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Dosing and monitoring of methadone in pregnancy: literature review.
MedLine Citation:
PMID:  23129867     Owner:  NLM     Status:  PubMed-not-MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: The pharmacokinetics of methadone is altered during pregnancy, but the most appropriate dosing and monitoring regimen has yet to be identified.
OBJECTIVE: To review dosing and monitoring of methadone therapy in pregnancy.
METHODS: A literature search was performed in several databases (PubMed, MEDLINE, Embase, International Pharmaceutical Abstracts, and the Cochrane Database of Systematic Reviews) from inception to May 2012. The search terms were "methadone", "pregnancy", "pharmacokinetic", "clearance", "metabolism", "therapeutic drug monitoring", and "methadone dosing". Additional papers were identified by searching the bibliographies of primary and review articles. All English-language primary articles related to methadone pharmacokinetics in pregnancy were included. Articles not related to maternal outcomes were excluded.
RESULTS: The literature search yielded 1 case report and 10 studies discussing use of methadone by pregnant women. Methadone pharmacokinetics in pregnancy has been studied in 3 pharmacokinetic trials, and split dosing of methadone in pregnant women has been described in 1 case report and 3 dosing trials. Only 4 trials evaluated monitoring of methadone concentration in pregnancy. The studies included in this review confirm that methadone pharmacokinetics is altered in pregnancy and is potentially correlated with increases in maternal withdrawal symptoms. Insufficient evidence is available to warrant routine monitoring of serum methadone concentrations in pregnant women with opioid dependence.
CONCLUSIONS: Few studies of methadone pharmacokinetics and therapeutic drug monitoring are available for pregnant women with opioid dependence. Although it is known that methadone pharmacokinetics is altered in pregnancy, there is insufficient evidence to guide dosage adjustments and serum concentration monitoring. Until further studies are available, regular follow-up of maternal withdrawal symptoms and empiric dosage adjustments throughout pregnancy are still recommended.
Authors:
Jennifer R Shiu; Mary H H Ensom
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  The Canadian journal of hospital pharmacy     Volume:  65     ISSN:  0008-4123     ISO Abbreviation:  Can J Hosp Pharm     Publication Date:  2012 Sep 
Date Detail:
Created Date:  2012-11-06     Completed Date:  2012-11-07     Revised Date:  2013-05-30    
Medline Journal Info:
Nlm Unique ID:  0215645     Medline TA:  Can J Hosp Pharm     Country:  Canada    
Other Details:
Languages:  eng     Pagination:  380-6     Citation Subset:  -    
Affiliation:
, BScPharm, PharmD, ACPR, is a Clinical Practice Leader, Alberta Health Services - Pharmacy Services, Edmonton, Alberta, Canada.
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