Changes in methadone maintenance therapy during and after pregnancy

Albright, Brittany; Torre, Lesley de la; Skipper, Betty J.; Price, Sylvia; Abbott, Patrick J.; Rayburn, William F.

doi:10.1016/j.jsat.2011.05.002

Cited by 28 publications

(23 citation statements)

References 24 publications

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“…33,34 Furthermore, pharmacodynamic studies show that escalations in dose are needed to maintain the therapeutic effect as pregnancy progresses owing to changes in methadone metabolism. 35 …”

Section: Is Neonatal Abstinence Syndrome a Problem?mentioning

confidence: 99%

The management of opioid dependence during pregnancy in rural and remote settings

Jumah

Graves

2014

CMAJ

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• Nonmedical use of prescription opioids during pregnancy is becoming more common, and members of Canada's Aboriginal population are disproportionately affected.• Methadone maintenance therapy has logistic limitations in rural and remote settings, but buprenorphine and slow-release morphine maintenance therapies are feasible alternatives.• Opioid detoxification in pregnancy is associated with high rates of relapse and should only be offered if a comprehensive rehabilitation program is available.• Treatment of opioid dependence and rehabilitation services should be provided to all women during pregnancy and the postpartum period.

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Section: Is Neonatal Abstinence Syndrome a Problem?mentioning

confidence: 99%

The management of opioid dependence during pregnancy in rural and remote settings

Jumah

Graves

2014

CMAJ

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“…The literature search yielded 1 case report 16 and 10 studies [9][10][11][17][18][19][20][21][22][23] discussing the use of methadone in pregnant women. Methadone pharmacokinetics in pregnancy was studied in 3 pharmacokinetic trials, [9][10][11] and split dosing of methadone in pregnant women was described in the case report 16 and in 3 dosing trials.…”

Section: Literature Reviewmentioning

confidence: 99%

“…Methadone pharmacokinetics in pregnancy was studied in 3 pharmacokinetic trials, [9][10][11] and split dosing of methadone in pregnant women was described in the case report 16 and in 3 dosing trials. [17][18][19] Only 4 trials evaluated measurement of methadone concentrations in pregnancy.…”

Section: Literature Reviewmentioning

confidence: 99%

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Dosing and Monitoring of Methadone in Pregnancy: Literature Review

Shiu

Ensom

2012

CJHP

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“…Prior observational studies found that women received minimal dose adjustments in the immediate period after delivery (Jones, Johnson et al, 2008; Albright et al, 2011). Postpartum dose reductions to half the third trimester dose as described by CSAT in the quotation above were not described in these studies.…”

Section: Introductionmentioning

confidence: 99%

Postpartum changes in methadone maintenance dose

Pace

Kaminetzky

Winter

et al. 2014

Journal of Substance Abuse Treatment

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The optimal approach to postpartum dosing among women treated with methadone maintenance is unclear. We examined doses among 101 methadone-maintained pregnant women 2, 6 and 12 weeks postpartum, and compared the incidence of having doses held for oversedation during pregnancy and postpartum. The average dose at delivery was 83.3 mg, and the mean change from delivery to 12 weeks postpartum was −3.7 mg (95% CI −6.3, −1.1). The incidence of oversedation events per 10,000 days was 2.8 among pregnant women and 5.6 for postpartum women (incidence rate ratio [IRR] 2.04, 95% CI 0.66, 6.28). After adjusting for benzodiazepine prescriptions, the IRR of an oversedation event among postpartum women compared to pregnant women was 1.74 (95% CI 0.56, 5.30). In conclusion, postpartum dose changes were small in a methadone clinic using clinical assessments to determine dose. Although the incidence of oversedation events remained low postpartum, the clinically important but not statistically significant increase in events among postpartum women and those prescribed benzodiazepines requires further research. While there are not yet adequate data to support pre-specified postpartum dose reductions, the findings suggest that more frequent clinical assessments continuing as late as 12 weeks postpartum may be warranted.

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Changes in methadone maintenance therapy during and after pregnancy

Cited by 28 publications

References 24 publications

The management of opioid dependence during pregnancy in rural and remote settings

The management of opioid dependence during pregnancy in rural and remote settings

Dosing and Monitoring of Methadone in Pregnancy: Literature Review

Postpartum changes in methadone maintenance dose

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