From the Guidelines
Ultram (tramadol) can cause seizures, particularly at higher doses above 400mg per day, and in patients with certain risk factors or taking other medications that lower the seizure threshold. This medication, which is used to treat moderate to moderately severe pain, carries a risk of seizures due to its mechanism of action, which affects not only opioid receptors but also inhibits the reuptake of serotonin and norepinephrine in the brain, potentially lowering the seizure threshold 1. The seizure risk is also higher in patients who take other medications that lower the seizure threshold, such as certain antidepressants, antipsychotics, or other opioids. People with epilepsy, a history of seizures, head trauma, metabolic disorders, or those undergoing alcohol or drug withdrawal are at increased risk.
Some key points to consider when prescribing Ultram include:
- The NCCN panel recommends a maximum daily dose of 400 mg for immediate-release formulations (100 mg 4 times a day), or 300 mg/day for extended-release formulations, for adults with normal hepatic and renal function 1.
- Lower doses are recommended for older adults (75 years and older) and those with hepatic and/or renal dysfunction to reduce the risk of seizures 1.
- Tramadol is less potent than other opioids and is considered to be approximately one-tenth as potent as morphine 1.
- Patients taking Ultram should be monitored for symptoms of seizures, such as confusion, muscle twitching, or loss of consciousness, and should seek immediate medical attention if these symptoms occur.
It is essential to take Ultram exactly as prescribed and to inform your doctor about all other medications you're taking to minimize the risk of seizures. Additionally, patients with a history of seizures or other risk factors should be closely monitored while taking Ultram 1.
From the FDA Drug Label
WARNING Seizures have been reported in patients receiving Tramadol hydrochloride within the recommended dosage range. Spontaneous post-marketing reports indicate that seizure risk is increased with doses of tramadol hydrochloride above the recommended range Concomitant use of tramadol hydrochloride increases the seizure risk in patients taking: Selective serotonin re-uptake inhibitors (SSRI antidepressants or anorectics), Tricyclic antidepressants (TCAs), and other tricyclic compounds (e.g., cyclobenzaprine , promethazine, etc.), or Other opioids.
Yes, Ultram (tramadol) can cause seizures, especially when taken within the recommended dosage range or above, and when used concomitantly with certain medications such as SSRIs, TCAs, or other opioids 2, 2. Patients with a history of seizures, epilepsy, or head trauma are also at increased risk of seizures when taking tramadol 2.
From the Research
Ultram and Seizures
- Ultram, also known as tramadol, is a synthetic opioid used to relieve moderate to severe pain 3.
- There have been reports of seizure activity after tramadol administration, particularly in cases of overdose 3.
- The risk of seizures associated with tramadol use is considered modest in the general population, but can be higher in individuals with certain medical comorbidities or those taking supratherapeutic doses 4.
Studies on Tramadol and Seizures
- A 1997 study reported a case of seizure activity after the inadvertent administration of 4 mg/kg of tramadol to a child 3.
- A 2018 study reviewed the literature on tramadol-induced serotonin syndrome and seizures, highlighting the importance of prompt recognition and management 4.
- A 2019 study found no association between tramadol use and seizures in a nested case-control study of US patients with employer-sponsored health benefits 5.
- A 2022 study conducted a case-case-time-control study and found no significant association between transient use of tramadol and incidence of seizures 6.
- A 2019 systematic review and meta-analysis found that the occurrence of seizures in patients exposed to tramadol was dose-dependent and related to male gender 7.
Risk Factors and Associations
- Medical comorbidities, use or abuse of supratherapeutic doses of tramadol, and concomitant administration of proconvulsant serotonergic cytochrome P-450 inhibitors may increase the risk of seizures 4.
- Male gender has been associated with a higher risk of seizures in patients taking tramadol 7.
- Naloxone administration has not been found to be associated with the occurrence of seizures 7.