Does the intake of Tramadol (tramadol) or Neurontin (gabapentin) during late pregnancy contribute t

Fråga: Does the intake of Tramadol (tramadol) or Neurontin (gabapentin) during late pregnancy contribute to an increased risk for withdrawal symptoms in the newborn?

The question relates to a pregnant woman (week 35). Due too slipped disc and severe back pain she has been taking Alvedon (paracetamol) and Dexofen (dextropropoxiphene), but without obtaining sufficient effect. Dexofen has now been withdrawn and the questioner asks if it is possible to use Tramadol (tramadol) or Neurontin (gabapentin).

Sammanfattning: Withdrawal symptoms after tramadol use late in pregnancy have been reported. There is very limited clinical data on the use of gabapentin during pregnancy. In the present case, morphine seems to be the most viable alternative.

Svar: The question concerning tramadol and pregnancy has previously been documented in Drugline (1). In the conclusion it was stated that opiate withdrawal symptoms and seizures in the neonate after delivery have been associated with tramadol use during late pregnancy. An updating literature search revealed one new reported case where withdrawal symptoms were seen in a male newborn. The mother had been taking 300 milligram tramadol per day regularly for 4 years (continued use after cholecystectomy). The first signs of withdrawal symptoms occurred after 24 hours; trembling was fully developed after 48 hours. Symptoms such as tachypnoea (84 breaths per minute), tachycardia (200 beats per minute), hypertonic muscle tone, a light single convulsion and signs of tetany when touched were also observed. The mother did not breast-feed and after symptomatic treatment with diazepam and phenobarbital the withdrawal symptoms subsided. During 13 days of observation, all laboratory parameters were normal, except for slightly elevated sodium and chloride levels (150 and 120 millimole per litre) (2).

Morphine, which has a much superior documentation compared to tramadol is probably a better alternative when an opiate is needed. Needless to say, a newborn exposed to morphine in utero should be carefully monitored for signs of withdrawal.

There is so far very limited experience on the use of gabapentin during pregnancy. Animal studies have indicated an increased frequency of malformations. The experience in women is very limited and gabapentin is thus recommended to be avoided during pregnancy (3). 1 Drugline no 14319 (year 1997) enclosed 2 Meyer FP, Rimasch H, Blaha B, Banditt P: Tramadol withdrawal in a neonate. Eur J Clin Pharmacol 1997; 53: 159-160 3 Drugline no 15611 (year 1999) enclosed