Document Detail

Tramadol (Ultram) concentrations in death investigation and impaired driving cases and their significance.
MedLine Citation:
PMID:  15461118     Owner:  NLM     Status:  MEDLINE    
We reviewed a series of 66 deaths in Washington State between 1995-2000 in which tramadol (Ultram and Ultracet, Ortho-McNeil) was detected in the decedent's blood, in order to assess the role tramadol was determined to have played. Additionally, we reviewed a series of 83 impaired driving cases in which tramadol was detected in order to establish a non-lethal blood tramadol concentration reference range. In both populations, tramadol was consistently found together with other analgesic, muscle relaxant, and CNS depressant drugs. Death was rarely attributable to tramadol alone. However, tramadol may be a significant contributor to lethal intoxication when taken in excess with other drugs, via the potential interaction with serotonergic antidepressant medications, as well as the potential for increased CNS depression. Although the incidence of tramadol detection has increased consistently over the last eight years, there is no evidence of a corresponding increase in the number of cases in which death was attributed solely to tramadol. Blood drug concentrations in many deaths exceeded the therapeutic serum range of 0.28-0.61 mg/L; however, the concentrations overlapped almost completely with the range identified in living subjects arrested for impaired driving. These findings suggest caution in the interpretation of blood tramadol concentrations outside of the recognized therapeutic range. It also suggests that the drug, even when used in moderate excess, is not a principle cause of death in suicidal or accidental deaths.
Jayne E Clarkson; J Matthew Lacy; Corinne L Fligner; Norman Thiersch; John Howard; Richard C Harruff; Barry K Logan
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Journal of forensic sciences     Volume:  49     ISSN:  0022-1198     ISO Abbreviation:  J. Forensic Sci.     Publication Date:  2004 Sep 
Date Detail:
Created Date:  2004-10-05     Completed Date:  2005-01-24     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0375370     Medline TA:  J Forensic Sci     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1101-5     Citation Subset:  IM    
Washington State Toxicology Laboratory, Forensic Laboratory Services Bureau, Washington State Patrol, 2203 Airport Way South, Seattle, WA 98134, USA.
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MeSH Terms
Analgesics, Opioid / blood*,  pharmacology,  poisoning
Automobile Driving*
Cause of Death*
Central Nervous System Depressants / poisoning
Drug Interactions
Forensic Medicine
Muscle Relaxants, Central / poisoning
Reference Values
Tramadol / blood*,  pharmacology,  poisoning
Reg. No./Substance:
0/Analgesics, Opioid; 0/Central Nervous System Depressants; 0/Muscle Relaxants, Central; 27203-92-5/Tramadol

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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