Seizure as a rare presentation of tramadol intoxication/withdrawal and fluoxetine as a potential anti-craving agent during tramadol abuse treatment

Tramadol is a centrally acting analgesic with opioid and monoaminergic actions. Tramadol is commonly prescribed for the treatment of moderately severe pain conditions. However, non-medical use of tramadol as well as tramadol poisoning is becoming a world concern. Studies have reported the potential risk of seizures in individuals who abuse tramadol. Here, we present the case of a 22-year-old female presenting with episodes of generalized tonic-clonic seizures after orally ingesting 1900 to 2100 mg tramadol, with a brief literature review. In addition, the case presented with seizure manifestations after tramadol dose tapering, de-escalation, and withdrawal periods. The case also presented that the patient benefited from fluoxetine during her craving days, although fluoxetine was prescribed to relive her stress. In addition, the case presented with tramadol abuse relapse and seizure induction after discharge. We suggest clinicians to focus on the potential occurrence of seizures during tramadol withdrawal and intoxication periods. Further studies need to be performed to identify the mechanisms and relationship of tramadol use with the onset of seizures. Relapse prevention needs to be a long-term strategy with continuous motivational interview and maintenance biological treatment.