Thursday, August 29, 2019

Hypoglycemia risk increases with the use of Tramadol for pain management

Hypoglycemia or low blood sugar affects a lot of people around the world. Hypoglycemia means that there is less sugar in your blood, which is the main source of energy for the body. Hypoglycemia can be caused due to treatment for diabetes – in order to keep the blood sugar controlled, it may fall below the normal levels.

 A recent investigation carried out by investigators has found that a common opioid, which is a prescription medicine that is known to have fewer side effects, could, in fact, increase risk of hypoglycemia.

A review conducted by FDA revealed that patients receiving tramadol were at 10 times higher risk of developing hypoglycemia that any other opioid except methadone. 

To determine the result of tramadol and how it can affect the risk of hypoglycemia in non-diabetic patients, various reports from the FDA databases were examined and it was found that people were prescribed tramadol as it has the least side effects among various opioids but in their research, they stumbled upon its adverse effect that it leads to a dangerous, unexpected hypoglycemia. 

To investigate the matter further, reports related to tramadol, codeine, hydrocodone, oxycodone, oxymorphone, hydromorphone, morphine, fentanyl, methadone, dextropropoxyphene, and tapentadol were grouped into separate groups for the analysis. SNRIs including duloxetine, venlafaxine, desvenlafaxine, and milnacipran used as monotherapy, and drugs with NMDAR activity such as minocycline, atomoxetine, ketamine, dextromethorphan, and memantine were also analyzed. 


Investigators noted the frequency of hypoglycemia reports were calculated for opioids, SNRIs, and NMDARs as a class for comparison with reports in the tramadol cohort. The investigators’ analyses revealed a significant increase in frequency of hypoglycemia reports in the tramadol cohort when compared to opioids-class (Report-Odds-Ratio (ROR) 11.36; 95% CI; (8.23, 15.66)), SNRIs-class (ROR 10.14 (7.08, 14.54), and NMDAR-class (ROR 14.57 (8.07, 26.31)).

Upon analysis, investigators found that the frequency of hypoglycemia reports was 0.10 for the codine cohort, 0.04 for fentanyl, 0.07 for hydrocodone, 0.19 for hydropmorphone, 0.04 for morphine, 0.09 for oxycodone, 0.87 for methadone, and 1.13 for tramadol. No reports were found for tapentadol, oxymorphone, or dextropropoxyphene.

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