Overdose with Tramadol
Tramadol belongs to psychotropic opioid analgesics. It is the most prescribed centrally acting analgesic in the world. Various sources classify it as both narcotic and non-narcotic. In accordance with the information presented on the website of the Ministry of Health of the Russian Federation, Tramadol is defined as an opioid analgesic with a mixed mechanism of action.
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Tramadol acts on the active centers of the brain and spinal cord:
- activates opiate receptors in the system that perceives and conducts pain impulses, blocking the synaptic transmission of specific mediators, and thereby helps to reduce the intensity of pain;
- slows down catabolism and inhibits the reverse neuronal uptake of catecholamines and serotonin, stabilizing their concentration in the structures of the nervous system;
- inhibits the activity of the cortical centers of the brain, has a sedative and hypnotic effect;
- inhibits the cough and respiratory centers, causes spasm of the smooth muscles of the sphincters, and so on.
The analgesic effect occurs within 10-15 minutes after administration, the duration of action is from 4 to 8 hours, depending on the dosage form. Method of production: tablets (including prolonged action) and capsules of 50 and 100 mg, solution for injection 50 mg / 1 ml, rectal suppositories 100 mg, drops for oral administration 100 mg / 1 ml.
The analgesic activity of the drug is 0.05-0.09 of the activity of morphine (according to some sources - 5 times lower than that of morphine, and 2 times higher than the activity of codeine), therefore the main indication for its appointment is pain of average, less often high intensity with the following conditions:
- oncological diseases;
- trauma;
- postoperative period;
- acute myocardial infarction;
- neuralgia;
- painful diagnostic or therapeutic manipulations.
At the time of taking Tramadol, it is necessary to abandon alcohol, tranquilizers, hypnotics and sedatives, since the drug enhances their depressing effect on the central nervous system.
How much Tramadol is needed for an overdose?
The dosage regimen and the duration of pharmacotherapy are determined by the attending physician, depending on the specific clinical situation.
The standard therapeutic dose for adults and children over 14 years of age when taken orally is 50 mg. If there is no effect, it is allowed to take the drug again after 30-60 minutes. For parenteral administration - 50-100 mg per injection, in the form of suppositories - 100 mg (repeated administration is allowed no earlier than 4 hours later).
The maximum daily dose of Tramadol for adults and children over 14 years old is 400 mg (in rare cases, at the discretion of the attending physician - 600 mg). The daily dose for elderly patients is 300 mg.
For children aged 1 to 14 years, the drug is administered orally in the form of drops or by injection. A single dose is calculated on the basis of body weight - 1-2 mg per kg, the maximum daily dose is from 4 to 8 mg / kg.
Excess of these dosages can lead to the development of acute or chronic intoxication, coma, death.
Signs of overdose
Acute overdose
The main signs of a mild Tramadol overdose are:
- constriction of the pupils;
- headache;
- moderate decrease in blood pressure;
- decrease in heart rate;
- excessive sweating;
- feeling of creeping on the skin;
- nausea.
Acute overdose of moderate severity has the following manifestations:
- anxiety, agitation;
- nausea, vomiting, abdominal pain;
- salivation;
- persistent constriction of the pupils ("pinpoint pupils");
- severe arterial hypotension;
- bradycardia;
- shortness of breath, respiratory discomfort.
In severe overdose with Tramadol, the following are noted:
- epileptiform seizures;
- oppression of consciousness;
- a sharp decrease in blood pressure (BP);
- pathological breathing, suffocation, episodes of spontaneous respiratory arrest;
- development of pulmonary edema is possible.
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Chronic overdose
With prolonged use of Tramadol in doses exceeding therapeutic, but insufficient for acute poisoning, chronic overdose develops. Her symptoms:
- depression, often with suicidal episodes;
- changes in mood (aggressiveness, emotional lability, irritability);
- headache;
- excessive sweating;
- tachycardia;
- pain in muscles and joints;
- decreased appetite, nausea, bouts of vomiting.
First aid for overdose with Tramadol
In the event of symptoms of an acute overdose of the injectable form of the drug, it is necessary to immediately stop the administration, give the victim a comfortable body position, provide fresh air, and urgently seek medical help.
If an overdose has occurred after taking the drug inside, you must:
- Rinse the stomach (drink 1-1.5 liters of warm water or a light pink solution of potassium permanganate (potassium permanganate) and induce vomiting by pressing on the root of the tongue).
- Take enterosorbent (Enterosgel, Polyphepan, Polysorb according to the scheme or activated carbon at the rate of 1 tablet per 10 kg of body weight).
- Take a saline laxative (magnesium sulfate).
Antidote
The specific antagonist of Tramadol is Naloxone.
When is medical attention required?
Medical assistance is needed if:
- a child, pregnant woman or elderly person is injured;
- first aid did not bring improvement or worsening is noted;
- the victim is in a state of oppressed consciousness, inaccessible or limited access to contact;
- active neurological symptoms have developed (convulsions, intense headache, speech and motor excitement, disorientation, etc.);
- BP is below 80/50 mm Hg. Art.;
- there is a high tachycardia, arrhythmia or bradycardia below 45-50 beats / min;
- developed intense breathing disorders.
If necessary, by the ambulance team, the victim is hospitalized in the toxicological or intensive care unit, where specific therapy is carried out:
- oxygen therapy, artificial lung ventilation;
- anticonvulsants (intravenous diazepam, sodium thiopental);
- with bradycardia - m-anticholinergics (Atropine), vasoconstrictors (Norepinephrine, Phenylephrine);
- stimulation of the respiratory center (Caffeine, Cordiamine);
- sedatives to relieve anxiety, feelings of fear;
- forced diuresis in the absence of contraindications;
- for the purpose of hemodilution (reducing the concentration of a toxic substance in the blood by diluting it) - infusion therapy with colloids and crystalloids.
Possible consequences
The consequences of an overdose with Tramadol can be:
- acute renal, hepatic failure;
- acute heart failure;
- toxic pulmonary edema;
- paralysis of the respiratory, vasomotor centers;
- toxic and hypoxic encephalopathy;
- collapse;
- coma, death.
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Olesya Smolnyakova Therapy, clinical pharmacology and pharmacotherapy About the author
Education: higher, 2004 (GOU VPO "Kursk State Medical University"), specialty "General Medicine", qualification "Doctor". 2008-2012 - Postgraduate student of the Department of Clinical Pharmacology, KSMU, Candidate of Medical Sciences (2013, specialty "Pharmacology, Clinical Pharmacology"). 2014-2015 - professional retraining, specialty "Management in education", FSBEI HPE "KSU".
The information is generalized and provided for informational purposes only. At the first sign of illness, see your doctor. Self-medication is hazardous to health!
