Efficacy and safety of naloxone in the management of postseizure complaints of tramadol intoxicated patients: a self-controlled study.
OBJECTIVE
Tramadol has become a major cause of drug-induced seizure recently. Naloxone is reported to attenuate the seizurogenic activity of tramadol. Thus, the authors aimed to study the efficacy and safety of naloxone in the management of postseizure complaints.


METHODS
This self-controlled study was conducted from August 2006 to August 2008. 59 tramadol intoxicated patients who did have postseizure complaints entered the study. After initial resuscitation and work-up, they received intravenous naloxone 0.05 mg every 3-5 min, and the presence of symptoms, presence of abnormal waves in cerebral state monitor (CSM), cerebral state index (CSI) and optical density (OD) were assessed.


RESULTS
47 participants completed the study, of whom 43 (91%) had symptom resolution after the intervention, and the presence of symptoms was significantly different before and after the intervention (p<0.001). 47 patients had abnormal waves in the CSM before the intervention, while 15 had abnormal waves in the CSM after intervention (p<0.001). The baseline mean of CSI was 81 (SD: 5.17), which was significantly increased to 92 (SD: 2.35) after naloxone injection (p<0.001). The baseline mean of OD was 7.1 (SD: 0.23), which was significantly increased to 7.7 (SD: 0.29) after naloxone injection (p<0.001).


CONCLUSIONS
Naloxone can be considered in the management of postseizure complaints of tramadol toxicity, but further rigorous studies are needed to provide sufficient evidence to support its routine use.
Saidi
Hossein
H
Emergency Medicine Department, Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran.
Ghadiri
Mohammad
M
Abbasi
Saeed
S
Ahmadi
Seyed-Foad
SF
D000328:Adult; D000701:Analgesics, Opioid / Q000506:poisoning*; D056805:Consciousness Monitors; D004827:Epilepsy / Q000139:chemically induced* / Q000188:drug therapy* / Q000503:physiopathology; D005260:Female; D006801:Humans; D007275:Injections, Intravenous; D008297:Male; D009270:Naloxone / Q000008:administration & dosage / Q000627:therapeutic use*; D009292:Narcotic Antagonists / Q000008:administration & dosage / Q000627:therapeutic use*; D014147:Tramadol / Q000506:poisoning*
D000701:Analgesics, Opioid; D009292:Narcotic Antagonists; D009270:Naloxone; D014147:Tramadol