Tramadol (Ultram®) Concentrations in Death Investigation and Impaired Driving Cases and Their Significance

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 cas...

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Bibliographic Details
Published in:Journal of forensic sciences 2004-09, Vol.49 (5), p.JFS2004019-5
Main Authors: Clarkson, JE, Lacy, JM, Fligner, CL, Thiersch, N, Howard, J, Harruff, RC, Logan, BK
Format: Article
Language:English
Subjects:
Analgesics, Opioid - blood
Analgesics, Opioid - pharmacology
Analgesics, Opioid - poisoning
Automobile Driving
Cause of Death
Central Nervous System Depressants - poisoning
Drug Interactions
Fatalities
Forensic Medicine
Forensic sciences
Humans
Muscle Relaxants, Central - poisoning
Reference Values
Side effects
Toxicology
Tramadol - blood
Tramadol - pharmacology
Tramadol - poisoning
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Summary: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 (1); 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.
ISSN:0022-1198
1556-4029
DOI:10.1520/JFS2004019