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Tramadol intoxication in children: An emerging issue.

Guillaume Drevin¹, Nicolas Picard², Antoine Baudriller³

¹Service de pharmacologie-toxicologie et pharmacovigilance, centre hospitalo-universitaire d'Angers, 49000 Angers, France.

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|June 13, 2024

Summary

Tramadol overdose in a child highlights significant pharmacokinetic variability, with a prolonged elimination half-life not explained by CYP2D6 genetics. This underscores the need for cautious prescribing and patient education.

Keywords:

CYP2D6 Children Overdose Pharmacogenetics Tramadol

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Area of Science:

Pharmacology
Pediatric Medicine
Clinical Toxicology

Background:

Tramadol is approved for pediatric use in Europe, but safety concerns persist.
A case of tramadol overdose in a 5-year-old child with sickle cell disease is presented.
Understanding tramadol's pharmacokinetics in children is crucial for safe prescribing.

Observation:

The child, a predicted CYP2D6 normal metabolizer, exhibited a prolonged tramadol elimination half-life of 6.3 hours.
Blood concentrations of tramadol and its metabolite M1 were monitored over 20 hours.
The prolonged half-life was attributed to factors affecting volume of distribution, not CYP2D6 genetic polymorphisms.

Findings:

Tramadol pharmacokinetics in children show significant variability due to physiological factors and CYP2D6 genetic polymorphisms.
The reported case demonstrated a longer-than-expected plasma elimination half-life for tramadol.
This variability is critical for preventing tramadol poisoning in pediatric patients.

Implications:

The case emphasizes the need for increased caution when prescribing tramadol to children.
Greater awareness of pharmacokinetic variability in pediatric patients is essential.
Therapeutic education for families managing children on tramadol is vital for safety.