The Effect of Naloxone on the Duration of Hospitalization Caused by Tramadol Poisoning: A Retrospective Cross-Sectional Study

Document Type : Original Article (s)

Authors

1 General Practitioner, Department of Emergency, School of Medicine, Alborz University of Medical Sciences, Karaj, Iran

2 Association Professor, Clinical Toxicology Fellowship, Department of Clinical Toxicology, Kosar Hospital Poison Center, Emergency Department Alborz University of Medical Sciences, Karaj, Iran

3 Faculty of Emergency Medicine, Department of Emergency Medicine and Toxicology, Emergency Department Alborz University of Medical Sciences, Karaj, Iran

4 Association Professor, Department of Emergency Medicine and Toxicology, Rajaee Hospital Emergency Department, Alborz University of Medical Sciences, Karaj,

5 Faculty of Emergency Medicine, Department of Emergency, School of Medicine and Toxicology, Alborz University of Medical Sciences, Karaj, Iran

Abstract

Background: This study examined the effect of naloxone on the duration of hospitalization caused by
tramadol poisoning.
Methods: The studied population included all patients with tramadol drug poisoning admitted to Kowsar Karaj Hospital in 2022. The sample size was 100 people. The research data were collected with the help of a questionnaire made by the researcher to collect demographic information and hospitalization information of the patients and were analyzed and studied statistically.
Findings: The average age of patients was 26.84 ± 6.801 years. 50% of the cases admitted to the study with suicidal intent were poisoned by tramadol. The average dose of naloxone prescribed for the patients was
0.552 ± 0.3855 mg. In the examination of the clinical manifestations of the patients, among the hospitalized patients, 8% were admitted with symptoms of seizures and 9% with symptoms of respiratory depression. The average duration of hospitalization of patients was 36.31 ± 16.991 hours. There was a significant relationship between the occurrence of respiratory depression and the dose of naloxone, and with the increase of the injection dose, the probability of occurrence of depression decreased. (P = 0.001). Concerning the length of hospitalization variable, the results showed that despite the significant difference in the dose of naloxone, higher doses required. They had a longer hospital stay (P = 0.001).
Conclusion: The duration of hospital stays, as well as the respiratory depression caused by tramadol poisoning, can be effectively minimized by using naloxone. Most of the poisonings were done in young people to commit suicide. It seems that it is necessary to inform them about the use of tramadol.

Highlights

Maryam Fadaie: Google Scholar, PubMed

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References

  1. Caupp S, Steffan J, Shi J, Wheeler KK, Spiller HA, Casavant MJ, et al. Opioid drug poisonings in Ohio adolescents and young adults, 2002-2014. Clin Toxicol (Phila) 2018; 56(8): 765-72.
  2. Masoumi G, Eizadi-Mood N, Akabri M, Sohrabi A, Khalili Y. Pattern of poisoning in Isfahan in Persian]. J Isfahan Med School 2012; 29(163): 2003-10.
  3. Beakley BD, Kaye AM, Kaye AD. Tramadol, pharmacology, side effects, and serotonin syndrome: a review. Pain Physician 2015; 18(4): 395-400.
  4. Hawton K, Bergen H, Simkin S, Wells C, Kapur N, Gunnell D. Six-year follow-up of impact of co-proxamol withdrawal in England and Wales on prescribing and deaths: time-series study. PLoS Med 2012; 9(5): e1001213.
  5. Gholami K, Shalviri G, Zarbakhsh A, Daryabari N, Yousefian S. New guideline for tramadol usage following adverse drug reactions reported to the Iranian Pharmacovigilance Center. Pharmacoepidemiol Drug Saf 2007; 16(2): 229-37.
  6. International Narcotics Control Board. List of narcotic drugs under control. [Online]. [cited 2004 Dec]; Avilable from: URL: https://www.indiapost.gov.in/MBE/DOP_PDFFiles/List_of_Narcotic_Drugs.pdf.
  7. Soleymani F, Shalviri G, Abdollahi M. Pattern of use and adverse drug reactions of tramadol; a review of 336, 610, 664 insured prescriptions during 5 years. Intern J Pharmacol 2011; 7(7): 757-60.
  8. Miotto K, Cho AK, Khalil MA, Blanco K, Sasaki JD, Rawson R. Trends in tramadol: pharmacology, metabolism, and misuse. Anesth Analg 2017; 124(1): 44-51.
  9. Haukka J, Kriikku P, Mariottini C, Partonen T, Ojanperä I. Non‐medical use of psychoactive prescription drugs is associated with fatal poisoning. Addiction 2018; 113(3): 464-72.
  10. Lagard C, Chevillard L, Malissin I, Risède P, Callebert J, Labat L, et al. Mechanisms of tramadol-related neurotoxicity in the rat: does diazepam/tramadol combination play a worsening role in overdose? Toxicol Appl Pharmacol 2016; 310: 108-19.
  11. Randall C, Crane J. Tramadol deaths in Northern Ireland: a review of cases from 1996 to 2012.
    J Forensic Leg Med 2014; 23: 32-6.
  12. Dahan A, Sarton E, Teppema L, Olievier C, Nieuwenhuijs D, Matthes HW, et al. Anesthetic potency and influence of morphine and sevoflurane on respiration in μ-opioid receptor knockout mice. Anesthesiology 2001; 94(5): 824-32.
  13. Raffa R, Nayak R, Liao S, Minn F. The mechanism (s) of action and pharmacokinetics of tramadol hydrochloride. Rev Contemp Pharmacother 1995; 6: 485-97.
  14. Gioia S, Lancia M, Bacci M, Suadoni F. Two fatal intoxications due to tramadol alone: autopsy case reports and review of the literature. Am J Forensic Med Pathol 2017; 38(4): 345-8.
  15. Marquardt KA, Alsop JA, Albertson TE. Tramadol exposures reported to statewide poison control system. Ann Pharmacother 2005; 39(6): 1039-44.
  16. Boyer EW. Management of opioid analgesic overdose. N Engl J Med 2012; 367(2): 146-55.
  17. Eizadi-Mood N, Ozcan D, Sabzghabaee AM, Mirmoghtadaee P, Hedaiaty M. Does naloxone prevent seizure in tramadol intoxicated patients? Intern J Preventive Med 2014; 5(3): 302-7.
  18. Janković SM, Pejčić AV, Milosavljević MN, Opančina VD, Pešić NV, Nedeljković TT, et al. Risk factors for potential drug-drug interactions in intensive care unit patients. J Crit Care 2018; 43: 1-6.
  19. Ahmed AI, El-Dawy K, Fawzy MM, Abdallah HA, Elsaid H, Elmesslamy WO. Retrospective review of tramadol abuse. Slov Vet Res 2018; 55(Suppl 20): 471-83.
  20. Källén B, Reis M. Use of tramadol in early pregnancy and congenital malformation risk. Reproduct Toxicol 2015; 58: 246-51.
  21. Jovanović-Čupić V, Martinović Ž, Nešić N. Seizures associated with intoxication and abuse of tramadol. Clin Toxicol (Phila) 2006; 44(2): 143-6.
  22. Thundiyil JG, Kearney TE, Olson KR. Evolving epidemiology of drug-induced seizures reported to a Poison Control Center System. J Med Toxicol 2007; 3(1): 15-9.
  23. Taghaddosinejad F, Mehrpour O, Afshari R, Seghatoleslami A, Abdollahi M, Dart RC. Factors related to seizure in tramadol poisoning and its blood concentration. J Med Toxicol 2011; 7: 183-8.
  24. Ryan NM, Isbister GK. Tramadol overdose causes seizures and respiratory depression but serotonin toxicity appears unlikely. Clin Toxicol (Phila) 2015; 53(6): 545-50.
  25. Lagard C, Malissin I, Indja W, Risède P, Chevillard L, Mégarbane B. Is naloxone the best antidote to reverse tramadol-induced neuro-respiratory toxicity in overdose? An experimental investigation in the rat. Clin Toxicol (Phila) 2018; 56(8): 737-43.
  26. Nakhaee S, Amirabadizadeh A, Brent J, Miri-Moghaddam E, Foadoddini M, Farrokhfall K, et al. Tramadol and the occurrence of seizures: a systematic review and meta-analysis. Crit Rev Toxicol 2019; 49(8): 710-23.
  27. Eizadi-Mood N, Ghandehari M, Mansourian M, Sabzghabaee AM, Samasamshariat S, Sadeghi E. Risk of seizure after naloxone therapy in acute tramadol poisoning: a systematic review with meta-analysis. Intern J Pre Med 2019; 10: 183.
  28. Goodarzi F, Mehrpour O, Eizadi-Mood N. A study to evaluate factors associated with seizure in Tramadol poisoning in Iran. Indian J Forensic Med Toxicol 2011; 5(2): 66-9.
  29. Akhavan R, Soroosh D, Habibzadeh SR, Maleki F, Dost ER, Teimouri A, et al. Tramadol poisoning: A systematic review of studies in Iran. International J Med Toxicol Forensic Med 2021; 11(3): 30181.
  30. Abbasi B, Hafezimoghadam P, Nejad NA, Sarvari M, Ramim T. Assessment of time interval between tramadol intake and seizure and second drug-induced attack. Tehran Uni Med J 2015; 73(8): 592-9.
  31. Majidi M, Nekouei S, Delirrad M. Demographic findings of tramadol poisoned women admitted to Ayatollah Taleghani Hospital, Urmia, Iran from Jan 2012 to Jan 2013 [in Persian]. Nurs Midwif J 2014; 12(8): 761-6.
  32. Delirrad M, Ebrahimi E, Majidi M. Evaluation of demographic characteristics and renal function indices in acute tramadol intoxicated patients in Ayatollah Taleghani Hospital, Urmia, Iran [in Persian]. Studies Med Sci 2015; 25(12): 1060-6.
  33. Lassen D, Damkier P, Brøsen K. The pharmacogenetics of tramadol. Clin Pharmacokinet 2015; 54(8): 825-36.
  34. Teppema LJ, Nieuwenhuijs D, Olievier CN, Dahan A. Respiratory depression by tramadol in the cat: involvement of opioid receptors. Anesthesiology 2003; 98(2): 420-7.
  35. Raffa RB, Friderichs E, Reimann W, Shank RP, Codd EE, Vaught JL. Opioid and nonopioid components independently contribute to the mechanism of action of tramadol, an 'atypical' opioid analgesic. J Pharmacol Exp Ther 1992; 260(1): 275-85.
  36. Shadnia S, Brent J, Mousavi-Fatemi K, Hafezi P, Soltaninejad K. Recurrent seizures in tramadol intoxication: implications for therapy based on 100 patients. Basic Clin Pharmacol Toxicol 2012; 111(2): 133-6.
  37. Tashakori A, Afshari R. Tramadol overdose as a cause of serotonin syndrome: a case series. Clin Toxicol (Phila) 2010; 48(4): 337-41.
  38. Farzaneh E, Mostafazadeh B, Mehrpour O. Seizurogenic effects of low-dose naloxone in tramadol overdose. Iranian J Pharmacol Therapeutics 2012; 11(1): 6-0.
  39. Saidi H, Ghadiri M, Abbasi S, Ahmadi SF. Efficacy and safety of naloxone in the management of postseizure complaints of tramadol intoxicated patients: a self-controlled study. Emerg Med J 2010; 27(12): 928-30.
  40. Gilbert PE, Martin WR. Antagonism of the convulsant effects of heroin, d-propoxyphene, meperidine, normeperidine and thebaine by naloxone in mice. J Pharmacol Exp Ther 1975; 192(3):
    538-41.
  41. Omrani A, Ghadami MR, Fathi N, Tahmasian M, Fathollahi Y, Touhidi A. Naloxone improves impairment of spatial performance induced by pentylenetetrazol kindling in rats. Neuroscience 2007; 145(3): 824-31.
Journal of Isfahan Medical School
Volume 42, Issue 759
3rd Week, May
May and June 2024
Pages 168-175

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History

  • Receive Date: 11 July 2023
  • Accept Date: 08 June 2024

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