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  • Tramadol withdrawal in newborn

    hi!

    i have been in tramadol for a couple of years and my OB kept me on through most of my pregnancy. Yesterday was my final dose after being weened off. I’m currently scheduled for a c-section st 39 weeks- so in 16 days.

    My doctor said while while two weeks *should* be long enough for my baby to not suffer withdrawal, she cannot guarantee if. We did a fast taper because at first she planned to keep me on till I delivered. It was not until I read horror stories about tramadol withdrawal in a fetus that she agreed to try and taper me down.

    Through the weening off process, I did not suffer withdrawal so far- even though we did it quickly. I see her tomorrow and she has told me if I exhibit symptoms of withdrawal she will have me take the minimum dose I can because if I withdrawal, so will my baby and they can’t help him while I’m pregnant. They can only monitor him when he’s born. Also, if I exhibit symptoms today, she told me not to wait till tomorrow and to call the office.

    I agreed fo this approach and I absolutely will follow it if it’s best for my child. What I’m wondering is- has anyone seen a baby withdrawal after the mother stopped taking tramadol 2 weeks prior to birth? Is 2 weeks enough time? There is a chance I will be able to deliver naturally whenever my little man decides to come. If that’s the case, maybe I make it to 40 weeks and and that would be 23 days tramadol free. Obviously I’m sure the longer the time, the better. But I just wanted some insight if anyone had seen withdrawal when a mother quit tramadol 2 weeks (or 16 days) prior to delivering.

    Thank you so much for your insight!

  • #2
    HMM:

    you didn't mention your dose, but I expect it was not as high as commonly seen in other studies. See some of the cases below in PubMed.

    I'd suggest that with the relatively short withdrawal, that with this drug, you are not likely to have many withdrawal side effects. Some clinicians actually USE this drug to withdraw patients off of strong opioids because its addictive potential is far less, and withdrawal is less severe.

    I'd stop worrying. you and your infant will do fine.

    Tom Hale Ph.d.
    Professor









    Subst Use Misuse. ([url]https://www.ncbi.nlm.nih.gov/pubmed/25544109#[/url]) 2015 Apr;50(5):582-9. doi: 10.3109/10826084.2014.991406. Epub 2014 Dec 27. Medical and Psychiatric Effects of Long-Term Dependence on High Dose of tramadol.


    Abstract

    BACKGROUND:


    Tramadol dependence has been studied recently after large-scale exposure. Although tramadoldependence has increased rapidly in Egypt since 2004, no studies have evaluated the effect of high dose long-term tramadol dependence. OBJECTIVES:


    To address the chronic sequel of tramadol dependence over at least 5 years duration with a large dose (more than 675 mg/day, three tablets or more, each tablet of 225 mg). The study was aimed to check the physical and psychiatric status during tramadol dependence and 3 months after complete treatment. METHODS:


    The present study was applied on 79 patients with single tramadol-dependence dose of 675 mg or more for 5 years or more. We examined the physical and psychological impact of tramadol abuse before and after 3 months of stoppage of the drug. RESULTS:


    The blood chemistry was nearly within normal parameters, although slight nonsignificant rise in liver enzymes was reported in some cases. Patients during tramadol dependence period were angry, hostile, and aggressive. On the other hand, after treatment the main problem observed was the significant increase in comorbid anxiety, depressive, and obsessive-compulsive symptoms, but no increase was found in psychotic symptoms. Tramadol-dependence dose was more important than duration of use in psychiatric illness. CONCLUSIONS:


    Tramadol dependence on high dose could be physically safe to some limit, but psychiatrically it has many side effects. KEYWORDS:


    Egypt; addiction; analgesic; complication; opioid PMID: 25544109
    =================================================

    Psychiatry Investig. ([url]https://www.ncbi.nlm.nih.gov/pubmed/24843378#[/url]) 2014 Apr;11(2):204-6. doi: 10.4306/pi.2014.11.2.204. Epub 2014 Apr 11. Acute-withdrawal restless legs syndrome following abrupt cessation of short-term tramadol.

    Author information ([url]https://www.ncbi.nlm.nih.gov/pubmed/24843378#[/url])

    Abstract


    We report a young man who had received tramadol for pain control and experienced an uncomfortable sensation in both legs immediately after tramadol withdrawal that worsened at rest and at night, and which could be relieved only by moving the legs. He suffered from insomnia and paced up and down in his house every night. Readministration of tramadol dramatically resolved his symptoms of restless legs syndrome (RLS), but they reappeared after tramadol withdrawal. Tramadol was therefore replaced with ropinirole, which was discontinued after several weeks, and there was no recurrence of his RLS symptoms. This patient appeared to have developed tramadol-withdrawal-induced RLS, and this case report emphasizes the importance of monitoring for withdrawal-type symptoms like RLS when tramadol intake is being stopped. KEYWORDS:


    Adverse effect; Restless legs syndrome; Tramadol; Withdrawal symptoms PMID: 24843378


    ================================================== ============


    J Opioid Manag. ([url]https://www.ncbi.nlm.nih.gov/pubmed/23709302#[/url]) 2013 Jan-Feb;9(1):35-41. doi: 10.5055/jom.2013.0145. Comparison of efficacy between buprenorphine and tramadol in the detoxification of opioid (heroin)-dependent subjects.


    . Author information ([url]https://www.ncbi.nlm.nih.gov/pubmed/23709302#[/url])

    Abstract

    AIM/BACKGROUND:


    Tramadol is a synthetic opiate and a centrally acting weak m-opioid receptor agonist. The potential advantages of tramadol include ease of administration, low abuse potential, and being nonscheduled. This study compared tramadol and buprenorphine for controlling withdrawal symptoms in patients with opioid dependence syndrome. METHODS:


    Consenting male subjects between 20 and 45 years of age who fulfilled the ICD-10-DCR criteria for opiate dependence syndrome were randomly assigned in a double-blind, double-dummy placebo-controlled trial for detoxification. Those with multiple drug dependence, abnormal cardiac, renal and hepatic functions, psychosis, or organic mental illness were excluded. Assessments included Subjective Opiate Withdrawal Scale (SOWS), Objective Opiate Withdrawal Scale (OOWS), Visual Analog Scale (VAS), and Side Effect Check List. Subjects were evaluated daily and study duration was 10 days. RESULTS:


    Sixty two subjects were enrolled. The mean SOWS and OOWS and VAS were significantly lower in the buprenorphine group on second and third day of detoxification as compared to the tramadol group. Although the retention rate was higher for buprenorphine group throughout the study, when compared with tramadol the difference was not significant on any day. Three subjects in the tramadol group had seizures. CONCLUSIONS:


    Tramadol was found to have limited detoxification efficacy in moderate to severe opioid withdrawal and substantial risk of seizures as compared to buprenorphine. Further studies are warranted to examine its efficacy in mild opioid withdrawal symptoms and its potential use in outpatient settings where its administration advantages may be valuable. PMID: 23709302

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    • #3
      I’m sorry! I was on 200-250mg/day and we tapered down to 50mg twice a day and then I quit. My doctor would have preferred to get me down to 50mg a day before I quit but like I said, once we schedule the c-section I wanted to be off as soon as possible, which was why I agreed to take it if I had to. I’ve not taken anything in 34ish hours and all I’ve had is a slightly stuffy/runny nose. I have had congestion my entire pregnancy so I am not sure if it’s related. I just feel like I have had a little more than usual lately.

      A lot of what I read before this had most people’s withdrawals starting 12-24 hours later. So naturally, I had hoped that this is the worst I will experience (I still hope that). And then of course I hope since I’m not feeling withdrawals, my baby isn’t either. I think my doctor wanted to error on the side of caution when talking about this with me. Do you think if I went into active labor before my c-section that my baby would withdrawal? Or do you think the dosage was still low enough even if it happened, it should be mild? I do know and understand a lot of it varies from baby to baby, and I absolutely welcome personal opinion or just things you’ve seen.

      I did read all of the tramadol info you provided above. And I definitely have to say I’m glad I was never on that kind of dose! I cannot imagine.

      Thank you so much for your response!! I truly appreciate it!!

      Comment


      • #4
        Тrаmаdоl shоuld nоt bе gіvеn tо а сhіld уоungеr thаn 12 уеаrs оld. Ultrаm ЕR shоuld nоt bе gіvеn tо аnуоnе уоungеr thаn 18 уеаrs оld. Dо nоt gіvе trаmаdоl tо аnуоnе уоungеr thаn 18 уеаrs оld whо rесеntlу hаd surgеrу tо rеmоvе thе tоnsіls оr аdеnоіds.

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