Analysis of Risk Factors for Tramadol Induced Serotonin Syndrome / 中国药师

ABSTRACT

Objective:To investigate the clinical characteristics and causes of serotonin syndrome induced by tramadol in order to provide references for rational drug use in clinical practice. Methods:The relevant literatures published in domestic medical journals from the building of database to 2016 were retrieved in PubMed, EMbase, CNKI and WanFang database and statistically analyzed in respects of types and relevance evaluation of adverse drug reactions, the age and gender distribution of patients, the application of drugs,occurrence time of serotonin syndrome,clinical manifestations,treatment and outcome. Results:A total of 21 cases of seroto-nin syndrome induced by tramadol were collected. Totally 19 cases were caused by combined drug use, among which 12 cases were combined with selective serotonin reuptake inhibitors. The results of relevance evaluation showed 19 cases of possible relevance and 2 cases of probable relevance. Totally 10 cases of severe adverse drug reactions were reported and 11 cases of common adverse drug reac-tions were exhibited. One patient was heterozygous for CYP2D6 polymorphisms(CYP2D6?1/?4) causing decreased metabolizing a-bility to tramadol. Totally 28.6% of patients developed symptoms in 24h after the addition of new serotonergic agents or increase the dosage of serotonergic agents. In most cases,the patients' syndrome resolved with discontinuation of at least one serotonergic drug and symptomatic treatment,usually in less than one week. Conclusion:When prescribing tramadol,physicians should be aware of seroto-nin syndrome induced by drug-drug interactions and possible pharmacogenetic factors. It is important that safety monitoring should be carried out in patients during the application of drugs to reduce the harm of adverse drug reactions.