Painkiller Linked to Low Blood Sugar

The painkiller tramadol (brand names Ultram, ConZip, Ultram ER) is linked to an increased risk of hospitalization for hypoglycemia (low blood sugar) in people both with and without diabetes, according to a recent study by scientists at McGill University in Montreal. The use of this medicine has grown in recent years, with retailers dispensing 43.8 million tramadol prescriptions in the United States in 2013.

Tramadol is considered to be a mild narcotic and is thought to be less likely to be addictive than other medicines in its class. Unlike other narcotics, it works by affecting the functioning of serotonin and norepinephrine, two chemicals in the body that play a role in glucose regulation — a possible explanation for the drug’s apparent link with low blood glucose.

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To evaluate whether the use of tramadol is associated with an increased risk of hospitalization for hypoglycemia compared to the use of codeine, another narcotic, researchers looked at data from 334,034 people newly treated with either of these medicines for pain between 1998 and 2012.

Over a five-year follow-up period, 1,105 people were hospitalized for low blood glucose, with 110 dying. The researchers found that taking tramadol was linked with a 52% higher risk of being hospitalized for low blood glucose compared with taking codeine, and within the first 30 days of tramadol use, the risk was nearly threefold that seen with codeine.

“Physicians need to be aware that the use of tramadol may be associated with an increased risk of severe hypoglycemia. Our findings should help them better assess the risks and benefits of this drug,” said study coauthor Laurent Azoulay, MD.

Although tramadol was found to be associated with an increased risk of low blood sugar, it is still important to note that the overall risk is small, with serious hypoglycemia occurring in fewer than 1 out of every 1,000 people taking the drug each year.

The authors note that their study does not prove a cause-and-effect relationship between tramadol and hypoglycemia, and state that more research into the matter is needed.

For more information, read the article “Opioid Linked to Low Blood Sugar” or see the study abstract in the journal JAMA Internal Medicine. And to learn more about low blood sugar, see these articles by our expert authors.