Substance abuse and dependence Tramadol induced status epilepticus in an old woman with polydrug abuse

Tramadol hydrochloride is a synthetic analogue of codeine, centrally acting analgesic used for the treatment of moderate to severe pain. Tramadol might cause seizures by stimulating the opioid receptors and possibly via an opioid dependent gamma-aminobutyric acid inhibitory pathway.(Rehni et al). Recent studies suggest that benzodiazepins (BZDs) are capable of inhibiting the metabolism of some opioid drugs, by competitive inhibition of CYP3A4. Codeine users are significantly more likely to be co-administrating large amounts of BZDs. In the literature there are several cases about epileptic attacks due to tramadol. In our report, we emphasise the multiple benzodizepine, tramadol and mirtazapine abuse in an elderly women. In this report; a 64 years old female patient had been treated for postoperative orthopedic surgery pains in the previous 2 years with 300 mg/day tramadol. She also abused alprazolam 6mg/day, lorazepam 7,5 mg/day, midazolam 45 mg/day, bromazepam 9 mg/day, and mirtazapine 30 mg/day for twenty years due to insomnia. She had a status epilepticus seizure after intake of 400 mg tramadol. We treated her with valproate 1000 mg/day, diazepam 40 mg/day, quetiapin 50 mg/day and duloxetine 30 mg/day successfully. Her treatment is still going on. Clinicians are advised to consider the potential for BZD abuse and adverse sequelae of tramadol, particularly in the elderly.