Acute Tramadol Ingestion With Transient Acute Kidney Injury in an Adolescent Female.
Creator
Mike TB; DeVault H; Blackford MG
Publisher
Journal Of Pediatric Pharmacology & Therapeutics
Date
2021
2021-05-19
Description
Renal toxicity has been described with tramadol overdoses; however, it is typically associated with rhabdomyolysis, multiorgan failure and/or mortality. Our patient was a 16-year-old female who was evaluated following an intentional tramadol ingestion, estimated 27.8 to 37 mg/kg, and had a seizure prior to arriving at our health care facility. Her symptoms were consistent with a tramadol ingestion; however, she developed transient acute renal impairment (peak serum creatinine, 4.04 mg/dL), which improved over 6 days with minimal intervention. No other causes were identified to explain her acute renal impairment thus it was attributed to the tramadol overdose. Providers should be aware that transient acute renal impairment could occur with an intentional tramadol ingestion and may not require aggressive intervention.
Subject
Tramadol is a centrally acting synthetic analgesic medication with both opioid and non-opioid affects, and it inhibits the re-uptake inhibitor of norepinephrine and serotonin. It is hepatically metabolized via CYP2D6 to its active metabolite, O-desmethyltramadol, which has greater pharmacologic activity than the parent compound. Both are excreted in the urine. Renal toxicity has been described with tramadol overdoses; however, it is typically associated with rhabdomyolysis, multiorgan failure, and/or mortality.1–3 We describe an adolescent who developed transient intrinsic renal injury, not associated with rhabdomyolysis, following an intentional overdose of tramadol.
Acute Tramadol Ingestion With Transient Acute Kidney Injury in an Adolescent Female.
Creator
Mike TB; DeVault H; Blackford MG
Publisher
Journal Of Pediatric Pharmacology & Therapeutics
Date
2021
2021-05
Description
Renal toxicity has been described with tramadol overdoses; however, it is typically associated with rhabdomyolysis, multiorgan failure and/or mortality. Our patient was a 16-year-old female who was evaluated following an intentional tramadol ingestion, estimated 27.8 to 37 mg/kg, and had a seizure prior to arriving at our health care facility. Her symptoms were consistent with a tramadol ingestion; however, she developed transient acute renal impairment (peak serum creatinine, 4.04 mg/dL), which improved over 6 days with minimal intervention. No other causes were identified to explain her acute renal impairment thus it was attributed to the tramadol overdose. Providers should be aware that transient acute renal impairment could occur with an intentional tramadol ingestion and may not require aggressive intervention. [ABSTRACT FROM AUTHOR]
Subject
acute kidney injury; DRUG side effects; adolescent; tramadol; ACUTE kidney failure; case report; adverse drug effect; analgesics; drug overdose; RHABDOMYOLYSIS; STRIATED muscle necrosis; TRAMADOL
Efficacy of Tramadol for Pain Management in Patients Receiving Strong Cytochrome P450 2D6 Inhibitors
Creator
Frost Derek A; Soric Mate M; Kaiser Ricky; Neugebauer Rachel E
Publisher
Pharmacotherapy
Date
2019
2019-06
Description
STUDY OBJECTIVE: Tramadol is metabolized by cytochrome P450 (CYP) 2D6 to form an active metabolite that exhibits its analgesic effect. Medications that inhibit this enzyme are used often in practice, yet the clinical impact of this interaction on the analgesic effects of tramadol has yet to be fully described. The objective was to determine whether a clinically relevant decrease in pain control is observed in patients taking scheduled tramadol concomitantly with a strong CYP2D6 inhibitor. DESIGN: Retrospective cohort study. SETTING: Large health care system. PATIENTS: One hundred fifty-two adult inpatients who received scheduled tramadol for at least 24 hours with (76 patients) or without (76 patients) a strong CYP2D6 inhibitor between January 1, 2012, and February 28, 2017, were included in the analysis. Patients hospitalized for opioid use disorder or those receiving substandard dosing of tramadol were excluded. MEASUREMENTS AND MAIN RESULTS: The primary outcome was mean breakthrough opiate consumption in the presence and absence of CYP2D6 inhibitors. Secondary outcomes included mean pain scores, length of hospital stay, tramadol discontinuation rates, and prespecified subgroup analyses based on patient sex, race, and specific CYP2D6 inhibitor administered. Patients receiving concurrent CYP2D6 inhibitors required significantly more breakthrough morphine milligram equivalents per day compared with patients receiving scheduled tramadol without CYP2D6 inhibitors (geometric mean ± SD 18.2 ± 6.3 vs 5.7 ± 6.7 mg morphine milligram equivalents, p<0.001). No significant differences existed between cohorts for mean pain score, length of hospital stay, or tramadol discontinuation rate. CONCLUSION: This study demonstrated a clinically relevant decrease in the efficacy of tramadol when used for pain control in patients receiving a strong CYP2D6 inhibitor. These results should encourage clinicians to review medication lists for this interaction and adjust regimens accordingly to ensure adequate pain control.
Subject
CYP2D6; cytochrome P450; drug interaction; pain control; tramadol