Methadone dosage for prevention of opioid withdrawal in children

Siddappa, Rajashekhar; Fletcher, James E.; Heard, Andrew; Kielma, Donna; Cimino, Michael; Heard, Christopher

doi:10.1046/j.1460-9592.2003.01153.x

Cited by 82 publications

(73 citation statements)

References 17 publications

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“…1,8,16,17,25–27,30–33,36 Some used statistical methods to establish predictive opioid thresholds, with cut-off lengths of therapy ranging from ≥5 27 to 8 days (OR=18, p = 0.02). 25 Exposures longer than 9 days were 100% predictive of IWS.…”

Section: Resultsmentioning

confidence: 99%

Risk Factors Associated With Iatrogenic Opioid and Benzodiazepine Withdrawal in Critically Ill Pediatric Patients

Best

Boullata

Curley³

2015

Pediatric Critical Care Medicine

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Objective Analgesia and sedation are common therapies in pediatric critical care, and rapid titration of these medications is associated with iatrogenic withdrawal syndrome (IWS). We performed a systematic review of the literature to identify all common and salient risk factors associated with IWS and build a conceptual model of IWS risk in critically ill pediatric patients. Data sources Multiple databases, including PubMed/Medline, EMBASE, CINAHL, and the Cochrane Central Registry of Clinical Trials were searched using relevant terms from January 1, 1980 to August 1, 2014. Study selection Articles were included if they were published in English and discussed IWS following either opioid or benzodiazepine therapy in children in acute or intensive care settings. Articles were excluded if subjects were neonates born to opioid- or benzodiazepine-dependent mothers, children diagnosed as substance abusers, or subjects with cancer-related pain; if data about opioid or benzodiazepine treatment were not specified; or if primary data were not reported. Data extraction and synthesis In total 1395 papers were evaluated, 33 of which met the inclusion criteria. To facilitate analysis, all opioid and/or benzodiazepine doses were converted to morphine or midazolam equivalents, respectively. A table of evidence was developed for qualitative analysis of common themes, providing a framework for the construction of a conceptual model. The strongest risk factors associated with IWS include duration of therapy and cumulative dose. Additionally, evidence exists linking patient, process and system factors in the development of IWS. Findings Most papers were prospective observational or interventional studies. Conclusions Given the state of existing evidence, well-designed prospective studies are required to better characterize IWS in critically ill pediatric patients. This review provides data to support the construction of a conceptual model of IWS risk that, if supported, could be useful in guiding future research.

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Section: Resultsmentioning

confidence: 99%

Risk Factors Associated With Iatrogenic Opioid and Benzodiazepine Withdrawal in Critically Ill Pediatric Patients

Best

Boullata

Curley³

2015

Pediatric Critical Care Medicine

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“…Based on a few prospective studies several authors recommend a daily tapering rate of 10-20% for children who receive benzodiazepines and/or opioids for more than 5-7 days [23][24][25]29]. This strategy did not result, however, in the absence of withdrawal symptoms.…”

Section: Discussionmentioning

confidence: 99%

“…Articles on withdrawal symptoms had to meet two criteria for inclusion in this review: describing a study of benzodiazepine and/or opioid withdrawal symptoms and relating to the age restriction. In total 20 articles, either case studies, retrospective or prospective studies, met these criteria [18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37]. Table 1 lists the studies from which the withdrawal symptoms were derived, grouped by type of medication, study design, and methodological quality.…”

Section: Methodsmentioning

confidence: 99%

“…In another study in ECMO patients the authors demonstrated that neonates who received total fentanyl doses higher than 1.2 mg/kg were 13 times more likely to experience opioid withdrawal after ECMO [37]. Evaluation of the various studies reveals that children in a PICU receiving benzodiazepines and/or opioids for 5 days or longer are at risk for developing withdrawal symptoms [17,[23][24][25][27][28][29][30][31]. Benzodiazepine and/or opioid withdrawal symptoms may occur if these medications are abruptly stopped or tapered off too rapidly in children showing physical dependence [38].…”

Section: Influencing Factorsmentioning

confidence: 99%

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Withdrawal symptoms in children after long-term administration of sedatives and/or analgesics: a literature review. “Assessment remains troublesome”

et al. 2007

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“…In vielen Kliniken wird nach Erreichen eines definierten Scores das Neugeborene medikamentös meist über orale Opiatzufuhr (z. B. auch Methadon) therapiert [13,17,18].…”

Section: Stillen Und Das Neonatale Entzugssyndromunclassified

Opiatabhängigkeit und Stillen - Literaturübersicht und Empfehlungen

Kashiwagi¹,

Schäfer²,

Kästner³

et al. 2005

Geburtsh Frauenheilk

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Die Empfehlungen zum Stillen bei opiatabhängigen Müttern bleiben ein viel diskutiertes Thema. Da Methadon derzeit Standard in der Substitutionsbehandlung opiatabhängiger Schwangerer ist, wurden für diese Substanz auch verschiedene Studien zur Abschätzung des Risikos für gestillte Neugeborene durchgeführt. Nach Durchsicht der aktuellen Literatur rechtfertigt die reine Opiatsubstitution nicht mehr das primäre Abstillen. Obgleich die untersuchten Fallzahlen klein sind, konnte in der Muttermilch abhängiger Mütter, als auch im Plasma deren Neugeborener, Methadon in nur minimalen Konzentrationen nachgewiesen werden. Offensichtlich variiert der Methadonmetabolismus individuell, so dass die Dosis kaum mit den Plasmaspiegeln korreliert. Veraltete Empfehlungen, Stillen ausschließlich bei sehr niedriger Methadondosis zuzulassen, wurden daher revidiert. Bei Methadonsubstitution muss jedoch an die Möglichkeit eines politoxikomanen Beigebrauches sowie an das Vorliegen einer HIV-Infektion gedacht werden, in diesen Fällen ist vom Stillen abzuraten. Schlüsselwörter Methadon · Opiatabhängigkeit · Buprenorphin · Stillen AbstractWeaning in opiate addicted mothers remains a matter of debate. As methadone is the substance of choice in the treatment of opiate addiction in pregnancy, various studies have been conducted to evaluate its potential risk for the breastfed neonate. Reviewing the current literature we came to the conclusion that study results are not sufficient to recommend general weaning in women under opiate maintenance treatment. Although the numbers of cases investigated are small, the concentration of methadone or alternative opiates in breast milk or the infant's plasma seems to be neglible. Prior recommendations to promote breastfeeding only in mothers treated with lower methadone doses have had to be retracted. There is now evidence that methadone metabolism differs individually and a correlation between methadone dosage and maternal plasma concentrations has not been confirmed. Nevertheless polytoxic behaviour with consumption of various toxic substances has to be taken into consideration and likewise the high infection rate with HIV in the opiate addicted patient. In these cases weaning should be recommended.

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Methadone dosage for prevention of opioid withdrawal in children

Abstract: Inadequate methadone is a risk factor for opioid withdrawal. A daily starting methadone dose equivalent to 2.5 times the daily fentanyl dose is effective in minimizing withdrawal symptoms.

Cited by 82 publications

References 17 publications

Risk Factors Associated With Iatrogenic Opioid and Benzodiazepine Withdrawal in Critically Ill Pediatric Patients

Risk Factors Associated With Iatrogenic Opioid and Benzodiazepine Withdrawal in Critically Ill Pediatric Patients

Withdrawal symptoms in children after long-term administration of sedatives and/or analgesics: a literature review. “Assessment remains troublesome”

Opiatabhängigkeit und Stillen - Literaturübersicht und Empfehlungen

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