When the Safe Alternative Is Not That Safe: Tramadol Prescribing in Children

Article Article scientifique Article When the Safe Alternative Is Not That Safe: Tramadol Prescribing in Children eng 2018 author Rodieux Frédérique 778571 author Vutskits Laszlo 109383 author Posfay Barbe Klara 39230 author Habre Walid 133724 author Piguet Valérie Madeleine 59481 author Desmeules Jules Alexandre 73542 author Samer Caroline Flora 105661 148 10.3389/fphar.2018.00148 29556194 1663-9812 Children represent a vulnerable population in which management of nociceptive pain is complex. Drug responses in children differ from adults due to age-related differences. Moreover, therapeutic choices are limited by the lack of indication for a number of analgesic drugs due to the challenge of conducting clinical trials in children. Furthermore the assessment of efficacy as well as tolerance may be complicated by children's inability to communicate properly. According to the World Health Organization, weak opioids such as tramadol and codeine, may be used in addition to paracetamol and ibuprofen for moderate nociceptive pain in both children and adults. However, codeine prescription has been restricted for the last 5 years in children because of the risk of fatal overdoses linked to the variable activity of cytochrome P450 (CYP) 2D6 which bioactivates codeine. Even though tramadol has been considered a safe alternative to codeine, it is well established that tramadol pharmacodynamic opioid effects, efficacy and safety, are also largely influenced by CYP2D6 activity. For this reason, the US Food and Drug Administration recently released a boxed warning regarding the use of tramadol in children. To provide safe and effective tramadol prescription in children, a personalized approach, with dose adaptation according to CYP2D6 activity, would certainly be the safest method. We therefore recommend this approach in children requiring chronic or recurrent nociceptive pain treatment with tramadol. In case of acute inpatients nociceptive pain management, prescribing tramadol at the minimal effective dose, in a child appropriate dosage form and after clear instructions are given to the parents, remains reasonable based on current data. In all other situations, morphine should be preferred for moderate to severe nociceptive pain conditions. Dewey 615 Dewey 617 Dewey 618 31 Section des sciences pharmaceutiques 17 58 Département de pédiatrie, gynécologie et obstétrique 223 63 Département d'anesthésiologie, pharmacologie, soins intensifs et urgences 229 false 543 Anesthésie et neurosciences 883 46 Enfants et hyperréactivité bronchique 69 302 Groupe Desmeules Jules (pharmacologie/toxicologie) 567 1280 Pharmaco-omiques et médecine de précision 1003 515 Recherche en infectiologie pédiatrique et en pédiatrie générale 853 Frontiers in Pharmacology 9 db1f0ff8-c041-4147-ad8f-7c3bcb531e0f Article (Published version) Public 2018-Frontiers-Rodieux-Tramadol.pdf 336447 application/pdf CC BY openAccess Faculté des sciences / Section des sciences pharmaceutiques Faculté de médecine / Section de médecine clinique / Département de pédiatrie, gynécologie et obstétrique Faculté de médecine / Section de médecine clinique / Département d'anesthésiologie, pharmacologie, soins intensifs et urgences

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When the Safe Alternative Is Not That Safe: Tramadol Prescribing in Children	Frontiers in Pharmacology			2018	489	215

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Piguet, Valérie Madeleine