Medical and Psychiatric Effects of Long-Term Dependence on High Dose of tramadol

Abstract

Background: Tramadol dependence has been studied recently after large-scale exposure. Although tramadol dependence has increased rapidly in Egypt since 2004, no studies have evaluated the effect of high dose long-term tramadol dependence. Objectives: To address the chronic sequel of tramadol dependence over at least 5 years duration with a large dose (more than 675 mg/day, three tablets or more, each tablet of 225 mg). The study was aimed to check the physical and psychiatric status during tramadol dependence and 3 months after complete treatment. Methods: The present study was applied on 79 patients with single tramadol-dependence dose of 675 mg or more for 5 years or more. We examined the physical and psychological impact of tramadol abuse before and after 3 months of stoppage of the drug. Results: The blood chemistry was nearly within normal parameters, although slight nonsignificant rise in liver enzymes was reported in some cases. Patients during tramadol dependence period were angry, hostile, and aggressive. On the other hand, after treatment the main problem observed was the significant increase in comorbid anxiety, depressive, and obsessive-compulsive symptoms, but no increase was found in psychotic symptoms. Tramadol-dependence dose was more important than duration of use in psychiatric illness. Conclusions: Tramadol dependence on high dose could be physically safe to some limit, but psychiatrically it has many side effects.

Keywords: :

• opioid
• complication
• analgesic
• addiction
• Egypt

THE AUTHORS

Mohamed Adel El-Hadidy, MD, is associative professor of psychiatry, Faculty of Medicine, Mansoura University, Egypt. He has worked in the Ministry of Health, Egypt, Taif Mental Hospital, Saudi Arabia, and the psychiatry department, Mansoura University Hospital. He has published 25 articles in local and international journals. His research interests include addiction.

Ahmed Mohamed Nabil Helaly, MD, PhD in toxicology, is lecturer in forensic and molecular toxicology, Faculty of Medicine, University of Mansoura, Egypt. His interest has shifted from clinical toxicology in the ER to a more molecular level. He finished PhD in genetics aiming to crystallize the AhR receptor. He managed to master the techniques and obtain the way of thinking. He has done three years of postdoctoral/lecturer in Mansoura University in mechanistic toxicology such as oxidative stress and inflammatory and signal transduction.

GLOSSARY

• DSM-IV-TR: Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) Revised.

• 5-HT2C receptor: The 5-HT2C receptor is a subtype of 5-HT receptor that binds endogenous neurotransmitter serotonin.

• HBV: Hepatitis B virus.

• HCV: Hepatitis C virus.

• NMDA receptor: The N-methyl-D-aspartate receptor (also known as the NMDA receptor or NMDAR), a glutamate receptor.

• SGOT: Serum glutamic oxaloacetic transaminase.

• SGPT: Serum glutamic-pyruvic transaminase.

• SNRI: Serotonin-norepinephrine reuptake inhibitors.

• Tramadol: It is a commonly prescribed painkiller.

Declaration of Interest

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the article.