• Tramadol (Ultram) is an uncontrolled substance in the opiod family that binds mu receptors and is indicated for moderate to moderately severe pain.

• Tramadol lowers seizure threshold to < 1/100,000, likely related to its inhibition of neuronal re-uptake of serotonin and norepinephrine in the CNS.

• Concurrent use with SSRI's, TCA's, MAOI's, neuroleptics, other opiods, naloxone (when given for tramadol overdose) and alcohol exacerbates the risk of seizure onset.

• Tramadol-related seizure is independent of dose (i.e. can occur at starting dose of 25 mg), although brisk titration up to maintenance doses does increase seizure risk.
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•  To avoid triggering a seizure, tramadol should not be used in patients with the following conditions:

             --  seizure disorder

             --  alcohol withdrawal

             --  alcoholism

             --  drug withdrawal

             --  CNS infections

             --  metabolic disorder

             --  head trauma