The online version of this article (doi:10.1186/1471-2253-14-33) contains supplementary material, which is available to authorized users.
No external funding and no competing interests declared.
ND conducted study in healthy volunteers, assisted in data collection and manuscript drafting. KS conducted study in patients, assisted in data collection and manuscript drafting. TR conducted study in patients, assisted in data collection, manuscript drafting and manuscript submission. AS conducted pharmacokinetic analysis, assisted in data analysis, interpretation and critical revision of manuscript. RU designed the study, involved in pharmacokinetic analysis, interpretation of data, assisted in manuscript drafting. SC assisted in conducting study in patients, data collection and manuscript drafting. JO contributed to experimental design and plan, assisted in conducting study in healthy volunteers and patients, data collection and manuscript drafting. MC designed the study in patients, assisted in conducting the study and manuscript drafting. GL designed the study in healthy volunteers, assisted in data interpretation and manuscript drafting. All authors read and approved the final manuscript.
Tramadol is an atypical centrally acting analgesic agent available as both oral and parenteral preparations. For patients who are unable to take tramadol orally, the subcutaneous route of administration offers an easy alternative to intravenous or intramuscular routes. This study aimed to characterise the absorption pharmacokinetics of a single subcutaneous dose of tramadol in severely ill patients and in healthy subjects.
Blood samples (5 ml) taken at intervals from 2 minutes to 24 hours after a subcutaneous dose of tramadol (50 mg) in 15 patients (13 male, two female) and eight healthy male subjects were assayed using high performance liquid chromatography. Pharmacokinetic parameters were derived using a non-compartmental approach.
There were no statistically significant differences between the two groups in the following parameters (mean ± SD): maximum venous concentration 0.44 ± 0.18 (patients) vs. 0.47 ± 0.13 (healthy volunteers) mcg/ml (p = 0.67); area under the plasma concentration-time curve 177 ± 109 (patients) vs. 175 ± 75 (healthy volunteers) mcg/ml*min (p = 0.96); time to maximum venous concentration 23.3 ± 2 (patients) vs. 20.6 ± 18.8 (healthy volunteers) minutes (p = 0.73) and mean residence time 463 ± 233 (patients) vs. 466 ± 224 (healthy volunteers) minutes (p = 0.97).
The similar time to maximum venous concentration and mean residence time suggest similar absorption rates between the two groups. These results indicate that the same dosing regimens for subcutaneous tramadol administration may therefore be used in both healthy subjects and severely ill patients.
Macintyre PE, Scott DA, Schug SA, Visser EJ, Walker SM: APM:SE Working Group of the Australian and New Zealand College of Anaesthetists and Faculty of Pain Medicine. Acute Pain Management: Scientific Evidence. 2010, Melbourne: ANZCA & FPM, 3
Cooper IM: Morphine for postoperative analgesia. A comparison of intramuscular and subcutaneous routes of administration. Anaesth Intensive Care. 1996, 24 (5): 574-578. PubMed
Macintyre PE, Schug SA: Acute Pain Management: a practical guide. 2007, London: Saunders Elsevier, 3
Lintz W, Beier H, Gerloff J: Bioavailability of tramadol after i.m. injection in comparison to i.v. infusion. Int J Clin Pharmacol Ther. 1999, 37 (4): 175-183. PubMed
Lim AW, Schug SA: Tramadol versus morphine as oral step-down analgesia after postoperative epidural anagesia. Reg Anaesth Pain Med. 2001, 26 (2): S133-
R Development Core Team: R: A language and environment for statistical computing. R Foundation for Statistical Computing. 2011, Vienna, Austria, http://www.R-project.org./.
Krishnamurthy RB, Upton RN, Fajumi AO, Lai S, Charlton CS, Ousley RM, Martinez AM, McConnell H, O'Connor SN, Ong J, Macintyre PE, Chapman MJ, Ludbrook GL: Pharmacokinetics of oxycodone after subcutaneous administration in a critically ill population compared with a healthy cohort. Anaesth Intensive Care. 2012, 40 (2): 269-274. PubMed
Blake DW, Yew CY, Donnan GB, Williams DL: Postoperative analgesia and respiratory events in patients with symptoms of obstructive sleep apnoea. Anaesth Intensive Care. 2009, 37 (5): 720-725. PubMed
Hollingshead J, Duhmke RM, Cornblath DR: Tramadol for neuropathic pain. Cochrane Database Syst Rev. 2006, 3: CD003726
Dworkin RH, O'Connor AB, Audette J, Baron R, Gourlay GK, Haanpaa ML, Kent JL, Krane EJ, Lebel AA, Levy RM, Mackey SC, Mayer J, Miaskowski C, Raja SN, Rice AS, Schmader KE, Stacey B, Stanos S, Teede RD, Turk DC, Walco GA, Wells CD: Recommendations for the pharmacological management of neuropathic pain: an overview and literature update. Mayo Clin Proc. 2010, 85 (3 Suppl): S3-S14. CrossRefPubMedPubMedCentral
- Pharmacokinetics of tramadol after subcutaneous administration in a critically ill population and in a healthy cohort
Neil M Dooney
Andrew A Somogyi
Richard N Upton
Stephanie N O’Connor
Marianne J Chapman
Guy L Ludbrook
- BioMed Central
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