Tramadol Intoxication in an 8-Months-Old Infant through Breastfeeding: A Case Report

Abstract

Tramadol is a widely used, synthetic centrally acting opioid analgesic commonly used for the treatment of moderate to severe pain. Very few reports about its excretion into breast milk were published and most of them suggested that short-term maternal use of tramadol is compatible with breastfeeding. No available data about its chronic daily use in addict lactating mothers. To date, there are no published reports of tramadol poisoning through breastfeeding. We report a case of tramadol intoxication in 8-month-old infant through breastfeeding as her mother was an addict on tramadol. The infant presented to the Emergency Department (ER) of the Poison Control Center (PCC) of Ain Shams University Hospital twice with 36 h apart. The first time, the infant was discharged from the hospital with no sequelae after receiving the appropriate management. The second time, the infant deceased due to cardiac arrest three days after tramadol poisoning. This case report highlights the dangers of excretion of tramadol in milk and the severity of complications that can even be near fatal to infant.

Supporting Lactation in Otolaryngology Patients Through Medication Optimization, Radiology Considerations, and More

“…Tramadol is not recommended for use during breastfeeding. There has been a case report on the death of an 8-month-old breastfed infant from tramadol; however, the case cannot be attributed to breast milk exposure alone, as the sudden onset of symptoms at 8 months of age seems implausible . Other studies have found no adverse effects attributable to tramadol with standard maternal dosages …”

“…There has been a case report on the death of an 8-month-old breastfed infant from tramadol; however, the case cannot be attributed to breast milk exposure alone, as the sudden onset of symptoms at 8 months of age seems implausible. 32 Other studies have found no adverse effects attributable to tramadol with standard maternal dosages. [33][34][35] Codeine and oxycodone are not recommended to be used during breastfeeding, and other narcotics are preferred.…”

British Society for Rheumatology guideline on prescribing drugs in pregnancy and breastfeeding: comorbidity medications used in rheumatology practice

“…LactMed states that the excretion of tramadol into milk is low and even lower amounts of the active metabolite, O-desmethyltramadol, are excreted and a study of breastfeeding in newborn infants found no adverse effects attributable to tramadol compared with controls [20]. There has been one death, however, in the 8-month-old breastfed infant of a woman addicted to tramadol, although the death was not definitely attributable to tramadol exposure in breastmilk [29]. Current RCOG advice states that tramadol can continue to be used (with caution) during breastfeeding and the lowest effective dose should be used for the shortest time possible [19].…”

Executive Summary: British Society for Rheumatology guideline on prescribing drugs in pregnancy and breastfeeding: comorbidity medications used in rheumatology practice

“…Recommendations were based on a systematic review [16] (including a large prospective cohort study of over 1.6 million women [27]), UKTIS [18] (including case reports [28]), LactMed [20] (including [29]) and RCOG guidance [19], as shown in Supplementary Table S3, available at Rheumatology online.…”