Background: Tramadol is a centrally acting opioid-like analgesic. It is one of the most commonly prescribed analgesics in the world. Fatalities due to Tramadol toxicity may occur either it is taken intentional or accidental.Methods: This is a prospective study conducted for all cases admitted to NECTR with acute Tramadol overdose from 1/8/2012 to 31/10/2012.Results: A total of 65 cases (45 men and 20 women) of acute Tramadol intoxications with the mean age of 27.12±8.45 years were identified. The mean dose was 1.66±1.76 g. Among these cases, 21.5% presented with respiratory failure and 24.6% experienced seizure. Death occurred in two patients. Conclusion: Acute Tramadol overdose causes CNS depression, vomiting, respiratory failure and seizures.