Tramadol is also metabolized by CYP2B6 and CYP3A4 enzymes into N-desmethyltramadol (inactive metabolite). Tramadol is metabolized by CYP2D6 to pharmacologically active O-desmethyltramadol (200 times more affinity than tramadol for opiate receptors). Īmitava Dasgupta, in Alcohol, Drugs, Genes and the Clinical Laboratory, 2017 CYP2D6 polymorphism and tramadol Interference with diagnostic tests In two cases false-positive phencyclidine urine drug screens in patients with seizures from tramadol misuse or abuse were shown to be due to tramadol and its active metabolite, N-desmethyltramadol. Metabolism Two non-diabetic patients, an 82-year-old man and an 82-year-old woman, developed severe hypoglycemia while taking oral tramadol. Seizures were more common in those who took higher reported doses. Most of the overdoses involved men (83%). Of 401 patients with a history of tramadol overdose, 121 (30%) had seizures and 14 (3.5%) became unconscious. Īn epileptic seizure has been attributed to intravenous tramadol after total abdominal hysterectomy in a 42-year-old woman with mental retardation and cerebellar ataxia. Serotonin syndrome has also been attributed to the combination of tramadol with citalopram in a 78-year-old woman. Nervous system Serotonin syndrome has been attributed to tramadol intoxication in an 8-month-old girl, who accidentally took a tablet of her father's medication the tramadol plasma concentration was 680 μg/l. The authors suggested that the cardiotoxicity was due to high circulating catecholamine concentrations. A 22-year-old woman, a CYP2D6 ultrarapid metabolizer, had a cardiac arrest in association with high concentrations of both tramadol and O-desmethyltramadol after intermittent use of tramadol to gain a “high” sensation. Aronson, in Side Effects of Drugs Annual, 2014 Tramadol Ĭardiovascular Tramadol is mainly metabolized to O-desmethyltramadol by CYP2D6.
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