| Selection of the initial methadone regimen for the management of iatrogenic opioid abstinence syndrome in critically ill children. | |
| | |
MedLine Citation:
|
PMID: 22392424 Owner: NLM Status: In-Data-Review |
Abstract/OtherAbstract:
|
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. |
| | |
Authors:
|
Peter N Johnson; Krystal A Boyles; Jamie L Miller |
Related Documents
:
|
22863184 - Use and functioning of the affected limb in children with unilateral congenital below-e... 69934 - Chromosome aberrations and sister-chromatid exchange in workers in chemical laboratorie... 21197164 - Is lead a concern in canadian autistic children? 22381254 - Lower extremity kinematics in children with and without flexible flatfoot: a comparativ... 12970974 - Overweight and obesity prevalence rates among youth in the carolinas. 9603674 - Coping strategies and laboratory pain in children with sickle cell disease. |
Publication Detail:
|
Type: Journal Article Date: 2012-01-24 |
Journal Detail:
|
Title: Pharmacotherapy Volume: 32 ISSN: 1875-9114 ISO Abbreviation: Pharmacotherapy Publication Date: 2012 Feb |
Date Detail:
|
Created Date: 2012-03-06 Completed Date: - Revised Date: - |
Medline Journal Info:
|
Nlm Unique ID: 8111305 Medline TA: Pharmacotherapy Country: United States |
Other Details:
|
Languages: eng Pagination: 148-57 Citation Subset: IM |
Copyright Information:
|
© 2012 Pharmacotherapy Publications, Inc. |
Affiliation:
|
Department of Pharmacy, Clinical and Administrative Sciences, University of Oklahoma College of Pharmacy, Oklahoma City, Oklahoma. |
Export Citation:
|
APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
|
|
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
Previous Document: Acceptable plasma concentrations of raltegravir and etravirine when administered by gastrostomy tube...
Next Document: Clinical controversies in thrombolytic therapy for the management of acute pulmonary embolism.