[en] Tramadol has been extensively prescribed for two decades. It is an opioid analgesic considered to induce fewer side effects than other compounds of this class. However, serious complications may occur in case of intoxication. We report here two cases of fatal intoxication due to tramadol ingestion. Tramadol, O-desmethyltramadol (ODT) and N-desmethyltramadol (NDT) were quantitatively and qualitatively determined in postmortem blood and urine, respectively. An HPLC method coupled with fluorescence detection was validated using total error approach for the analysis of tramadol, ODT, and NDT in blood. In case1, concentrations of tramadol and its metabolites were 7.7 mg/L (tramadol), 1.33 mg/L (ODT), and 0.6mg/L (NDT). In case 2, concentrations found were 48.34 mg/L (tramadol), 2.43 mg/L (ODT), and 10.09 mg/L (NDT). Opposite ratios of ODT/NDT concentrations observed in different cases were suggested to be useful for the evaluation of the delay between ingestion and death. However, the changes in metabolites levels may also be explained by pharmacokinetic interactions and quantitative differences in the activity of the cytochrome-P450 2D6. Interestingly, norfluoxetine was detected in sub-therapeutic levels in case 2. Most of these aspects in tramadol-related fatalities are reviewed in this paper, and an overview of fatal intoxications due to tramadol is presented.
Research Center/Unit :
CIRM - Centre Interdisciplinaire de Recherche sur le Médicament - ULiège
Disciplines :
Pharmacy, pharmacology & toxicology
Author, co-author :
De Backer, Benjamin ; Université de Liège - ULiège > Département de pharmacie > Chimie toxicologique
Renardy, Françoise ; Université de Liège - ULiège > Département des sciences de la santé publique > Médecine légale - Criminalistique
Denooz, Raphaël ; Université de Liège - ULiège > Département de pharmacie > Département de pharmacie
CHARLIER, Corinne ; Centre Hospitalier Universitaire de Liège - CHU > Toxicologie clinique
Language :
English
Title :
Quantification in postmortem blood and identification in urine of tramadol and its two main metabolites in two cases of lethal tramadol intoxication
Publication date :
November 2010
Journal title :
Journal of Analytical Toxicology
ISSN :
0146-4760
eISSN :
1945-2403
Publisher :
Preston Publications Inc, Niles, United States - Illinois
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