Tramadol toxicity phytotherapy: The protective role of medicinal plants against tramadol toxicity

The side effects of chronic exposure to synthetic drugs such as tramadol have become a concern for the health system. Medicinal plants can be used as rich sources of natural compounds with therapeutic properties to reduce the side effects of synthetic drugs such as tramadol. Hence, this study sought to review the published research concerning the protective role of medicinal plants against tramadol toxicity. This systematic review was conducted according to the preferred reporting items for systematic reviews and meta-analyses (PRISMA) statement. This study included all published articles evaluating the efficacy of the medicinal plants against tramadol toxicity until December, 2021. For this systematic review, search was performed using keywords including tramadol, toxicity, poisoning, overdose, medicinal plants, and herbal medicines from reliable databases such as PubMed, Google Scholar, Web of Science, Wiley, Elsevier, and Science Direct. The risk of bias tool for animal intervention studies (SYRCLE’s RoB tool) criteria and the OECD guidelines and the WHO Good Laboratory Practice (GLP) handbook were used for quality assessment of animal and in vitro studies, respectively. This review determined 18 medicinal plants and one multi herbal formulation against tramadol toxicity. Plants such as Nigella sativa (Black Seed), Moringa Oleifera (Drumstick tree), and Aloe Vera, pomegranate, wheat, barely, pumpkin, walnut, kiwi fruit, turmeric, apple, fennel, and garlic also displayed therapeutic effects against tramadol toxicity. This review exhibits a wide range of medicinal plants with therapeutic effects such as antioxidant, anti-inflammatory and anti-apoptotic properties which could protect the organs of the body against toxicity caused by tramadol. Hence, the use of these plants or their compounds can be effective in reducing the complications caused by many diseases.