Has gamma-glutamyl transpeptidase (GT) elevation been described during medication with tramadol? If

Fråga: Has gamma-glutamyl transpeptidase (GT) elevation been described during medication with tramadol? If so, what levels? The question arose when a man with a history of alcohol abuse stated his elevated GT must be due to tramadol medication.

Sammanfattning: Elevated gamma-glutamyl transpeptidase levels have been described in relation to tramadol medication as a part of a mixed liver reaction. The levels have been 4-12 times the upper limit of normal.

Svar: Fatal hepatic failure has been described following accidental tramadol overdosage (1).

In the Swedish Adverse Drug Reactions Register (Swedis) there are 13 reports of liver reactions judged as having a possible relation to tramadol medication (2). All but one patient was on paracetamol concomitantly and in most cases liver function tests returned to normal after withdrawal of tramadol. In the one case without paracetamol, acute pancreatitis developed 7 days after prescription of tramadol to a woman on mesalazine since 5 years. The most frequent reaction seems to be a mixed liver reaction with transaminases around 5-6 times the upper limit of normal and GT levels between 3 and 10 ukat/L (reference value < 0.8). There are no reports on isolated GT elevation (2).