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The opioid drug tramadol may cause blood sugar to drop to life-threatening levels, research suggests.
Scientists analysed 12million adverse events reports collected by the US Food and Drug Administration (FDA) over 15 years.
The painkiller, marketed as ConZip or Ultram, was found to have a significant risk of hypoglycaemia, which can lead to confusion, seizures or even death.
This could be particularly dangerous for diabetics, warned the scientists from the University of California, San Diego.
These patients are already at risk of hypoglycaemia due to the blood sugar lowering medication they take.
The legal opioid tramadol could cause blood sugar to drop to life-threatening levels (stock)
Since tramadol's approval in the US in 1995, it has often been prescribed over other opioids due to its supposed superior safety and lower risk of addiction.
However, compared to virtually every other opioid, tramadol has a 10 times higher risk of hypoglycaemia, the study found.
Other studies have linked tramadol to low blood sugar, but official health bodies do not list it as a recognised side effect.
The NHS lists very common tramadol side effects, affecting more than one in 10, as nausea and dizziness.
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Common side effects, which occur in around one in 100 people, include headaches, vomiting and dry mouth.
Serious side effects are rarer still but include shallow breathing, hallucinations and seizures, officials say.
RxList, the online resource of US prescription medications, also does not mention hypoglycaemia as a tramadol side effect.
To find out more about it's risks, the researchers analysed voluntary reports of side effects from drugs sent to the FDA by patients between January 2004 and March 2019.
'The impetus was the recent dramatic surge in tramadol popularity and prescription,' study author Dr Tigran Makunts said.
'We wanted to have an objective data-driven look at its adverse effects and bumped into a dangerous, unlisted and unexpected hypoglycaemia.'
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