Background: Although tramadol induced neuropsychiatric toxicity, dependence and withdrawal have been extensively reported in chronic pain sufferers, such cases continue to surface in clinical practice.
Objective: We describe two cases of atypical withdrawal after abrupt discontinuation of tramadol and a case of serotonin syndrome. The outcome was favourable in all three cases.
Discussion: Patients and prescribers are reminded of the risk of severe morbidity including seizures associated with tramadol withdrawal. Serotonin syndrome can be precipitated with tramadol use especially in combination with other serotonergic drugs.