학술논문
Tramadol intoxication in children: An emerging issue.
Document Type
Academic Journal
Author
Drevin G; Service de pharmacologie-toxicologie et pharmacovigilance, centre hospitalo-universitaire d'Angers, 49000 Angers, France. Electronic address: Guillaume.Drevin@chu-angers.fr.; Picard N; Service de pharmacologie, toxicologie et pharmacovigilance, centre hospitalo-universitaire de Limoges, 87000 Limoges, France.; Baudriller A; Service de pharmacologie-toxicologie et pharmacovigilance, centre hospitalo-universitaire d'Angers, 49000 Angers, France; Université d'Angers, 49000 Angers, France.; Pena-Martin M; Service de pharmacologie-toxicologie et pharmacovigilance, centre hospitalo-universitaire d'Angers, 49000 Angers, France.; Ferec S; Service de pharmacologie-toxicologie et pharmacovigilance, centre hospitalo-universitaire d'Angers, 49000 Angers, France.; Leuger L; Service de pharmacologie-toxicologie et pharmacovigilance, centre hospitalo-universitaire d'Angers, 49000 Angers, France.; Briet M; Service de pharmacologie-toxicologie et pharmacovigilance, centre hospitalo-universitaire d'Angers, 49000 Angers, France; Université d'Angers, 49000 Angers, France; Unité MitoVasc, Team Carme, SFR ICAT, UMR CNRS 6015, Inserm U1083, University Angers, 49000 Angers, France.; Abbara C; Service de pharmacologie-toxicologie et pharmacovigilance, centre hospitalo-universitaire d'Angers, 49000 Angers, France.
Source
Publisher: Elsevier Masson Country of Publication: France NLM ID: 0420544 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1958-5578 (Electronic) Linking ISSN: 00405957 NLM ISO Abbreviation: Therapie Subsets: MEDLINE
Subject
Language
English
Abstract
Background: Prescribing tramadol in children raises safety concerns. In Europe, tramadol is still approved and licensed for use in children over 1-3 years of age, depending on the country. In this context, the authors report a case of a tramadol overdose in a 5-year-old-child with a medical history of homozygous sickle cell disease.
Methods: Tramadol and M1 were quantified using liquid chromatography with a diode array detection method. CYP2D6 genotype was determined using a next generation sequencing platform (MISeq, Illumina).
Results: Tramadol and M1 were quantified in blood respectively at 5.48 and 1.32μg/mL at admission, at 0.77 and 0.35μg/mL 12hours later, and at 0.32 and 0.18μg/mL 20hours later. The patient was predicted as a CYP2D6 normal metabolizer (*35/*29).
Conclusion: One of the most important difficulties with the use of tramadol in children relates to its pharmacokinetic (PK) properties. Indeed, tramadol's PK is characterized by a great variability related to: (i) anatomical/physiological factors that impact the volume of distribution (Vd); (ii) CYP2D6 genetic polymorphisms. Considering such an issue is particularly relevant to prevent poisoning. In the reported case, the plasma elimination half-life was estimated at 6.3h, significantly more than those reported in 2-8 year-old children (about 3h). This discrepancy does not seem related to genetic polymorphisms but rather to the Vd. Indeed, the patient was predicted to be a CYP2D6 normal metabolizer (*35/*29). The case presented here highlights the risk associated with the tramadol use in children and emphasizes the importance of considering PK variability among this population. Such variability necessitates greater caution in prescribing tramadol in children and highlights the importance of therapeutic education for families of children treated with this painkiller.
(Copyright © 2024 Société française de pharmacologie et de thérapeutique. Published by Elsevier Masson SAS. All rights reserved.)
Methods: Tramadol and M1 were quantified using liquid chromatography with a diode array detection method. CYP2D6 genotype was determined using a next generation sequencing platform (MISeq, Illumina).
Results: Tramadol and M1 were quantified in blood respectively at 5.48 and 1.32μg/mL at admission, at 0.77 and 0.35μg/mL 12hours later, and at 0.32 and 0.18μg/mL 20hours later. The patient was predicted as a CYP2D6 normal metabolizer (*35/*29).
Conclusion: One of the most important difficulties with the use of tramadol in children relates to its pharmacokinetic (PK) properties. Indeed, tramadol's PK is characterized by a great variability related to: (i) anatomical/physiological factors that impact the volume of distribution (Vd); (ii) CYP2D6 genetic polymorphisms. Considering such an issue is particularly relevant to prevent poisoning. In the reported case, the plasma elimination half-life was estimated at 6.3h, significantly more than those reported in 2-8 year-old children (about 3h). This discrepancy does not seem related to genetic polymorphisms but rather to the Vd. Indeed, the patient was predicted to be a CYP2D6 normal metabolizer (*35/*29). The case presented here highlights the risk associated with the tramadol use in children and emphasizes the importance of considering PK variability among this population. Such variability necessitates greater caution in prescribing tramadol in children and highlights the importance of therapeutic education for families of children treated with this painkiller.
(Copyright © 2024 Société française de pharmacologie et de thérapeutique. Published by Elsevier Masson SAS. All rights reserved.)