Journal of Clinical Case Reports

Tramadol Disposition in Neonates and Opioid Related Side Effects: The Route of Administration Matters

Abstract

Karel Allegaert

We read the case series of Bilgili et al. on prolonged apnea and sedation in 3 former preterm babies after administration of oral tramadol (2 mg.kg-1) with great interest. Although there may have been additional risks associated with the apnea and sedation events in these specific cases (e.g. low hematocrit, former preterm neonates), we confirm that these side effects were clinically significant and serious. We reported on a similar, unanticipated side effect profile following low dose oral chloral hydrate administration in former preterm neonates for procedural sedation. At least, such observations confirm that prospective studies are urgently needed to improve the effect/side effect balance of analgesic treatment in neonates. Consequently, the authors need to be congratulated for both their effort to perform the study and report the unanticipated side effects. As a neonatologist and clinical pharmacologist with clinical and research experience with this compound in neonates, I would like to draw the attention of the readers and authors to a likely pathogenetic explanation of these events since this likely relates to tramadol metabolism and its routes of elimination.