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Yoo O, Tang EKY, Salman S, Nguyen MN, Sommerfield D, Sommerfield A, Khan N, von Ungern Sternberg BS, Lim LY. A randomised controlled trial of a novel tramadol chewable tablet: pharmacokinetics and tolerability in children. Anaesthesia 2022; 77:438-448. [PMID: 35083739 DOI: 10.1111/anae.15650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/02/2021] [Indexed: 11/29/2022]
Abstract
Tramadol is a bitter atypical opioid analgesic drug and is prescribed to treat postoperative pain in children. However, in many countries there is no licensed paediatric tramadol formulation available. We have formulated a novel chewable chocolate-based drug delivery system for the administration of tramadol to children. This pilot, single-centre, open-label, randomised clinical study assessed the taste tolerability and comparative population pharmacokinetics of the novel tramadol chewable tablet against a compounded tramadol hydrochloride oral liquid, at a dose of 1 mg.kg-1 . A 5-point facial hedonic scale was used by the children, parents and nurses to assess tolerability. One hundred and forty-one children aged 3-16 years were given tramadol 30 min before general anaesthesia. Blood samples were taken following the induction of anaesthesia and for up to 5 h following tramadol administration. Tramadol and its active metabolite O-desmethyltramadol were analysed using reversed-phase high-performance liquid chromatography. A population pharmacokinetic model was built using non-linear mixed effects modelling. The relative bioavailability for the tablet was 1.25 times higher (95%CI 1.16-1.35) than for tramadol hydrochloride oral liquid, while the absorption rate constant for the tablet was significantly lower (1.97 h-1 vs. 3.34 h-1 , p < 0.001). Larger inter-individual variability in absorption rates were observed with the liquid tramadol. The tramadol chewable tablet was more acceptable in taste to children when assessed by the children, parents and nurses (all p < 0.001). We conclude that the novel tramadol chewable tablet has favourable acceptability and more reliable relative bioavailability in children compared with tramadol hydrochloride oral liquid.
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Affiliation(s)
- O Yoo
- Department of Mathematics and Statistics, University of Western Australia, Perth, WA, Australia
| | - E K Y Tang
- Department of Mathematics and Statistics, University of Western Australia, Perth, WA, Australia
| | - S Salman
- Clinical Pharmacology and Toxicology Unit, PathWest, Perth, WA, Australia.,Department of Mathematics and Statistics, University of Western Australia, Perth, WA, Australia
| | - M N Nguyen
- Department of Mathematics and Statistics, University of Western Australia, Perth, WA, Australia
| | - D Sommerfield
- Department of Mathematics and Statistics, University of Western Australia, Perth, WA, Australia.,Department of Anaesthesia and Pain Management, Perth's Children Hospital, Perth, WA, Australia
| | - A Sommerfield
- Department of Anaesthesia and Pain Management, Perth's Children Hospital, Perth, WA, Australia.,Peri-operative Medicine Team, Telethon Kids Institute, Perth, WA, Australia
| | - N Khan
- Department of Mathematics and Statistics, University of Western Australia, Perth, WA, Australia
| | - B S von Ungern Sternberg
- Department of Anaesthesia and Pain Management, Perth's Children Hospital, Perth, WA, Australia.,Division of Emergency Medicine, Anaesthesia and Pain Medicine, Medical School, University of Western Australia, Perth, WA, Australia
| | - L Y Lim
- Division of Pharmacy, School of Allied Health, University of Western Australia, Perth, WA, Australia
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Yoo O, Tang EKY, Nguyen MN, Salman S, Hua AJ, von Ungern Sternberg BS, Lim LY. HPLC-UV assay of tramadol and O-desmethyltramadol in human plasma containing other drugs potentially co-administered to participants in a paediatric population pharmacokinetic study. J Chromatogr B Analyt Technol Biomed Life Sci 2021; 1184:122971. [PMID: 34649173 DOI: 10.1016/j.jchromb.2021.122971] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 09/28/2021] [Accepted: 09/30/2021] [Indexed: 12/12/2022]
Abstract
Multimodal analgesia is employed in paediatric pain management to maximise analgesia and minimise side effects. Tramadol is dosed at 1-1.5 mg/kg to treat severe pain in children but the assay for tramadol in plasma samples for pharmacokinetic and toxicology studies does not often consider concurrently administered medications. In this study we developed and validated an HPLC-UV method to quantify tramadol and its main metabolite (O-desmethyltramadol) in human plasma in the presence of seven potentially interfering drugs. Sample preparation method was developed by combining liquid-liquid extraction and protein precipitation. Chromatographic separation was achieved on a BDS-Hypersil-C18 column (5 µm, 250 × 4.6 mm) using a double gradient method. The limit of quantification was 6.7 ng/ml for both tramadol and ODT. The precision and accuracy were in compliance with ICH guidelines. This method was successfully employed to analyse the blood samples of 137 paediatric participants in a tramadol pharmacokinetic trial.
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Affiliation(s)
- O Yoo
- Division of Pharmacy, School of Allied Health, University of Western Australia, Perth, Australia
| | - E K Y Tang
- Division of Pharmacy, School of Allied Health, University of Western Australia, Perth, Australia
| | - M N Nguyen
- Division of Pharmacy, School of Allied Health, University of Western Australia, Perth, Australia
| | - S Salman
- Clinical Pharmacology and Toxicology Unit, PathWest, Perth, Australia; Division of of Emergency Medicine, Anaesthesia and Pain Medicine, Medical School, University of Western Australia, Perth, Australia
| | - A J Hua
- Division of Pharmacy, School of Allied Health, University of Western Australia, Perth, Australia
| | - B S von Ungern Sternberg
- Division of of Emergency Medicine, Anaesthesia and Pain Medicine, Medical School, University of Western Australia, Perth, Australia; Department of Anaesthesia and Pain Management, Perth's Children Hospital, Australia; Perioperative Medicine Team, Telethon Kids Institute, Perth, Australia
| | - L Y Lim
- Division of Pharmacy, School of Allied Health, University of Western Australia, Perth, Australia.
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Salman S, Tang EKY, Cheung LC, Nguyen MN, Sommerfield D, Slevin L, Lim LY, von Ungern Sternberg BS. A novel, palatable paediatric oral formulation of midazolam: pharmacokinetics, tolerability, efficacy and safety. Anaesthesia 2018; 73:1469-1477. [DOI: 10.1111/anae.14318] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/06/2018] [Indexed: 11/28/2022]
Affiliation(s)
- S. Salman
- Faculty of Health and Medical Sciences; Medical School; University of Western Australia; Perth Australia
| | - E. K. Y. Tang
- Division of Pharmacy; Faculty of Health and Medical Sciences; School of Allied Health; University of Western Australia; Perth Australia
| | - L. C. Cheung
- Telethon Kids Institute; University of Western Australia; Perth Australia
- School of Pharmacy and Biomedical Sciences; Curtin University; Perth Australia
- Department of Pharmacy; Princess Margaret Hospital for Children; Perth Australia
| | - M. N. Nguyen
- Division of Pharmacy; Faculty of Health and Medical Sciences; School of Allied Health; University of Western Australia; Perth Australia
| | - D. Sommerfield
- Department of Anaesthesia and Pain Management; Princess Margaret Hospital for Children; Perth Australia
| | - L. Slevin
- Telethon Kids Institute; University of Western Australia; Perth Australia
| | - L. Y. Lim
- Division of Pharmacy; Faculty of Health and Medical Sciences; School of Allied Health; University of Western Australia; Perth Australia
| | - B. S. von Ungern Sternberg
- Department of Anaesthesia and Pain Management; Princess Margaret Hospital for Children; Perth Australia
- Faculty of Health and Medical Sciences; Medical School; University of Western Australia; Perth Australia
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