Tramadol

[Theresia]

I am caring for a mom who took Tramadol through her pregnancy for chronic pain. Her infant is in the NICU exhibiting withdrawal symptoms. The neonatologist said mom should not breastfeed because she is going to continue the med and that would be bad for the baby. Tramadol is listed as an L2 in the Thomas Hale moms milk and medication book. I don't really understand the opposition on the part of the Neo.

[cpride]

Dear Theresia,

Tramadol is a new class of analgesic that most closely resembles opiates but appears to be less addicting. The relative infant dose is lower and the half-life is only slightly longer than hydrocodone so is a good alternative to the opiates for breastfeeding mothers.

Since the infant was exposed to this medication in utero, he/she should have developed the hepatic enzymes to metabolize the medication. Also, providing mother's milk may decrease some of the withdrawal symptoms her infant is experiencing.

The mother should not exceed 50 mg to 100 mg every 4 to 6 hours and should observe her infant for sedation and constipation. You should talk with the neonatologist about his/her specific concerns.

Sincerely,
Cindy Pride, MSN, CPNP
TTUHSC InfantRisk Center