What is the safe administration protocol for intravenous (IV) Tramadol (tramadol hydrochloride), including minimum age, dosage per kilogram, method of administration, compatible fluids, and rate of infusion?

From the Guidelines

Intravenous tramadol should be administered to patients 12 years and older, with a typical adult dose of 50-100 mg every 4-6 hours (maximum 400 mg/day) 1. For children 12-17 years, the dose is 1-2 mg/kg every 4-6 hours (maximum 400 mg/day). Tramadol is not recommended for children under 12 years due to the risk of respiratory depression. The minimum age to give tramadol is 12 years, and the per kg dose for children 12-17 years is 1-2 mg/kg. For IV administration, dilute tramadol in 50-100 mL of compatible fluids such as 0.9% sodium chloride, 5% dextrose, or lactated Ringer's solution. Administer as a slow infusion over 15-30 minutes to minimize side effects like hypotension and nausea. Rapid IV push should be avoided. Some key points to consider when administering tramadol include:

• Monitor patients closely for respiratory depression, hypotension, and signs of serotonin syndrome, especially in elderly patients or those with renal or hepatic impairment.
• Tramadol works as a weak mu-opioid receptor agonist and also inhibits serotonin and norepinephrine reuptake, providing analgesia through dual mechanisms.
• Reduce the dose in elderly patients and those with renal or hepatic impairment, as recommended by the NCCN panel 1.
• The rate of infusion should be slow, over 15-30 minutes, to minimize side effects.
• Compatible fluids for IV administration include 0.9% sodium chloride, 5% dextrose, or lactated Ringer's solution. The most recent and highest quality study, published in 2019, supports the use of tramadol for moderate to moderately severe pain, but recommends caution due to the risk of serotonin syndrome and other adverse effects 1.

From the FDA Drug Label

The FDA drug label does not answer the question.

From the Research

Administration of Intravenous Tramadol

• Intravenous tramadol can be administered for the management of moderate to severe pain, including postoperative pain 2, 3.
• The recommended dose of intravenous tramadol is 50-150mg, which is equivalent in analgesic efficacy to morphine 5-15mg 2.
• For children, a dose of 0.25 mg/kg/h can be used for continuous infusion over 24 hours 4.

Minimum Age for Administration

• There is no specific minimum age mentioned in the provided studies for the administration of intravenous tramadol.
• However, a study on children aged 1-8 years used intravenous tramadol for postoperative pain management, suggesting that it can be used in pediatric patients 4.

Per Kilogram Doses

• For children, a dose of 0.25 mg/kg/h can be used for continuous infusion over 24 hours 4.
• Another study used a dose of 90 mg/kg/day of paracetamol in combination with tramadol for children after major abdominal surgery 4.

Method of Administration

• Intravenous tramadol can be administered using a dedicated infusion device, such as a Graseby 2100 syringe pump 4.
• It can also be given as a bolus injection or as a continuous infusion over a period of time 3.

Compatible Fluids

• There is no specific information on compatible fluids for intravenous tramadol in the provided studies.
• However, it is generally recommended to use a compatible fluid, such as normal saline or dextrose, when administering intravenous medications.

Rate of Infusion

• The rate of infusion for intravenous tramadol can vary depending on the specific clinical situation and the patient's response to the medication.
• A study used a continuous infusion of 0.25 mg/kg/h over 24 hours for children after major abdominal surgery 4.
• Another study used a dosing regimen of 50mg every 4 hours, as needed, for up to 7 days 3.