Overview

• Adjusted seizure risk was 9% higher when tramadol was used before a CYP2D6‑inhibiting antidepressant and about 6% higher when tramadol was added after the antidepressant.
• Absolute seizure rates ranged from roughly 16 to 22 per 100 person‑years across exposure patterns in the nursing‑home population studied.
• Antidepressants identified as CYP2D6 inhibitors in the study included fluoxetine, paroxetine and bupropion.
• A sensitivity analysis using hydrocodone found no similar increase in seizures with CYP2D6‑inhibiting antidepressants, suggesting the signal may be specific to tramadol.
• The authors emphasized the observational design and reliance on prescription records, noting the findings show an association rather than proof of causation.