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DI-090 Conditions of use and tolerance of tramadol in the hospitalised elderly

Background Pain is a very common symptom in older people whose care is complex1,2. Few data are available on the safety of tramadol. Purpose The objective was to describe prescriptions of tramadol in the hospitalised elderly and to assess its tolerance. Material and methods The computerised medical data of a French hospital of 222 beds were used, for a total of 45 012 patient stays. They included drug administrations, laboratory results, diagnostic and discharge letters. Automated queries allowed description of prescriptions of analgesics in patients aged 75 years and older and to detect co-prescriptions of tramadol with molecules that can potentiate its adverse effects. The Kramer algorithm was used to assess the causality of tramadol in the prescription of antiemetics or laxatives. Results Among the 7362 patient stays included in the study, 47.2% received at least one analgesic, essentially non-opioid analgesics. Administration of weak opioids concerned 16.5% of stays. Review of the 1092 stays with administration of tramadol found 8 cases of constipation and 6 cases of nausea potentially related to tramadol. 33 patient stays presented administration of tramadol despite severe respiratory failure which is a contraindication. Finally, 6 cases presented a contraindicated drug association with tramadol. Conclusion Analgesic prescriptions concerned approximately half of the elderly hospitalised population in this study. Tramadol is the most prescribed analgesic after paracetamol. The position of tramadol in the treatment of pain in the elderly requires prospective studies on tolerance in this sensitive population at high risk of adverse drug events. Our results based on retrospective data suggest that tramadol prescriptions are realised in accordance with the recommendations and that digestive tolerance is satisfactory. References and/or Acknowledgements Jakobsson U, Klevsgård R, Westergren A, et al. Old people in pain: a comparative study. J Pain Symptom Manage 2003;26:625‑36 Lazarou J, Pomeranz BH, Corey PN. Incidence of adverse drug reactions in hospitalized patients: a meta-analysis of prospective studies. JAMA, 1998;279:1200‑5 This study was conducted as part of a project funded by the Medical Research Foundation (FRM). The FRM did not taken part in the study. No conflict of interest.