Tramadol-Induced Generalized Tonic–Clonic Seizure Following Therapeutic-Dose Administration in a Chronic Alcoholic Patient: A Case Report

Resumen

Background: Tramadol, a synthetic opioid analgesic, is widely used for moderate to severe pain but carries a risk of seizures, particularly in predisposed individuals. We report a case of a 47-year-old male with chronic alcohol use and childhood epilepsy who developed a generalized tonic–clonic seizure within two minutes of receiving intravenous tramadol (100 mg) for pain management of esophageal varices. The event was promptly controlled with lorazepam and levetiracetam, with no recurrence after tramadol discontinuation. Tramadol lowers the seizure threshold via inhibition of GABA neurotransmission and enhancement of serotonergic and noradrenergic activity. Alcohol dependence and pre-existing epilepsy markedly increase susceptibility. This case highlights that the seizures can occur with tramadol even at therapeutic doses in patients with epilepsy or chronic alcoholism. Clinicians should prefer safer alternatives and remain vigilant to prevent avoidable adverse drug reactions.