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Tramadol overdose: review of the literature

Intoxication au tramadol : mise au point

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Réanimation

Abstract

In France, like in several other European countries, dextroproxyphene has been banned from the market in 2011. Consequently, a significant increase in tramadol prescriptions as well as a significant increase in tramadol overdoses and poisonings could be expected. Tramadol is a synthetic opioid responsible for numerous adverse effects in case of overdose, including life-threatening ones such as loss of consciousness, seizures, serotonin syndrome, and more rarely hypotension and cardiovascular failure. Such complications have been reported in Iran, where tramadol is largely abused among opioid-dependent drug users. Thus, a strict toxicological surveillance should be developed in France to prevent a possible increase in tramadol-related morbidity and fatalities among acute poisoned patients, as reported in Iran.

Résumé

La France, à l’instar de plusieurs autres pays européens, a décidé de retirer du marché en 2011 toutes les spécialités à base de dextropropoxyphène. De ce fait, une augmentation significative des prescriptions d’antalgiques à base de tramadol pourrait être observée, avec comme conséquence une augmentation des cas de surdosage et d’intoxication. Le tramadol est un opioïde de synthèse à l’origine de nombreux risques y compris vitaux pouvant conduire un patient intoxiqué en réanimation : troubles de la conscience, convulsions, syndrome sérotoninergique et plus rarement hypotension et état de choc. De telles observations ont largement été documentées en Iran, où ce médicament est à l’origine d’un détournement d’usage chez les consommateurs de drogues dépendants aux opioïdes. Une vigilance particulière doit donc être instaurée en France pour éviter que le tramadol ne conduise à son tour à un accroissement significatif de la morbimortalité des intoxications aiguës, comme déjà observé en Iran.

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Authors and Affiliations

  1. Medical Toxicology Research Centre, Medical Toxicology Centre, Mashhad University of Medical Sciences, Mashhad, Iran

    R. Afshari & R. Afshar

  2. Réanimation médicale et toxicologique, hôpital Lariboisière, université Paris-Diderot, Inserm, U705, Paris, France

    B. Mégarbane

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  1. R. Afshari
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  2. R. Afshar
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  3. B. Mégarbane
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Correspondence to B. Mégarbane.

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Afshari, R., Afshar, R. & Mégarbane, B. Tramadol overdose: review of the literature. Réanimation 20, 436–441 (2011). https://doi.org/10.1007/s13546-011-0306-3

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