Which Opioid Increases the Risk for Hypoglycemia?

Tramadol is significantly associated with hypoglycemia, according to new research.

The study authors reached this conclusion after determining that—compared with other opioids, serotonin and norepinephrine reuptake inhibitions (SNRIs), and N-methyl-D-aspartate receptors (NMDARs)—tramadol increased the risk for hypoglycemia among patients who were not concurrently using medication and who did not have comorbidities.

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To study the association between different therapeutics and hypoglycemia, the researchers analyzed 12,004,552 reports from the FDA’s Adverse Effect Reporting System (FAERS) and Adverse Event Reporting System (AERS) databases. While the FAERS reports included data from September 2012 to March 2019, the AERS reports included data from January 2004 to August 2012.

The researchers identified reports that included any of the 11 opioids, 4 SNRIs, and 5 NMDARs they were using in their analysis. The reports also had to indicate that the treatment was being used as a monotherapy and that the patient did not have diabetes. In all, 83,662 reports on opioids, 45,201 reports on SNRIs, and 16,541 on NMDARs were evaluated. 

The reports showed that, compared with the 10 other opioids, as well as with the SNRIs and NMDARs, tramadol had a significant elevation on hypoglycemia, which was defined as plasma glucose concentration below 70 mg/dL.

Of the other opioids, only methadone demonstrated similarities to tramadol in its association with hypoglycemia.

“It may be beneficial to monitor glucose levels when initiating tramadol or methadone in both diabetic and non-diabetic patients,” the researchers concluded. “Alternative opioids or non-opioid pain medications may be safer to use with patients at risk of hypoglycemia or any complications associated with hypoglycemia.”

—Colleen Murphy

Reference:

Makunts T, U A, Atayee RS, Abagyan R. Retrospective analysis reveals significant association of hypoglycemia with tramadol and methadone in contrast to other opioids [published online August 28, 2019]. Sci Rep. doi:10.1038/s41598-019-48955-y.