Trapadol Overdosage

Tramadol HCl + Paracetamol (Trapadol) is a fixed combination of active ingredients. In case of overdose, the symptoms may include the signs and symptoms of toxicity of tramadol or acetaminophen or both of these active ingredients.
Symptoms of overdose from tramadol: In principle, an intoxication with tramadol, symptoms similar to those of other centrally acting analgesics (opioids) are to be expected. These include in particular, miosis, vomiting, cardiovascular collapse, consciousness disorders up to coma, convulsions and respiratory depression up to respiratory arrest.
Symptoms of overdose from acetaminophen: An overdose is of particular concern in young children. Symptoms of acetaminophen overdosage in the first 24 hours are pallor, nausea, vomiting, anorexia and abdominal pain. Liver damage may become apparent 12 to 48 hours after ingestion. Abnormalities of glucose metabolism and metabolic acidosis may occur. In severe poisoning, hepatic failure may progress to encephalopathy, coma and death. Acute renal failure with acute tubular necrosis may develop even in the absence of severe liver damage. Cardiac arrhythmias and pancreatitis have been reported.
Liver damage is possible in adults who have taken 7.5-10 g or more of acetaminophen. It is considered that excess quantities of a toxic metabolite (usually adequately detoxified by glutathione when normal doses of acetaminophen are ingested), become irreversibly bound to liver tissue.
Emergency treatment: Transfer immediately to a specialised unit.
Maintain respiratory and circulatory functions.
Prior to starting treatment, a blood sample should be taken as soon as possible after overdose in order to measure the plasma concentration of acetaminophen and tramadol and in order to perform hepatic tests.
Perform hepatic tests at the start (of overdose) and repeat every 24 hours. An increase in hepatic enzymes (ASAT, ALAT) is usually observed, which normalizes after one or two weeks.
Empty the stomach by causing the patient to vomit (when the patient is conscious) by irritation or gastric lavage.
Supportive measures such as maintaining the patency of the airway and maintaining cardiovascular function should be instituted; Naloxone should be used to reverse respiratory depression; fits can be controlled with Diazepam.
Tramadol is minimally eliminated from the serum by haemodialysis or haemofiltration. Therefore, treatment of acute intoxication with Acetaminophen & Tramadol hydrochloride with haemodialysis or haemofiltration alone is not suitable for detoxification.
Irrespective of the reported quantity of acetaminophen ingested, the antidote for acetaminophen, NAC, should be administered orally or intravenously, as quickly as possible, if possible, within 8 hours following the overdose.