SHM Converge Scientific Abstract ePoster Gallery-How to Train Your Dramadol - Novel Use of Ssri to Manage Atypical Tramadol Withdrawal

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This case report describes a 50-year-old woman with a long history of heavy tramadol use who presented after being found unconscious. Once she became more alert, she revealed taking tramadol for 20 years, up to 1500 mg daily. Her hospital course evolved over 48 hours with symptoms consistent with tramadol withdrawal: nausea, abdominal pain, body aches, anxiety, tremulousness, tachycardia, hypertension, insomnia, emotional lability, hyperverbal behavior, and headache.<br /><br />Tramadol withdrawal is challenging because tramadol has dual actions: it is a µ-opioid agonist and also inhibits serotonin and norepinephrine reuptake. As a result, withdrawal can include not only typical opioid withdrawal symptoms but also atypical neuropsychiatric features such as paranoia, depersonalization, derealization, hallucinations, numbness, tingling, and tinnitus. These atypical symptoms are reported in about one in eight cases, especially with high daily doses.<br /><br />The patient underwent extensive evaluation for altered mental status, including CT, lumbar puncture, MRI, and EEG, all of which were unremarkable. Initial treatment included methadone, clonidine, ketorolac, and clorazepate for presumed withdrawal. When symptoms worsened, she was transitioned to fluoxetine, an SSRI, along with clorazepate, which led to significant improvement. She was discharged on this regimen and instructed to taper clorazepate over one week. At two-week follow-up, her symptoms remained well controlled.<br /><br />The authors highlight that there are no evidence-based guidelines for tramadol withdrawal, but this case suggests SSRIs may be a useful adjunct for managing atypical withdrawal symptoms, likely due to tramadol’s serotonergic effects. Early recognition of atypical presentations is important for proper diagnosis and treatment.

Asset Subtitle

Tai Do

Meta Tag

Author List Kayla Patel, Tai Do, Usha Anand

Category Clinical Vignettes

Concept Tramadol

Concept Withdrawal Syndrome

Concept Mu-opioid receptor agonism

Concept Serotonin Reuptake Inhibition

Concept Norepinephrine reuptake inhibition

Distinguished Non-Finalist

Presenter Organization WellStar Kennestone RMC

Presenting Author Tai Do

Track Adult

Keywords

tramadol withdrawal

opioid withdrawal

serotonin reuptake inhibition

norepinephrine reuptake inhibition

atypical withdrawal symptoms

fluoxetine treatment

altered mental status

heavy tramadol use

case report

withdrawal management

Tramadol

Withdrawal Syndrome

Mu-opioid receptor agonism

Serotonin Reuptake Inhibition

Norepinephrine reuptake inhibition