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Tramadol related deaths have occurred in many patients with previous histories of suicidal ideation or attempts or disturbance as well as histories of misuse of tranquilizers, other cnc-active drugs or alcohol. The development of potentially life-threatening serotonin syndrome may occur with the use different tramadol products, including tramadol hydrochloride medicines , particularly with concomitant use of different serotonergic dosages. Serotonin syndrome may include mental status changes like agitation, coma, hallucinations, autonomic instability like hyperthermia, blood pressure, tachycardia, hyperreflexia, incoordination, vomiting etc.

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