Decontamination

The benefits of activated charcoal for gastrointestinal decontamination must be weighed against the small increased risk of aspiration from seizures following tramadol poisoning.

For tramadol doses more than 1 g in adults and 10 mg/kg in children, offer activated charcoal for gastrointestinal decontamination to alert and cooperative patients who are able to protect their airway and present within:

• 2 hours after ingesting an immediate-release preparation
• 4 hours after ingesting a modified-release preparation.

If the patient is intubated, activated charcoal can be given any time after ingestion via a nasogastric or orogastric tube—confirm correct placement of the nasogastric or orogastric tube beforehand.