Chlordiazepoxide Preventive Effect on Tramadol Overdose Induced Serotonin Syndrome Evaluated by Hunter and Radomski Criteria: A Clinical Trial

Jump To References Section

Authors

  • ,IR
  • ,IR

Keywords:

Hunter criteria, radomski criteria, serotonin syndrome, tramadol

Abstract

Introduction: Tramadol is an analgesic medication that is frequently abused. It has two functions; mu"‘opioid receptors agonism, as well as, serotonergic activities. It has shown that tramadol overdose may induce serotonin syndrome (SS). This study evaluates whether early treatment with chlordiazepoxide could prevent SS in admitted tramadol overdoses. Materials and Methods: In this single blind randomized control trial, 50% of admitted tramadol overdoses in Imam Reza (p) Hospital from 21 September 2011 to 21 January 2012 were recruited. Cases received chlordiazepoxide and controls received placebo. Clinical findings were recorded in a pre"‘designed spread sheet every 6 hours in the first 24 hours of admission. SS was determined by two independent methods; Hunter Criteria (HC) and Radomski Criteria (RC). Results: In total, five patients developed SS when HC or RC was taken into account. Among them, four cases were shared. None of the SS cases diagnosed with HC received chlordiazepoxide. However, just one SS case diagnosed with RC was from the case group. Based on HC, chlordiazepoxide decreased the Risk Ratio (CI 95%) of SS to 0.80 (0.66-0.97) (P = 0.025). This effect did not reach statistically significant levels when SS was diagnosed with RC. Conclusion: This study supports the fact that pre"‘treatment with chlordiazepoxide could prevent tramadol overdose induced SS.

Downloads

Download data is not yet available.

Published

2018-08-09

How to Cite

Mansouripour, S. M., & Afshari, R. (2018). Chlordiazepoxide Preventive Effect on Tramadol Overdose Induced Serotonin Syndrome Evaluated by Hunter and Radomski Criteria: A Clinical Trial. Toxicology International, 20(2), 126–131. Retrieved from http://www.informaticsjournals.com/index.php/toxi/article/view/21718

Issue

Section

Original Research
Received 2018-08-09
Accepted 2018-08-09
Published 2018-08-09

 

References

Sansone RA, Sansone LA. Tramadol: Seizures, serotonin syndrome, and coadministered antidepressants. Psychiatry (Edgmont) 2009;6:17"‘21.

Grond S, Sablotzki A. Clinical pharmacology of tramadol. Clin Pharmacokinet 2004;43:879"‘923.

Reeves RR, Burke RS. Tramadol: Basic pharmacology and emerging concepts. Drugs Today (Barc) 2008;44:827"‘36.

Tashakori A, Afshari R. Tramadol overdose as a cause of serotonin syndrome: A case series. Clin Toxicol (Phila) 2010;48:337"‘41.

Afshari R, Mégarbane B. Tramadol overdose: Review of the literature. Réanimation 2011;20:436"‘41.

Taghaddosinejad F, Mehrpour O, Afshari R, Seghatoleslami A, Abdollahi M, Dart RC. Factors related to seizure in tramadol poisoning and its blood concentration. J Med Toxicol 2011;7:183"‘8.

Afshari R, Majdzadeh R, Balali"‘Mood M. Pattern of acute poisonings in Mashhad, Iran 1993"‘2000. J Toxicol Clin Toxicol 2004;42:965"‘75.

Afshari R, Ghooshkhanehee H. Tramadol overdose induced seizure, dramatic rise of CPK and acute renal failure. J Pak Med Assoc 2009;59:178.

Peacock LE, Wright F. Serotonin syndrome secondary to tramadol and citalopram. Age Ageing 2011;40:528.

Spiller HA, Gorman SE, Villalobos D, Benson BE, Ruskosky DR, Stancavage MM, et al. Prospective multicenter evaluation of tramadol exposure. J Toxicol Clin Toxicol 1997;35:361"‘4.

Radomski JW, Dursun SM, Reveley MA, Kutcher SP. An exploratory approach to the serotonin syndrome. Med Hypotheses 2000;55:218"‘24.

Maréchal C, Honorat R, Claudet I. Serotonin syndrome induced by tramadol intoxication in an 8"‘month"‘old infant. Pediatr Neurol 2011;44:72"‘4.

Graudins A, Stearman A, Chan B. Treatment of the serotonin syndrome with cyproheptadine. J Emerg Med 1998;16:615"‘9.

Houlihan DJ. Serotonin syndrome resulting from coadministration of tramadol, venlafaxine, and mirtazapine. Ann Pharmacother 2004;38:411"‘3.

Dunkley EJ, Isbister GK, Sibbritt D, Dawson AH, Whyte IM. The hunter serotonin toxicity criteria: Simple and accurate diagnostic decision rules for serotonin toxicity. QJM 2003;96:635"‘42.

Bar"‘Or D, Salottolo KM, Orlando A, Winkler JV. Tramadol ODT Study Group. A randomized double"‘blind, placebo"‘controlled multicenter study to evaluate the efficacy and safety of two doses of the tramadol orally disintegrating tablet for the treatment of premature ejaculation within less than 2 minutes. Eur Urol 2012;61:736"‘43.

Vizcaychipi MP, Walker S, Palazzo M. Serotonin syndrome triggered by tramadol. Br J Anaesth 2007;99:919.

Frank C. Recognition and treatment of serotonin syndrome. Can Fam Physician 2008;54:988"‘92.

Mason PJ, Morris VA, Balcezak TJ. Serotonin syndrome. Presentation of two cases and review of the literature.Medicine (Baltimore) 2000;79:201"‘9.

Evans CE, Sebastian J. Serotonin syndrome. Emerg Med J 2007;24:e20.

McDaniel WW. Serotonin syndrome: Early management with cyproheptadine. Ann Pharmacother 2001;35:870"‘3.

Jones D, Story DA. Serotonin syndrome and the anaesthetist.Anaesth Intensive Care 2005;33:181"‘7.

Ables AZ, Nagubilli R. Prevention, recognition, and management of serotonin syndrome. Am Fam Physician 2010;81:1139"‘42.