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Background: The most common drug poisoning in Iran, especially in Tehran, is poisoning with tramadol which is a synthetic analgesic. Like poisoning with other opioids, poisoning with tramadol is commonly treated using naloxone. As documented in poisoning references, seizure is a serious and dangerous side effect of this poisoning. The aim of this study was to compare the prevalence of seizure between patients with tramadol overdose who received or did not receive naloxone in Imam Khomeini Hospital, Ardabil, Iran. Methods: In this cross-sectional, descriptive study during 2007-10 data about 122 patients with tramadol overdose in Imam Khomeini Hospital was collected using a questionnaire. The collected data was analyzed in SPSS. Findings: Males constituted 89.3% of the participants (n = 109). The mean age of subjects was 27.0 ± 7.2 years. Seizure was observed in 21 persons (17.2%). No significant relationship existed between seizure and sex, age, and history of addiction to tramadol and other opioids (P > 0.05). Among the 60 subjects who received naloxone, 28.3% had seizure. The prevalence of seizure in persons who did not receive naloxone was 11.2%. The highest prevalence of seizure caused by naloxone was seen during the first 1.5 hours after injection. The lowest dose of naloxone that caused seizure was 1000 mg. Conclusion: Seizure caused by tramadol had no relationship with sex, age, and history of addiction to tramadol or other opioids. Moreover, seizure occurrence is rare in therapeutic dosage. Using naloxone in treatment of tramadol overdose increases the risk of seizure. Keywords: Tramadol, Naloxone, Seizure, Intoxicated