Tramadol - Toxicology Due to different CYP-2D6 genotypes, people variably metabolize tramadol into its active metabolite, M1 This leads to an unpredictable mix of SNRI and opioid effects in patients • Ultra-rapid metabolizers - Some people are ultra-rapid metabolizers of tramadol (By the same CYP2D6 polymorphism resulting in codeine ultra-rapid metabolism) - Death and life threatening respiratory depression have occurred following a single dose of tramadol inchildren - Risk of infant respiratory depression in breast-feeding if mother or child are ultra-rapid metabolizers • Poor metabolizers - In poor metabolizers, people may experience little, or no analgesic activity as the M1 metabolite cannot be created. (By the same CYP-2D6 polymorphism resulting in poor codeine metabolism and little to no analgesic activity). By Dr. Kathryn Watson @Kat_Watson #Tramadol #Toxicology #Toxicity #Diagnosis #Pharmacology