Clinical presentation

Tramadol poisoning may be asymptomatic. If symptoms occur, prominent features include:

  • respiratory effects
    • respiratory depression, which includes reduced minute volume, and reduced respiratory rate or apnoea; respiratory depression is more likely with co-ingestion of other sedatives
    • aspiration pneumonitis, pulmonary oedema
  • central nervous system effects
    • seizures—can be delayed in onset up to 12 hours after ingestion of an immediate-release preparation and up to 24 hours after ingestion of a modified-release preparationsRyan, 2015
    • sedation
    • agitation
  • cardiovascular effects
    • tachyarrhythmias (eg sinus tachycardia, ventricular tachycardia), hypertension
    • QT-interval prolongation (rare)
  • metabolic effects—hypoglycaemia (uncommon).

The risk of serotonergic toxidrome is low unless tramadol is co-ingested with another serotonergic drug, particularly a monoamine oxidase inhibitorHabibollahi, 2019Ryan, 2015.