Tjäderborn Micaela, Jönsson Anna K, Hägg Staffan, Ahlner Johan
Department of Forensic Genetics and Forensic Toxicology, National Board of Forensic Medicine, Linköping, Sweden.
Forensic Sci Int. 2007 Dec 20;173(2-3):107-11. doi: 10.1016/j.forsciint.2007.02.007. Epub 2007 Mar 9.
Tramadol is an extensively used centrally acting analgesic and is considered a safe drug devoid of many serious adverse effects of traditional opioids. However, recently, toxicity and an abuse potential of tramadol have been reported. This study examined fatal unintentional tramadol intoxications among Swedish forensic autopsy cases between 1995 and 2005. All fatal intoxications were selected, in which toxic concentrations of tramadol (>1 microg/g femoral blood) had been detected, and where the forensic pathologist considered the intoxication unintentional and the fatal outcome at least partly explained by tramadol. Toxicology analyses, police reports, autopsy protocols and medical records were scrutinized. A total of 17 cases (eleven men and six women) of fatal unintentional tramadol intoxications were identified. For these cases the median age was 44 years (range 18-78 years) and the median tramadol concentration was 2.0 microg/g (range 1.1-12.0 microg/g). Other pharmaceutical substances, illicit drugs or ethanol were detected in addition to tramadol in all of these cases. In fact, intoxication with multiple drugs was considered the cause of death in 10 (59%) cases. However, in seven cases tramadol was the only substance present in toxic concentrations. A history of substance abuse was identified in 14 (82%) subjects and a present tramadol abuse in 8 (47%). These results suggest that fatal intoxications with tramadol may occur unintentionally and that subjects with a history of substance abuse may be at certain risk. Precaution is therefore warranted when prescribing tramadol in such patients.
曲马多是一种广泛使用的中枢性镇痛药，被认为是一种安全的药物，没有传统阿片类药物的许多严重不良反应。然而，最近，曲马多的毒性和滥用潜力已被报道。本研究调查了1995年至2005年间瑞典法医尸检案例中的致命非故意曲马多中毒情况。选择了所有检测到曲马多有毒浓度（>1微克/克股血）的致命中毒案例，且法医病理学家认为中毒是非故意的，并且死亡结果至少部分由曲马多引起。仔细审查了毒理学分析、警方报告、尸检报告和医疗记录。共确定了17例致命非故意曲马多中毒案例（11名男性和6名女性）。这些案例的中位年龄为44岁（范围18 - 78岁），曲马多中位浓度为2.0微克/克（范围1.1 - 12.0微克/克）。在所有这些案例中，除曲马多外还检测到了其他药物、非法药物或乙醇。事实上，10例（59%）案例中多药中毒被认为是死亡原因。然而，在7例案例中，曲马多是唯一存在有毒浓度的物质。14名（82%）受试者有药物滥用史，8名（47%）有当前曲马多滥用情况。这些结果表明，曲马多致命中毒可能是非故意发生的，有药物滥用史的受试者可能有一定风险。因此，在此类患者中开具曲马多处方时应谨慎。
