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Tramadol-related psychosis in a patient with bipolar I disorder

  • Kuan-Jen Chen (a1), Mong-Liang Lu (a1) (a2) and Winston W. Shen (a1) (a2)



Tramadol hydrochloride (HCl) is a centrally acting synthetic opioid analgesic. Psychotic symptoms are relatively rare in reported adverse events. Here, we report a patient who presented with tramadol-related psychotic symptoms.


A 59-year-old female had underlying bipolar I disorder and received lithium treatment with stable affective status. 1 month before hospitalisation, she had been taking tramadol HCl/acetaminophen for joint pain. She then developed obvious persecutory delusion. However, her clinical picture did not meet the criteria of any mood episode. After treatment of risperidone in addition to lithium, she was discharged without any psychotic symptom. She remained euthymic without any psychotic symptom on monotherapy of lithium (300 mg) three tablets once daily.


Tramadol HCl is commonly prescribed in clinical practice and psychotic symptoms related to it are uncommon. We should be careful about the rare but important adverse events while prescribing tramadol HCl.


Corresponding author

Mong-Liang Lu, Department of Psychiatry, Taipei Medical University-Wan Fang Hospital, No. 111, Section 3, Hsin-Long Road, Taipei 116, Taiwan.Tel: +88 622 930 7930, ext. 53961; Fax: +88 622 930 2448; E-mail:


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1. ULTRACET® (tramadol hydrochloride/acetaminophen) tablets [package insert on the Internet]. Raritan (NJ): Ortho-McNeil-Janssen Pharmaceuticals Inc. 2003; Available at Accessed December 5, 2014.
2. PANAMAX® (acetaminophen) [package insert on the Internet]. Macquarie Park (NSW): Sanofi Aventis Australia Pty Ltd 1991; Available at Accessed December 5, 2014.
3. Lee, CR, McTavish, D, Sorkin, EM. Tramadol: a preliminary review of its pharmacodynamic and pharmacokinetic properties, and therapeutic potential in acute and chronic pain states. Drugs 1993;46:313340.
4. Medicines Control Agency. Committee on safety of medicines. In focus: tramadol. Curr Probl Pharmacovigilance 1996;22:11.
5. ULTRAM® (tramadol hydrochloride) tablets [package insert on the Internet]. Raritan (NJ): Ortho-McNeil Pharmaceutical Inc. 2003; Available at Accessed December 5, 2014.
6. Conde, LC, Garcia, MDCA, Rodriguez, BP, Castro, AMF. Acute psychotic disorder secondary to the treatment with tramadol. Eur J Clin Pharmacol 2013;15:4951.
7. Driessen, B, Reimann, W, Giertz, H. Effects of the central analgesic tramadol on the uptake and release of noradrenaline and dopamine in vitro. Br J Pharmacol 1993;108:806811.
8. Hara, K, Minami, K, Sata, T. The effects of tramadol and its metabolite on glycine, gamma-aminobutyric acid A, and N-methyl-D-aspartate receptors expressed in Xenopus oocytes. Anesth Analg 2005;100:14001405.
9. Javitt, DC, Zukin, SR, Heresco-Levy, U, Umbricht, D. Has an angel shown the way? Etiological and therapeutic implications of the PCP/NMDA model of schizophrenia. Schizophr Bull 2012;38:958966.
10. Pellegrino, P, Carnovale, C, Borsadoli, C et al. Two cases of hallucination in elderly patients due to a probable interaction between flu immunization and tramadol. Eur J Clin Pharmacol 2013;69:16151616.
11. Boyer, EW, Shannon, M. The serotonin syndrome. N Engl J Med 2005;352:11121120.
12. Radomski, JW, Dursun, SM, Reveley, MA, Kutcher, SP. An exploratory approach to the serotonin syndrome: an update of clinical phenomenology and revised diagnostic criteria. Med Hypotheses 2000;55:218224.



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