Overdosage

Symptoms:

Miosis,
vomiting,
cold and clammy skin,
respiratory depression,
lethargy,
flaccid skeletal muscle,
coma,
seizures, 
bradycardia, 
hypotension,
cardiac arrest, 
cardiac collapse and death.

Management: Treatment is supportive and ensure adequate ventilation. Although naloxone will reverse some, but not all, symptoms of tramadol overdosage, there is an increased risk of seizures which has to be taken into consideration. Haemodialysis is unlikely to be helpful.