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Causes, Nature and Toxicology of Tramadol-Associated Deaths Reported in the Peer-Reviewed Literature: A Systematic Review of Case Studies and Case Series

Background Despite the increased reporting of tramadol poisoning, the nature and toxicology of tramadol-associated deaths have not been adequately subjected to systematic evaluation. This study aims to investigate the causes, nature and toxicology of tramadol-associated deaths by systematically rev...

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Main Authors: Alrashdi, Saud, Paudyal, Vibhu, Elnaem, Mohamed Hassan Abdelaziz, Cheema, Ejaz
Format: Article
Language:English
English
Published: Springer Nature 2021
Subjects:
R Medicine (General)
RM Therapeutics. Pharmacology
Online Access:http://irep.iium.edu.my/91386/1/10.1007/s40267-021-00859-6
http://irep.iium.edu.my/91386/2/91386_Causes%2C%20Nature%20and%20Toxicology%20of%20Tramadol-Associated%20Deaths%20Reported_Scopus.pdf
http://irep.iium.edu.my/91386/
https://link.springer.com/article/10.1007%2Fs40267-021-00859-6
https://doi.org/10.1007/s40267-021-00859-6
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spelling my.iium.irep.913862022-08-02T07:16:53Z http://irep.iium.edu.my/91386/ Causes, Nature and Toxicology of Tramadol-Associated Deaths Reported in the Peer-Reviewed Literature: A Systematic Review of Case Studies and Case Series Alrashdi, Saud Paudyal, Vibhu Elnaem, Mohamed Hassan Abdelaziz Cheema, Ejaz R Medicine (General) RM Therapeutics. Pharmacology Background Despite the increased reporting of tramadol poisoning, the nature and toxicology of tramadol-associated deaths have not been adequately subjected to systematic evaluation. This study aims to investigate the causes, nature and toxicology of tramadol-associated deaths by systematically reviewing the case studies and case series published in peer-reviewed journals. Methods Scopus, Embase, Medline and Google Scholar were searched from inception until 30 May 2020 to identify the case studies and case series published in English that reported tramadol-associated deaths. Data on number of deaths, routes of administration, toxicological data and any concomitant drug usage were extracted. The Joanna Briggs Institute’s quality assessment tool was used to assess the quality of included studies. Results The initial searches identified 451 articles. Of these, 12 studies (eight case studies and four case series) were considered in the review, which represented a total of 181 deaths, with UK (n = 127) and Sweden (n = 17) reporting most deaths. Intentional suicide was the cause of tramadol poisoning in 54 of the 181 cases. Data on routes of administration were often missing; however, the most common related was the oral route (15.5%). Mixed drug toxicity was among the causes of reported deaths (n = 127, 70.2%), where in most cases, individuals were receiving other central nervous system depressants, especially benzodiazepines. However, tramadol, as the sole cause of death, was reported in eight cases. The mean level of blood tramadol for the deaths was 10.6 µg/mL. Conclusion The unintentional nature of many tramadol deaths has been reported, and it is important to consider that the drug can be acquired through illicit means. Healthcare practitioners need to build a strong understanding about tramadol’s possible toxicity and should exercise caution when a patient is to use tramadol in combination with other drugs. Springer Nature 2021-08-06 Article PeerReviewed application/pdf en cc_by_nd http://irep.iium.edu.my/91386/1/10.1007/s40267-021-00859-6 application/pdf en http://irep.iium.edu.my/91386/2/91386_Causes%2C%20Nature%20and%20Toxicology%20of%20Tramadol-Associated%20Deaths%20Reported_Scopus.pdf Alrashdi, Saud and Paudyal, Vibhu and Elnaem, Mohamed Hassan Abdelaziz and Cheema, Ejaz (2021) Causes, Nature and Toxicology of Tramadol-Associated Deaths Reported in the Peer-Reviewed Literature: A Systematic Review of Case Studies and Case Series. Drugs & Therapy Perspectives. ISSN 1172-0360 E-ISSN 1179-1977 https://link.springer.com/article/10.1007%2Fs40267-021-00859-6 https://doi.org/10.1007/s40267-021-00859-6
institution Universiti Islam Antarabangsa Malaysia
building IIUM Library
collection Institutional Repository
continent Asia
country Malaysia
content_provider International Islamic University Malaysia
content_source IIUM Repository (IREP)
url_provider http://irep.iium.edu.my/
language English
English
topic R Medicine (General)
RM Therapeutics. Pharmacology
spellingShingle R Medicine (General)
RM Therapeutics. Pharmacology
Alrashdi, Saud
Paudyal, Vibhu
Elnaem, Mohamed Hassan Abdelaziz
Cheema, Ejaz
Causes, Nature and Toxicology of Tramadol-Associated Deaths Reported in the Peer-Reviewed Literature: A Systematic Review of Case Studies and Case Series
description Background Despite the increased reporting of tramadol poisoning, the nature and toxicology of tramadol-associated deaths have not been adequately subjected to systematic evaluation. This study aims to investigate the causes, nature and toxicology of tramadol-associated deaths by systematically reviewing the case studies and case series published in peer-reviewed journals. Methods Scopus, Embase, Medline and Google Scholar were searched from inception until 30 May 2020 to identify the case studies and case series published in English that reported tramadol-associated deaths. Data on number of deaths, routes of administration, toxicological data and any concomitant drug usage were extracted. The Joanna Briggs Institute’s quality assessment tool was used to assess the quality of included studies. Results The initial searches identified 451 articles. Of these, 12 studies (eight case studies and four case series) were considered in the review, which represented a total of 181 deaths, with UK (n = 127) and Sweden (n = 17) reporting most deaths. Intentional suicide was the cause of tramadol poisoning in 54 of the 181 cases. Data on routes of administration were often missing; however, the most common related was the oral route (15.5%). Mixed drug toxicity was among the causes of reported deaths (n = 127, 70.2%), where in most cases, individuals were receiving other central nervous system depressants, especially benzodiazepines. However, tramadol, as the sole cause of death, was reported in eight cases. The mean level of blood tramadol for the deaths was 10.6 µg/mL. Conclusion The unintentional nature of many tramadol deaths has been reported, and it is important to consider that the drug can be acquired through illicit means. Healthcare practitioners need to build a strong understanding about tramadol’s possible toxicity and should exercise caution when a patient is to use tramadol in combination with other drugs.
format Article
author Alrashdi, Saud
Paudyal, Vibhu
Elnaem, Mohamed Hassan Abdelaziz
Cheema, Ejaz
author_facet Alrashdi, Saud
Paudyal, Vibhu
Elnaem, Mohamed Hassan Abdelaziz
Cheema, Ejaz
author_sort Alrashdi, Saud
title Causes, Nature and Toxicology of Tramadol-Associated Deaths Reported in the Peer-Reviewed Literature: A Systematic Review of Case Studies and Case Series
title_short Causes, Nature and Toxicology of Tramadol-Associated Deaths Reported in the Peer-Reviewed Literature: A Systematic Review of Case Studies and Case Series
title_full Causes, Nature and Toxicology of Tramadol-Associated Deaths Reported in the Peer-Reviewed Literature: A Systematic Review of Case Studies and Case Series
title_fullStr Causes, Nature and Toxicology of Tramadol-Associated Deaths Reported in the Peer-Reviewed Literature: A Systematic Review of Case Studies and Case Series
title_full_unstemmed Causes, Nature and Toxicology of Tramadol-Associated Deaths Reported in the Peer-Reviewed Literature: A Systematic Review of Case Studies and Case Series
title_sort causes, nature and toxicology of tramadol-associated deaths reported in the peer-reviewed literature: a systematic review of case studies and case series
publisher Springer Nature
publishDate 2021
url http://irep.iium.edu.my/91386/1/10.1007/s40267-021-00859-6
http://irep.iium.edu.my/91386/2/91386_Causes%2C%20Nature%20and%20Toxicology%20of%20Tramadol-Associated%20Deaths%20Reported_Scopus.pdf
http://irep.iium.edu.my/91386/
https://link.springer.com/article/10.1007%2Fs40267-021-00859-6
https://doi.org/10.1007/s40267-021-00859-6
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score 13.211869

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