Tramadol Dosing for a 14-Year-Old Child Weighing 49kg
For a 14-year-old child weighing 49kg, the recommended tramadol dosage 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
Specific Dosing Calculation
Based on the child's weight of 49kg:
- Initial dose: 49-73.5 mg (1-1.5 mg/kg) every 4-6 hours
- Practical dosing: 50-75 mg every 4-6 hours
- Maximum daily dose: 392 mg (8 mg/kg/day) or 400 mg, whichever is lower
Administration Guidelines
- For oral immediate-release formulations: 50-75 mg every 4-6 hours as needed
- For breakthrough pain in post-anesthesia care unit: 49-73.5 mg (1-1.5 mg/kg), titrated to effect
- For breakthrough pain on the ward: 49-73.5 mg (1-1.5 mg/kg) every 4-6 hours as needed
Monitoring Requirements
When administering tramadol to this pediatric patient, monitor for:
- Respiratory status
- Sedation level
- Nausea and vomiting
- Dizziness
- Dry mouth
Important Precautions
- Tramadol has a dual mechanism of action as a weak mu-opioid receptor agonist and an inhibitor of norepinephrine and serotonin reuptake 1
- It is approximately one-tenth as potent as morphine 1
- Adverse effects are dose-dependent, particularly nausea, so consider starting at the lower end of the dosing range 2
- Common side effects include dizziness, nausea, dry mouth, and sedation 3
Contraindications and Drug Interactions
- Do not administer if the patient is taking monoamine oxidase inhibitors 1
- Use with caution or avoid if the patient is taking serotonergic medications due to risk of serotonin syndrome 1
- Avoid concomitant administration with tricyclic antidepressants 1
- Use with caution if the patient has renal impairment, hepatic impairment, or history of seizures 1
Dosage Adjustments
- If the patient experiences inadequate pain control with the initial dose, titrate upward within the recommended range
- If adverse effects occur, consider reducing the dose while maintaining the dosing interval
- For extended treatment, consider the lowest effective dose to minimize risk of tolerance or dependence, although tramadol has a relatively low dependence potential compared to traditional opioids 2
Clinical Considerations
- Tramadol provides effective analgesia for moderate to severe pain in pediatric patients while offering a more favorable side effect profile than traditional opioids 1
- The CDC recommends caution with opioid dosing in general, as risks for serious harms increase at higher opioid dosages 4
- Tramadol should not be combined with metoclopramide in pediatric patients 4