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. 2019 Oct 9:10:183.
doi: 10.4103/ijpvm.IJPVM_268_18. eCollection 2019.

Risk of Seizure after Naloxone Therapy in Acute Tramadol Poisoning: A Systematic Review with Meta-Analysis

Nastaran Eizadi-Mood  1 , Maliheh Ghandehari  2 , Marjan Mansourian  3 , Ali Mohammad Sabzghabaee  4 , Shiva Samasamshariat  3 , Erfan Sadeghi  5
Affiliations

Risk of Seizure after Naloxone Therapy in Acute Tramadol Poisoning: A Systematic Review with Meta-Analysis

Nastaran Eizadi-Mood et al. Int J Prev Med. .

Abstract

Background: Many studies have focused on the relationship between naloxone and seizure in tramadol poisoning but the results are in conflict. We performed a meta-analysis study to see whether naloxone prevents or increase the risk of seizure in tramadol poisoning.

Methods: Bibliographic literature searches were conducted in the ISI Web of Science, Excerpta Medica Database (EMBASE), PubMed, and Cochrane from January 1990 to December 2017 for relevant articles. Pooled data were analyzed by calculating odds ratios (ORs) with 95% confidence intervals (CIs). The outcome includes seizure. To investigate the publication bias, Begg's and Egger's tests were used along with funnel plot as a graphical test.

Results: Seven studies met the inclusion criteria. The meta-analysis showed I 2, 27%, (P value, 0.23) indicating no significant heterogeneity. As a result, using the fixed effect, the OR was 1.14 (95% CI = 0.60-2.18, P value, 0.69) which was not significant, means naloxone did not increase the risk of seizure.

Conclusions: Naloxone therapy did not increase the risk of seizure significantly in the treatment of acute tramadol poisoning. We suggest considering the risk/benefit when administration naloxone, especially for the seizure risk factors including previous history of seizure, tramadol misuse, and co-ingestion.

Keywords: Meta-analysis; naloxone therapy; poisoning; review; tramadol overdose.

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Conflict of interest statement

There are no conflicts of interest.

Figures

Figure 1
Figure 1
Flow chart of the literature search for performing the meta-analysis
Figure 2
Figure 2
Funnel plot of articles about the relationship between naloxone administration and seizure in tramadol toxicity
Figure 3
Figure 3
Forest plot of relationship between naloxone administration and seizure in tramadol
See this image and copyright information in PMC

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