UMEM Educational Pearls

Category: Pharmacology & Therapeutics

Title: Therapeutic Tramadol Use Significantly Increases Seizure Risk

Keywords: tramadol, seizure (PubMed Search)

Posted: 12/3/2015 by Bryan Hayes, PharmD (Emailed: 12/5/2015) (Updated: 7/6/2016)
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Tramadol has a reputation for being a safe, non-opioid alternative to opioids. Nothing could be further from the truth. Several blogs have published about the dangers of tramadol:

But what about seizure risk? Previous studies have been unable to confirm an increased seizure risk with therapeutic doses of tramadol (Seizure Risk Associated with Tramadol Use from EM PharmD blog). However, a new study refutes that premise.

22% of first-seizure patients had recent tramadol use!

  1. Mean total tramadol dose in last 24 hours (reported): 140 mg
  2. Duration of tramadol use less than 10 days: 84.5%
  3. Seizure within 6 hours of tramadol consumption: 74%

This was a retrospecitve study without laboratory confirmation of tramadol intake. Nevertheless, it behooves us not to think of tramadol as a safer alternative to opioids. It is an opioid after all, and it comes with significant adverse effects.


Asadi P, et al. Prevalence of Tramadol Consumption in First Seizure patients; a One-Year Cross-sectional Study. Emerg (Tehran) 2015;3(4):159-61. [PMID 26495407]

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