Which pain medication is associated with a higher risk of seizures, especially in recreational use?

Tramadol is associated with a higher risk of seizures, particularly when used recreationally or in excessive doses. This risk is primarily due to its unique mechanism of action, which is different from classic opioids. Tramadol acts as a weak agonist at the mu-opioid receptor and also inhibits the reuptake of norepinephrine and serotonin. This inhibition can lead to an increase in neurotransmitter levels which, in higher concentrations, may lower the seizure threshold.

Patients with certain predisposing factors, such as a history of seizures, concurrent use of certain medications (such as selective serotonin reuptake inhibitors or other drugs that lower the seizure threshold), or excessive doses of tramadol, are at even greater risk. This characteristic emphasizes the importance of monitoring patients prescribed tramadol, especially if they have a history of seizure disorders or if they may misuse the medication for recreational purposes.

In contrast, ibuprofen, oxycodone, and acetaminophen do not share this seizure risk profile to the same extent. Ibuprofen is a nonsteroidal anti-inflammatory drug (NSAID) primarily used for pain relief and has minimal effects on central nervous system excitability. Oxycodone, while an opioid with various side effects, is