Tramadol (Ultram) is an uncontrolled substance in the opiod family that binds mu receptors and is indicated for moderate to moderately severe pain.
Tramadol lowers seizure threshold to < 1/100,000, likely related to its inhibition of neuronal re-uptake of serotonin and norepinephrine in the CNS.
Concurrent use with SSRI's, TCA's, MAOI's, neuroleptics, other opiods, naloxone (when given for tramadol overdose) and alcohol exacerbates the risk of seizure onset.
Tramadol-related seizure is independent of dose (i.e. can occur at starting dose of 25 mg), although brisk titration up to maintenance doses does increase seizure risk.
To avoid triggering a seizure, tramadol should not be used in patients with the following conditions:
