcin et al 6 describe tramadol as having antidepressant-like effects.

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Not surprisingly, using liquid chromatography to detect levels of tramadol in urine, venlafaxine may cause false positive results. Tramadol accounts for a significant number of drug interactions. For example, in an Australian veterans study, Roughead et al 8 examined adverse drug interactions in 46, participants taking antidepressants. Of the 8. Of these various interactions, tramadol has Ketterlng potential to trigger two dramatic events—seizures and serotonin syndrome.

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Potential severity of drug interactions with tramadol according to Clinical Psychopharmacology 4. Potential drug interactions with tramadol according Gay sauna south beach Gillingham AccessMedicine 9.

Tramadol monotherapy. Seizures have been reported with tramadol monotherapy in animal and Tramadol Kettering online studies, 4 both at recommended 10 and high doses. While fewer than one percent 80 had an alleged seizure after their first prescription of tramadol, the risk increased 2- to 6-fold when adjusted for selected medical comorbidities and concomitant prescribed drugs.

In an Australian study, Labate et al 13 found that 8. To illustrate the risk of excessive dosing, in a study of tramadol abusers, Jovanovic-Cupic et al 17 found that With regard to seizures in genuine overdoses, Thundiyil et al 18 examined all such cases logged by the California Poison Control System in Of the identified cases of seizures with drug overdoses, tramadol accounted for 29 7. Likewise, Spiller et al 16 examined tramadol overdoses that were documented by seven poison control centers and found that eight percent of the victims experienced brief seizures.

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