Is prophylactic administration of the anticonvulsants necessary in tramadol-intoxicated patients after an initial seizure?

Abstract

Shadnia et al. [11] 2012 100 7% Letter to the editor Tramadol is nowadays one of the most commonly abused drugs in Iran. In our country, few emergency physicians have never visited a tramadol-intoxicated patient referring after overdose or with side effects of its use. One of the complications of tramadol use, abuse, or overdose is seizure [1-4]. It has been shown that the tramadol-induced seizures are not dose-dependent [5]. To date, the incidence rate of recurrent/multiple seizures in tramadol-intoxicated patients has been determined in several studies as shown in Table 1 [3,6-11]. The important question is that is there a need for prophylactic administration of anticonvulsants in tramadolintoxicated patients referring with an initial seizure? Of note, in some poison treatment centers of Iran, administration of benzodiazepine is a routine treatment in such patients. As you know, in the setting of clinical toxicology, except for the intravenous overdose of vincristine [12], severe toxicity with methylxanthines [13], strychnine toxicity [14], and withdrawal of ethanol and some benzodiazepines [15], no other condition exists for whose prevention of recurrent or multiple seizures, prophylactic anticonvulsants have been recommended [16]. This certainly applies to the tramadol-induced seizures, as well, because these seizures have no special characteristic for which we believe them to be different from other drugand toxin-induced seizures. For instance, tramadol-induced seizures are tonic-clonic, short-lived, and self-limited similar to the most of other drug-induced seizures [16]. In addition, in the setting of poisoning, even where there is the likelihood of recurrent seizures (except for the above-mentioned conditions), prophylactic administration of the anticonvulsants has not been recommended and in the case of