Which two side effects are particularly prevalent in tramadol use?

Tramadol, although often considered a safer alternative to more potent opioids, has a unique pharmacological profile that can lead to certain side effects that are particularly prevalent. One of the key side effects associated with tramadol use is the risk of seizures. This is due to its mechanism of action, as tramadol not only acts as an opioid analgesic but also inhibits the reuptake of norepinephrine and serotonin. The combination of these actions increases the potential for seizures, especially when tramadol is used in higher doses or in conjunction with other medications that also lower the seizure threshold.

Additionally, tramadol can cause serotonin syndrome, a potentially life-threatening condition that arises when there is an excess of serotonin in the central nervous system. This can occur when tramadol is combined with other serotonergic agents—such as certain antidepressants, selective serotonin reuptake inhibitors (SSRIs), or triptans—due to its ability to increase serotonin levels. Symptoms of serotonin syndrome include confusion, agitation, hyperreflexia, myoclonus, and autonomic instability.

These two side effects—seizures and serotonin syndrome—are significant considerations in tramadol use, particularly given its unique pharmacological effects and the risk of interactions with other medications.