Abstract | OBJECTIVE: To describe a case of tramadol withdrawal in a neonate and treatment with clonidine after exposure to long-term maternal use of high-dose tramadol. CASE SUMMARY: A 34-week gestational age neonate displayed symptoms of tramadol withdrawal within 48 hours of delivery. Due to a confusing initial clinical picture, including presumed congenital Chlamydia, questionable seizures, and an original report of maternal use of ketorolac ( Toradol), diagnosis was delayed until day of life 5. Symptoms included jitteriness, myoclonic movements, and irritability. Upon further questioning of the mother, it was revealed that she was actually taking tramadol 600-800 mg daily. The infant was placed on maintenance therapy with oral clonidine (from 1 to 3 microg/kg orally every 3 hours) until discontinuation on day of life 11. After 3 days off treatment, he began to display symptoms of withdrawal again. Clonidine was restarted at 1 microg/kg orally every 8 hours and he was discharged home on maintenance clonidine therapy at 18 days postnatal age. A 7-day tapering regimen was initiated 2 weeks after discharge, and no further withdrawal symptoms occurred. DISCUSSION: CONCLUSIONS: Withdrawal can be prolonged in infants exposed to maternal tramadol use. Clonidine may be a safe and effective option for managing symptoms of neonatal tramadol abstinence.
|
Authors | Keliana O'Mara, Peter Gal, Christie Davanzo |
Journal | The Annals of pharmacotherapy
(Ann Pharmacother)
2010 Jul-Aug
Vol. 44
Issue 7-8
Pg. 1342-4
ISSN: 1542-6270 [Electronic] United States |
PMID | 20587741
(Publication Type: Case Reports, Journal Article)
|
Chemical References |
- Adrenergic alpha-Agonists
- Tramadol
- Clonidine
|
Topics |
- Adrenergic alpha-Agonists
(administration & dosage, therapeutic use)
- Adult
- Clonidine
(administration & dosage, therapeutic use)
- Dose-Response Relationship, Drug
- Female
- Humans
- Infant, Newborn
- Male
- Neonatal Abstinence Syndrome
(drug therapy)
- Opioid-Related Disorders
(complications)
- Pregnancy
- Pregnancy Complications
(drug therapy)
- Time Factors
- Tramadol
(administration & dosage, adverse effects)
|