title: Tissue distribution of tramadol and metabolites in an overdose fatality.
abstract: Tramadol (Ultram) is a centrally acting, synthetic analgesic agent. Although it has some affinity for the opiate receptors, tramadol is believed to exert its analgesic effect by inhibiting the re-uptake of norepinephrine and serotonin. There are several published cases of tramadol's involvement in drug-related deaths and impairment. Reports of deaths involving tramadol alone with associated tissue concentrations are rare. This report documents a case in which tramadol overdose was identified as the cause of death. The following tramadol concentrations were found in various tissues: blood, 20 mg/L; urine, 110.2 mg/L; liver, 68.9 mg/kg; and kidney, 37.5 mg/kg. Tissue distributions of the two primary metabolites, N-desmethyl and O-desmethyl tramadol, are also reported. In each tissue or fluid except urine, the tramadol concentration was greater than either metabolite, consistent with other reports of drug-impaired drivers and postmortem cases. The O-desmethyl metabolite concentration was greater than the N-desmethyl metabolite concentration in all tissues; this is in contrast to other postmortem reports, in which the majority of cases report concentrations of O-desmethyl as less than those of N-desmethyl. This may be useful as an indicator of time lapse between ingestion and death.
authors: Armed Forces Institute of Pathology, Division of Forensic Toxicology, Rockville, Maryland 20850-3125, USA. moore@email.afip.osd.mil
authors: K A
authors: KA
authors: Moore
authors: S J
authors: SJ
authors: Cina
authors: R
authors: R
authors: Jones
authors: D M
authors: DM
authors: Selby
authors: B
authors: B
authors: Levine
authors: M L
authors: ML
authors: Smith
mesh_terms: D000328:Adult; D000701:Analgesics, Opioid / Q000493:pharmacokinetics* / Q000506:poisoning*; D062787:Drug Overdose / Q000473:pathology; D017809:Fatal Outcome; D005260:Female; D005554:Forensic Medicine; D008401:Gas Chromatography-Mass Spectrometry / Q000379:methods; D006801:Humans; D014018:Tissue Distribution; D014147:Tramadol / Q000493:pharmacokinetics* / Q000506:poisoning*
chemical_list: D000701:Analgesics, Opioid; D014147:Tramadol