Tramadol, a widely prescribed analgesic for moderate to severe pain, has raised concerns due to its association with an increased risk of seizures. This literature review aims to explore the role of pharmacokinetics in tramadol-induced seizures. A comprehensive literature review was conducted, analyzing studies ranging from cross-sectional and cohort studies to case reports and animal research. The results indicate a complex relationship between tramadol dosage and seizure risk, with some studies suggesting a dose-dependent risk while others highlight individual variability and genetic predispositions. Based on the reviewed literature, we hypothesize that individuals with downregulation or low expression of Mu opioid and GABA receptors are at an increased risk for tramadol-induced seizures due to altered neurotransmitter modulation and impaired inhibitory control over neuronal excitability. This study emphasizes the need for cautious tramadol prescription and suggests further research into biomarkers that could predict seizure risk in patients taking tramadol.