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J Korean Soc Emerg Med > Volume 33(1); 2022 > Article
Journal of The Korean Society of Emergency Medicine 2022;33(1): 130-133.
Serial blood and urine measurement of drugs in a patient with acute intoxication of tramadol and zolpidem resulting in QT prolongation: a case report
Bonggyu Lee1, Jung Soo Park1,2 , Suncheun Kim3 , Dongwoo Kim3, Dongeun Park3, Hyejin Chang3, Yeonho You1 , Changshin Kang1 , Hongjoon Ahn1 , Won Joon Jeong1
1Department of Emergency Medicine, Chungnam National University Hospital, Daejeon, Korea
2School of Medicine, Chungnam National University, Daejeon, Korea
3Forensic Toxicology Division, National Forensic Service, Daejeon, Korea
Correspondence  Won Joon Jeong ,Tel: 042-280-6003, Fax: 042-280-6019, Email: gardenjun@hanmail.net,
Received: February 2, 2021; Revised: April 16, 2021   Accepted: April 20, 2021.  Published online: February 28, 2022.
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.
Key words: Zolpidem; Tramadol; QT prolongation; Drug overdose
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