Document Detail


Novel pharmacotherapeutic strategies for treatment of opioid-induced neonatal abstinence syndrome.
MedLine Citation:
PMID:  23059064     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
The non-medical use of prescription drugs, in general, and opioids, in particular, is a national epidemic, resulting in enormous addiction rates, healthcare expenditures, and overdose deaths. Prescription opioids are overly prescribed, illegally trafficked, and frequently abused, all of which have created a new opioid addiction pathway, adding to the number of opioid-dependent newborns requiring treatment for neonatal abstinence syndrome (NAS), and contributing to challenges in effective care in maternal and fetal/neonatal (M-F/N) medicine. The standard of care for illicit or prescription opioid dependence during pregnancy is opioid agonist (methadone or buprenorphine) substitution therapy, which are also frequently abused. The next generation of pharmacotherapies for the treatment of illicit or prescription opioid addiction in the M-F/N interactional dyad must take into consideration the interplay between genetic, epigenetic, and environmental factors. Addiction to illicit drugs during pregnancy presents unique challenges to effectively treat the mother, and the developing fetus and infant after delivery. New pharmacotherapies should be safe to the developing fetus, effective in treating the physical and psychological consequences of addiction in the mother, and reduce the incidence and severity of NAS in the infant after birth. More pharmacotherapeutic options should be available to the physician such that a more individualized rather than a one-drug/strategy-fits-all approach can be used. A myriad of new and exciting pharmacotherapeutic strategies for the treatment of opioid dependence and addiction are on the horizon. This review focuses on such three strategies: (i) pharmacotherapeutic targeting of the serotonergic system; (ii) mixed opioid immunotherapeutics (vaccines); (iii) pharmacogenomics as a therapeutic strategy to insure personalized care. We review and discuss how these strategies may offer additional treatment modalities for the treatment of M-F/N during pregnancy and the treatment of the infant after birth.
Authors:
Gabrielle L McLemore; Tamorah Lewis; Catherine H Jones; Estelle B Gauda
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Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural; Review     Date:  2012-10-09
Journal Detail:
Title:  Seminars in fetal & neonatal medicine     Volume:  18     ISSN:  1878-0946     ISO Abbreviation:  Semin Fetal Neonatal Med     Publication Date:  2013 Feb 
Date Detail:
Created Date:  2013-01-07     Completed Date:  2013-06-24     Revised Date:  2014-08-27    
Medline Journal Info:
Nlm Unique ID:  101240003     Medline TA:  Semin Fetal Neonatal Med     Country:  Netherlands    
Other Details:
Languages:  eng     Pagination:  35-41     Citation Subset:  IM    
Copyright Information:
Copyright © 2012 Elsevier Ltd. All rights reserved.
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MeSH Terms
Descriptor/Qualifier:
Analgesics, Opioid / adverse effects*,  therapeutic use
Buprenorphine / therapeutic use
Female
Humans
Immunotherapy
Infant, Newborn
Methadone / therapeutic use
Neonatal Abstinence Syndrome / drug therapy*,  prevention & control
Opiate Substitution Treatment*
Pregnancy
Serotonin Uptake Inhibitors / therapeutic use
Grant Support
ID/Acronym/Agency:
R25 DA021630/DA/NIDA NIH HHS; R25 DA021630/DA/NIDA NIH HHS
Chemical
Reg. No./Substance:
0/Analgesics, Opioid; 0/Serotonin Uptake Inhibitors; 40D3SCR4GZ/Buprenorphine; UC6VBE7V1Z/Methadone
Comments/Corrections

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