Recommended Dosage of Tramadol in Pediatric Patients
The recommended dose of tramadol for pediatric patients is 1 to 1.5 mg/kg every 4 to 6 hours, with a maximum daily dose of 8 mg/kg/day not to exceed 400 mg per day. 1, 2
Dosing Guidelines by Route of Administration
Intravenous Tramadol
- For breakthrough pain in PACU: 1 to 1.5 mg/kg, titrated to effect 1
- For breakthrough pain in the ward: 1 to 1.5 mg/kg, every 4 to 6 hours 1
Oral Tramadol
- For breakthrough pain in the ward: 1 to 1.5 mg/kg, every 4 to 6 hours 1
- For prolonged pain (7-30 days): 1-2 mg/kg orally every 4-6 hours 2
Safety Considerations
Tramadol has a dual mechanism of action that contributes to its efficacy and safety profile:
- Acts as a weak μ-opioid receptor agonist
- Inhibits norepinephrine and serotonin reuptake 3
This dual mechanism results in:
- Lower respiratory depression risk compared to traditional opioids
- Lower dependence potential in short-term use 4
Important Monitoring Parameters
When administering tramadol to pediatric patients, monitor for:
- Respiratory status
- Sedation level
- Nausea and vomiting (most common side effects)
- Dizziness and dry mouth
Contraindications and Precautions
- Do not administer to patients taking monoamine oxidase inhibitors
- Avoid concomitant administration with tricyclic antidepressants 3
- Use with caution in patients with:
- Renal impairment
- Hepatic impairment
- History of seizures
Clinical Pearls
- Tramadol has approximately one-fifth the potency of morphine when administered parenterally 4
- The onset of analgesia begins within one hour of oral administration, with peak effects at approximately two hours 5
- The M1 metabolite (O-desmethyl tramadol) has greater affinity for opioid receptors than the parent drug 3
- Metabolism is affected by CYP2D6 polymorphism, which can lead to variability in analgesic response 6
Common Pitfalls to Avoid
- Overdosing: Always calculate dose based on weight and ensure it does not exceed maximum recommendations
- Inadequate monitoring: Respiratory depression is rare but possible, especially when combined with other CNS depressants
- Drug interactions: Be aware of potential interactions with serotonergic medications that could lead to serotonin syndrome
- Rapid administration: IV tramadol should be administered slowly to minimize side effects
Tramadol provides effective analgesia for moderate to severe pain in pediatric patients while offering a more favorable side effect profile than traditional opioids when used appropriately.