Efficacy of an enteral 10-day methadone wean to prevent opioid withdrawal in fentanyl-tolerant pediatric intensive care unit patients

Meyer, Michael T.; Berens, Richard J.

doi:10.1097/00130478-200110000-00009

Cited by 72 publications

(79 citation statements)

References 17 publications

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“…Meyer et al 150 described a protocol for rescue therapy in 29 patients 1 day to 20 years of age on admission who developed withdrawal during the course of nonstandardized tapers of prolonged continuous fentanyl infusion. Withdrawal was defined as the observation of 3 consecutive Finnegan scores ≥8 obtained at 2-hour intervals.…”

Section: Management Of Acquired Opioid and Benzodiazepine Dependencymentioning

confidence: 99%

Neonatal Drug Withdrawal

Hudak¹,

Tan²,

Frattarelli³

et al. 2012

Pediatrics

758

608

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Maternal use of certain drugs during pregnancy can result in transient neonatal signs consistent with withdrawal or acute toxicity or cause sustained signs consistent with a lasting drug effect. In addition, hospitalized infants who are treated with opioids or benzodiazepines to provide analgesia or sedation may be at risk for manifesting signs of withdrawal. This statement updates information about the clinical presentation of infants exposed to intrauterine drugs and the therapeutic options for treatment of withdrawal and is expanded to include evidence-based approaches to the management of the hospitalized infant who requires weaning from analgesics or sedatives.

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Section: Management Of Acquired Opioid and Benzodiazepine Dependencymentioning

confidence: 99%

Neonatal Drug Withdrawal

Hudak¹,

Tan²,

Frattarelli³

et al. 2012

Pediatrics

758

608

View full text Add to dashboard Cite

show abstract

“…It is also possible that a longer methadone taper would have produced different results. Although previous reports (17,33,34) suggest that a 10-day taper is appropriate, the taper may been more effective if it had occurred over a longer period of time.…”

Section: Discussionmentioning

confidence: 88%

“…The fentanyl infusion was weaned off within 72 hrs of receiving the first dose of methadone. Similar methadone tapering schedules, in terms of a loading dose and then a taper over 10 days, have been published (7,17).…”

Section: Methodsmentioning

confidence: 99%

“…The low dose of methadone was chosen based on published reports describing opioid tolerance and its treatment and is the lowest published dose (4,6,18). The high dose of methadone was chosen based on equianalgesic dose conversion and is the highest published dose (17). The lowest and highest published doses were used to maximize the probability of detecting a difference between study groups.…”

Section: Methodsmentioning

confidence: 99%

“…There are no prospective, randomized trials of methadone dosing schedules in children exposed to prolonged infusions of fentanyl. The starting dose of methadone needed to prevent opioid withdrawal in a pediatric patient administered a prolonged infusion of fentanyl has varied widely (6,7,14,17,18). There are numerous conversion tables that convert fentanyl and morphine doses to methadone doses; however, the resulting recommended equianalgesic methadone doses have varied widely (19).…”

mentioning

confidence: 99%

See 2 more Smart Citations

A trial of methadone tapering schedules in pediatric intensive care unit patients exposed to prolonged sedative infusions*

Bowens

Thompson

et al. 2011

Pediatric Critical Care Medicine

100

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Selection of the Initial Methadone Regimen for the Management of Iatrogenic Opioid Abstinence Syndrome in Critically Ill Children

Johnson

Boyles²,

Miller

2012

Pharmacotherapy

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Iatrogenic opioid abstinence syndrome (IOAS) is a common complication in critically ill infants and children receiving prolonged exposure to continuous infusions of opioids. Although no guidelines are available regarding management of IOAS in children, several treatment options are available, including clonidine, morphine, and methadone. Methadone is commonly prescribed due to its long half-life and antagonism of the N-methyl-d-aspartate receptor. Different approaches, such as weight-based and formula-based methods, have been used to determine the initial methadone dosing regimen. Because of the vast differences in the recommended dosing regimen from these sources, we conducted a literature search to identify articles evaluating the initial methadone dosing regimen for prevention and/or treatment of IOAS in children. Specifically, we evaluated the reported frequency of withdrawal and oversedation after initiation of methadone treatment. Our literature search was limited to English-language articles in the MEDLINE (1950-March 2011), EMBASE (1988-March 2011), International Pharmaceutical Abstracts (1970-March 2011), and Cochrane Library (1996-March 2011) databases. Relevant abstracts and reference citations were also reviewed. A total of eight reports representing 183 patients were included in the analysis. There was wide discrepancy in the initial methadone dosing regimen. Approximately one-third of all patients experienced withdrawal after starting methadone, and there did not appear to be a difference between weight-based and formula-based regimens. Seven patients experienced oversedation; however, not all articles reported this complication. It appears that a standard approach to initial methadone dosing does not exist because withdrawal occurred despite the regimen started. Therefore, it seems best to begin with the lowest dose possible and titrate to the child's response to avoid complications such as oversedation. Routine monitoring should be performed in all patients to guide clinicians in the management of IOAS.

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Efficacy of an enteral 10-day methadone wean to prevent opioid withdrawal in fentanyl-tolerant pediatric intensive care unit patients

Abstract: Opioid withdrawal symptoms in pediatric intensive care unit patients after prolonged fentanyl exposure can be avoided by using an enteral, 10-day, single daily dose methadone weaning protocol.

Cited by 72 publications

References 17 publications

Neonatal Drug Withdrawal

Neonatal Drug Withdrawal

A trial of methadone tapering schedules in pediatric intensive care unit patients exposed to prolonged sedative infusions*

Selection of the Initial Methadone Regimen for the Management of Iatrogenic Opioid Abstinence Syndrome in Critically Ill Children

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