Serial blood and urine measurement of drugs in a patient with acute intoxication of tramadol and zolpidem resulting in QT prolongation: a case report
- Author:
Bonggyu LEE
1
;
Jung Soo PARK
;
Suncheun KIM
;
Dongwoo KIM
;
Dongeun PARK
;
Hyejin CHANG
;
Yeonho YOU
;
Changshin KANG
;
Hongjoon AHN
;
Won Joon JEONG
Author Information
1. Department of Emergency Medicine, Chungnam National University Hospital, Daejeon, Korea
- Publication Type:Case Report
- From:Journal of the Korean Society of Emergency Medicine
2022;33(1):130-133
- CountryRepublic of Korea
- Language:English
-
Abstract:
We reported a case of acute intoxication by tramadol and zolpidem, resulting in QT prolongation in a patient. A 38-year-old male patient presented to the emergency department (ED) because of poisoning from 3 g of tramadol and 50 mg of zolpidem 4 hours before. During supportive treatment, he developed QT prolongation without clinical manifestations. He was discharged 5 days after admission without any sequelae. We measured the blood and urine concentrations of tramadol and zolpidem at various time points, which revealed a blood tramadol concentration-dependent change in QT intervals and an increased blood tramadol concentration at 8 hours after the ED visit. Tramadol and zolpidem were metabolized by the same enzyme, cytochrome P450 3A4. Therefore, competitive inhibition may increase drug toxicity. In addition, the blood concentration of tramadol may increase and result in QT prolongation even after appropriate initial treatment.
