Tramadol and the occurrence of seizures: a systematic review and meta-analysis

Abstract

Introduction: Tramadol is a synthetic opioid which is commonly used around the world to relieve moderate to severe pain. One of the serious possible complications of its use is seizures. The present study aims to investigate and summarize the studies related to tramadol and occurrences of seizures after tramadol use and factors influencing these seizures.

Methodology: Our systematic review is compliant with PRISMA guidelines. Two researchers systematically searched PubMed/Medline, Web of Sciences, and Scopus. Cohort, case-control, cross-sectional studies, and clinical trials. The risk of bias was assessed using the Newcastle–Ottawa Scale After article quality assessment, a fixed or random model, as appropriate, was used to pool the results in a meta-analysis. Heterogeneity between the studies was assessed with using I-square and Q-test. Forest plots demonstrating the point and pooled estimates were drawn.

Results: A total of 51 articles with total sample size of 101 770 patients were included. The results showed that seizure event rate in the subgroups of tramadol poisoning, therapeutic dosage of tramadol, and tramadol abusers was 38% (95% CI: 27–49%), 3% (95% CI: 2–3%), 37% (95% CI: 12–62%), respectively. Tramadol dose was significantly higher in the patients with seizures than those without (mean differences: 0.82, CI 95%: 0.17–1.46). The odds for occurrence of seizures were significantly associated with male gender (pooled OR: 2.24, CI 95%: 1.80–2.77). Naloxone administration was not associated to the occurrence of seizures (pooled OR: 0.47, 95% CI: 0.15–1.49).

Conclusions: Our results demonstrate that the occurrence of seizures in patients exposed to tramadol are dose-dependent and related to male gender, but not related to naloxone administration. Given that, most of the evidence derives from studies utilizing a cross-sectional design, the association of tramadol with seizures should not be considered to be definitively established

Keywords:

• Tramadol
• seizure
• systematic review
• meta-analysis
• ingested dose
• naloxone

Acknowledgments

The authors sincerely thank the anonymous reviewers for the valuable comments received, which helped the authors to improve the quality of this article.

Declaration of interest

The research representing this article has been funded by the Birjand University of Medical Sciences (Grant number: 455668) and Iran National Science Foundation (INSF) (Grant number: 97012231). The authors take full responsibility for the writing and content of this article, and confirm that there are no conflicts of interests associated with this academic publication.

Author contributions

SN, AA, JB, EMM, MF, KhF, MH, OM contributed to conception, design, and preparation of the manuscript. SN, AA conducted literature search and SN, MH contributed in article selection, SN and OM made data extraction. SN, AA, JB, OM contributed to acquisition, analysis, and interpretation. SN, AA, JB, EMM, MF, KhF, MH, MA, OM made substantial contributions in drafting the manuscript and revising it critically for important intellectual content. All authors have read and approved the final version of manuscript.