The effect of tramadol on blood glucose concentrations: a systematic review

ABSTRACT

Introduction

Studies comprehensively summarizing the impact of tramadol use on glucose homeostasis are very sparse. Thus, the present study was performed to collect and summarize the latest information about this issue in a systematic way.

Areas covered

An exhaustive literature search was carried out using relevant keywords. Web of Sciences, PubMed, Scopus, and Google scholar were interrogated until 30 June 2019. Case-control, cohort, cross-sectional, clinical trial, case report, and animal studies that focused on the objective of the study were retrieved. This review summarizes the results of 761 papers on glycemic changes due to tramadol exposure. Thirty-six publications reported hypoglycemia and 17 hyperglycemia during tramadol use. Twenty-two studies either reported normal blood glucose concentrations, or did not observe any difference in the blood glucose levels following tramadol use. Finally, hypoglycemia was reported in diabetic individuals exposed to tramadol in 12 studies.

Expert opinion

The data suggest that primarily hypoglycemia but some degree of hyperglycemia has been reported with tramadol use. Importantly, all studies on tramadol use in diabetes reported hypoglycemia. Tramadol-induced hypoglycemia may be severe in some cases. The risk of alterations in glucose homeostasis accompanying tramadol exposure indicates time importance of careful blood glucose monitoring during tramadol use.

KEYWORDS:

• Tramadol
• hypoglycemia
• hyperglycemia
• blood glucose level
• poisoning

Article Highlights

• Hypoglycemia with a higher frequency and, to a lesser degree, hyperglycemia has been reported among tramadol consumers users with both therapeutic use and in overdose.

• All of the studies conducted on diabetic subjects reported hypoglycemia.

• In contrast to most human experience, animal studies primarily demonstrate elevated serum glucose concentrations in response to tramadol administration

• Impairments in levels of insulin and cortisol have been reported following tramadol administration

Author contributions

SN, JB, CH, KF, MSh, MA, OM contributed to the conception, design, and preparation of the manuscript. SN, OM, JB conducted the data collection and contributed to acquisition and interpretation. SN, JB, CH, MSh, KF, 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.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Additional information

Funding

This paper was not funded.