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Submitted on April 2nd, 2007
On November 13, 2004, rapper and founding member of Wu-Tang Clan, Ol’ Dirty Bastard—born Russell Jones—died by an accidental overdose of legal and illegal drugs (according to results of an autopsy). ODB had a lethal mixture of cocaine and the prescription painkiller Tramadol in his system at the time of his shocking death. This was ruled an accident according to the New York Medical Examiner’s Office. Reportedly, he had been complaining of chest pains the day of his death. Tramadol should not be combined with other drugs such as narcotics, alcohol, hypnotics, centrally acting analgesics, opioids or psychotropic drugs.
Tramadol hydrochloride is a white, crystalline, bitter and odorless powder. It is readily soluble in water and ethanol and has a pKa of 9.41. The inactive ingredients in a Tramadol tablet are corn starch, lactose, methylcellulose, magnesium stearate, microcrystalline cellulose, polysorbate 80, polyethylene glycol, sodium starch glycolate, wax and titanium dioxide.
Tramadol is an analgesic with putative opioid as well as non-opioid modes of action. The respiratory effects of Tramadol are unclear, as some clinical studies indicate very little or no respiratory depression—others find significant respiratory effects. Of course, some case reports suggest the respiratory depressant effect of Tramadol is normally underestimated. The differences could be caused by the various methods used to test ventilatory control, the state of arousal or even the doses and routes of administration. Tramadol shouldn’t be administered to patients who have previously demonstrated hypersensitivity to Tramadol, opioids or any other component of Tramadol (Ultram). Tramadol may even worsen respiratory depression and the central nervous system in patients.
Fatal potential consequences of an overdose of Tramadol are lethargy, coma, seizure, respiratory depression, cardiac arrest and of course, death. Fatalities have been recently reported in post marketing in association with intentional and unintentional overdose with Tramadol. In treating an overdose, primary attention should definitely be given to maintain adequate ventilation along with the general supportive treatment. Although naloxone will reverse some symptoms caused by an overdose with Tramadol, the risk of seizures is still enhanced with naloxone administration. Seizures have been reported in many patients receiving Tramadol (Ultram) within the recommended range of dosage. Spontaneous post-marketing reports imply that seizure risk is increased with doses of Tramadol above the recommended range. Combining Tramadol with other drugs increases the seizure risk in patients.
The risk of convulsions may even increase in patients with epilepsy, those with a history of seizures or in patients with a recognized risk for seizure—head trauma, alcohol and drug withdrawal, metabolic disorders and CNS infections. In Tramadol overdose, naloxone administration may enhance the risk of a seizure. Fatal anaphylactoid reactions have been reported in individuals receiving therapy with Tramadol. Other reported allergic reactions include hives, pruritis, bronchospasm, angioedema, toxic epidermal necrolysis and Stevens-Johnson syndrome. Patients with a history of these reactions to codeine and other opioids may be at an increased risk and thus shouldn’t receive Tramadol. Tramadol may impair physical or mental abilities required for the performance of potentially hazardous tasks—driving a car, operating machinery.
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