Bu makalede<\/a>; son y\u0131llarda tramadol kullan\u0131m\u0131 insidans\u0131n\u0131n artm\u0131\u015f olmas\u0131 ve n\u00f6bete sebep olabilecek karakteristik \u00f6zelliklerinin bilinmeyenleri g\u00f6z \u00f6n\u00fcne alarak, tramadol zehirlenmesi, n\u00f6bet olu\u015fumu ve bu n\u00f6betlerle ili\u015fkili fakt\u00f6rlerin incelenmesi a\u00e7\u0131s\u0131ndan literat\u00fcrde bu konularla ilgili bas\u0131lm\u0131\u015f yay\u0131nlar\u0131n sistematik olarak incelenmesi ve meta-analizinin yap\u0131lmas\u0131 planlanm\u0131\u015f. Meta-analize belirlenilen kriterlere uygun 51 \u00e7al\u0131\u015fma dahil edilmi\u015f (1).<\/p>\n\u00c7al\u0131\u015fman\u0131n amac\u0131 tramadol kullan\u0131m\u0131 olan hastalarda olu\u015fan n\u00f6betlerin s\u0131kl\u0131\u011f\u0131yla ili\u015fkili bilimsel verilerin \u00f6zetlenmesi ve hastalarda n\u00f6bet olu\u015fumuna sebep olabilecek fakt\u00f6rlerin \u00e7al\u0131\u015f\u0131lmas\u0131 olarak belirtilmi\u015f. Sonu\u00e7lara bak\u0131ld\u0131\u011f\u0131nda n\u00f6betlerin \u00f6nemli \u00f6l\u00e7\u00fcde doza ba\u011f\u0131ml\u0131 ve \u00f6zellikle erkek cinsiyet ile ili\u015fkili oldu\u011fu g\u00f6zlemlenmi\u015f.<\/p>\n
S. Nakhaee ve ark. ger\u00e7ekle\u015ftirdikleri bu \u00e7al\u0131\u015fma, tramadol maruziyeti olan hastalarda n\u00f6bet insidans\u0131 ve bununla ili\u015fkili fakt\u00f6rleri inceleyen ilk sistematik derleme ve meta-analiz olarak g\u00f6ze \u00e7arpmakta. Fakat meta-analizde her \u00e7al\u0131\u015fman\u0131n sonu\u00e7lar\u0131n\u0131 etkileyebilecek potansiyel de\u011fi\u015fkenler tam olarak ayarlanamam\u0131\u015f. \u00d6rne\u011fin bir\u00e7ok \u00e7al\u0131\u015fma ara\u015ft\u0131r\u0131lan vakalar\u0131n ya\u015f aral\u0131\u011f\u0131n\u0131 s\u0131n\u0131rlamam\u0131\u015f.<\/p>\n
Ancak bu konudaki toplu \u00e7al\u0131\u015fmalar tramadol kullan\u0131m\u0131yla n\u00f6bet geli\u015febilece\u011fini do\u011fruluyor. Bu nedenle, tramadol kullan\u0131rken n\u00f6bet geli\u015fimi i\u00e7in risk fakt\u00f6r\u00fc bulunan veya daha \u00f6nce n\u00f6bet ge\u00e7irmi\u015f olan hastalarda daha dikkatli olunmas\u0131n\u0131 \u00f6neriliyor.<\/p>\n
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Fig\u00fcr:<\/strong> Tramadol\u00fcn tetikledi\u011fi n\u00f6betler 3 subgrupta incelenmi\u015f: Zehirlenme, T\u00f6ropatik Kullan\u0131m ve K\u00f6t\u00fcye Kullan\u0131m<\/p>\nDi\u011fer \u00c7al\u0131\u015fmalar<\/strong><\/u><\/h2>\n\u0130ncelenen \u00e7al\u0131\u015fmalara bak\u0131ld\u0131\u011f\u0131nda Tramadol\u00fcn n\u00f6bet patofizyolojisine etkisi konusunda farkl\u0131 g\u00f6r\u00fc\u015fler mevcut. Bir pre-klinik \u00e7al\u0131\u015fmada (2) tramadol\u00fcn prokonv\u00fclzan ve antikonv\u00fclzan aktivitesi raporlanmakla beraber ba\u015fka bir \u00e7al\u0131\u015fmada, ilgili meta-analizle do\u011fru orant\u0131l\u0131 olarak konv\u00fclsan etkinin doza ba\u011f\u0131ml\u0131 oldu\u011fu g\u00f6sterilmi\u015f. Burada de\u011ferlendirilen g\u00f6zlemsel \u00e7al\u0131\u015fmalara k\u0131yasla daha d\u00fc\u015f\u00fck kan\u0131t d\u00fczeyi olsa da, bir\u00e7ok vaka sunumu da tramadol kullan\u0131m\u0131 sonras\u0131nda n\u00f6bet geli\u015fimini desteklemekte.<\/p>\n
Tramadol maruziyeti sonras\u0131 olu\u015fan n\u00f6rotoksisitenin ise opiod etkilerinden ziyade seratonin ve noradrenalin gerial\u0131m\u0131n\u0131n inhibisyonuyla ili\u015fkili oldu\u011fu g\u00f6r\u00fcl\u00fcyor. Yine de y\u00fcksek doz tramadol\u00fcn sebep oldu\u011fu varsay\u0131lan GABA-A resept\u00f6r inhibisyonu, n\u00f6bet e\u015fi\u011finin d\u00fc\u015fmesini a\u00e7\u0131klayabilir.<\/p>\n
En y\u00fcksek n\u00f6bet s\u0131kl\u0131\u011f\u0131n\u0131n \u0130ranl\u0131 ve M\u0131s\u0131rl\u0131 pop\u00fclasyonda oldu\u011funu g\u00f6zlemlenmi\u015f. Bu farkl\u0131l\u0131klar genetik fakt\u00f6rler, \u0131rksal farkl\u0131l\u0131klar veya tramadol kullan\u0131m varyasyonlar\u0131ndan kaynaklan\u0131yor olabilir. Farkl\u0131 \u00e7al\u0131\u015fma gruplar\u0131 ve sosyoekonomik durum, t\u0131bbi bak\u0131ma eri\u015fim, hastal\u0131k ge\u00e7mi\u015fi, hastal\u0131k risk fakt\u00f6rleri aras\u0131ndaki farkl\u0131l\u0131klar ve tan\u0131 kriterleri de raporlanan n\u00f6bet oranlar\u0131n\u0131n de\u011fi\u015fkenli\u011fini a\u00e7\u0131klayabilir. \u00d6te yandan yak\u0131n zamanda yay\u0131mlanan ba\u015fka bir \u00e7al\u0131\u015fmaya g\u00f6re, tramadol doz a\u015f\u0131m\u0131 sonras\u0131 n\u00f6bet geli\u015fim s\u0131kl\u0131\u011f\u0131n\u0131n Asyal\u0131larda daha fazla oldu\u011fu g\u00f6sterilmi\u015ftir. Bu da tramadol\u00fcn bu pop\u00fclasyonda sitokrom P450 2D6 taraf\u0131ndan daha az metabolize edilmesine ba\u011fl\u0131 olabilir (3).<\/p>\n
Bu \u00e7al\u0131\u015fman\u0131n potansiyel olarak \u00f6nemli bulgusu n\u00f6bet geli\u015fiminin tramadol kullan\u0131m\u0131n\u0131n dozuna ba\u011fl\u0131 olarak geli\u015fti\u011fi y\u00f6n\u00fcndeki \u00e7\u0131kar\u0131m\u0131d\u0131r. Bu bulgunun bilimsel anlamda s\u0131n\u0131rl\u0131l\u0131\u011f\u0131 ise klinik vakalardaki ilac\u0131n biyoyararlan\u0131m\u0131n\u0131n bilinememesidir.<\/p>\n
\u00c7al\u0131\u015fmada tramadol maruziyeti sonras\u0131 naloksan kullan\u0131m\u0131n\u0131n n\u00f6bete sebep olan ya da n\u00f6beti engelleyen bir etkisi oldu\u011fu kan\u0131tlanamam\u0131\u015f. Opiod toksisitesinde naloksan birinci tercih tedavidir, ancak tramadol a\u015f\u0131r\u0131 dozu sonras\u0131 n\u00f6betlerin engellenmesi amac\u0131yla kullan\u0131m\u0131 konusunda tutarl\u0131 sonu\u00e7lar yoktur. Naloksan\u0131n prokonv\u00fclsif bir etkisi yoktur. Ancak n\u00f6bet geli\u015fimini engellemesi sorusu mevcut veriler \u0131\u015f\u0131\u011f\u0131nda cevaplanamayacakt\u0131r.<\/p>\n
\u00c7al\u0131\u015fman\u0131n \u00f6nemli 2 k\u0131s\u0131tl\u0131l\u0131\u011f\u0131 bulunuyor. Birincisi, farkl\u0131 \u00e7al\u0131\u015fmalar aras\u0131ndaki benzerli\u011fin meta-analiz i\u00e7in yetersiz olmas\u0131, ikincisi ise uygun \u00e7al\u0131\u015fma say\u0131s\u0131 az oldu\u011fu i\u00e7in, \u00e7al\u0131\u015fmalar\u0131n kalitesi, \u00e7e\u015fidi ve \u00e7al\u0131\u015fma modeli de\u011ferlendirilememi\u015f olmas\u0131d\u0131r.<\/p>\n
Son S\u00f6z<\/u><\/strong><\/h2>\nBulgulara g\u00f6re, tramadol kullan\u0131m\u0131 sonras\u0131 n\u00f6bet geli\u015fimi doza ba\u011f\u0131ml\u0131d\u0131r. Erkeklerde daha s\u0131k olmak \u00fczere, hastan\u0131n cinsiyeti bu n\u00f6betleri etkileyebilir. Naloksan kullan\u0131m\u0131 n\u00f6bet geli\u015fimini artt\u0131r\u0131yor gibi g\u00f6r\u00fcnmemektedir. Bunlarla birlikte, tramadol kullan\u0131m\u0131n\u0131n n\u00f6bet geli\u015fimiyle ili\u015fkisi kesin olarak s\u00f6ylenemez. Yine de g\u00fcncel litarat\u00fcr \u00a0verileri \u0131\u015f\u0131\u011f\u0131nda, n\u00f6bet geli\u015fimini ind\u00fckledi\u011fi d\u00fc\u015f\u00fcn\u00fclmektedir.<\/p>\n
Referanslar<\/strong><\/u><\/h2>\n\n- S. Nakhaee 2020: Tramadol and the occurrence of seizures: a systematic review and metaanalysis, Critical Reviews in Toxicology, DOI: 10.1080\/10408444.2019.1694861<\/li>\n
- Potschka H, Friderichs E, Loscher W. 2000. Anticonvulsant and proconvulsant effects of tramadol, its enantiomers and its M1 metabolite in the rat kindling model of epilepsy. Br J Pharmacol. 131(2):203\u2013212.<\/li>\n
- Bradford LD. 2002. CYP2D6 allele frequency in European Caucasians, Asians, Africans and their descendants. Pharmacogenomics. 3(2): 229\u2013243.<\/li>\n<\/ol>\n","protected":false},"excerpt":{"rendered":"
Bildi\u011fimiz \u00fczere, Tramadol s\u0131k kullan\u0131lan bir sentetik opiod analjeziktir. Kullan\u0131m\u0131 bir\u00e7ok \u00fclkede 1980\u2019lerde onaylanm\u0131\u015f ve d\u00fcnyada en \u00e7ok kullan\u0131lan opiod olmu\u015ftur. Son…<\/p>\n","protected":false},"author":1083,"featured_media":1940,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"inline_featured_image":false,"_lmt_disableupdate":"","_lmt_disable":"","footnotes":""},"categories":[10014,10019],"tags":[147,305,415,416,417],"class_list":["post-1007","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-akademik-blog-yazisi","category-tft","tag-epilepsi","tag-nobet","tag-tramadol","tag-tramadol-yan-etklieri","tag-tramadol-zehirlenmesi"],"acf":[],"_links":{"self":[{"href":"https:\/\/tatd.org.tr\/toksikoloji\/wp-json\/wp\/v2\/posts\/1007","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/tatd.org.tr\/toksikoloji\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/tatd.org.tr\/toksikoloji\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/tatd.org.tr\/toksikoloji\/wp-json\/wp\/v2\/users\/1083"}],"replies":[{"embeddable":true,"href":"https:\/\/tatd.org.tr\/toksikoloji\/wp-json\/wp\/v2\/comments?post=1007"}],"version-history":[{"count":0,"href":"https:\/\/tatd.org.tr\/toksikoloji\/wp-json\/wp\/v2\/posts\/1007\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/tatd.org.tr\/toksikoloji\/wp-json\/wp\/v2\/media\/1940"}],"wp:attachment":[{"href":"https:\/\/tatd.org.tr\/toksikoloji\/wp-json\/wp\/v2\/media?parent=1007"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/tatd.org.tr\/toksikoloji\/wp-json\/wp\/v2\/categories?post=1007"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/tatd.org.tr\/toksikoloji\/wp-json\/wp\/v2\/tags?post=1007"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}
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