title: Enteral methadone to expedite fentanyl discontinuation and prevent opioid abstinence syndrome in the PICU.
abstract: OBJECTIVE
  To determine if enterally administered methadone can facilitate fentanyl discontinuation and prevent withdrawal in children at high risk for opioid abstinence syndrome.
  
  
  METHODS
  Retrospective analysis.
  
  
  METHODS
  Pediatric intensive care unit (PICU) in a tertiary care children's hospital.
  
  
  METHODS
  Twenty-two children (aged 6.1 +/- 5.4 yrs) who received continuous fentanyl infusion for 9 days or longer.
  
  
  METHODS
  Guidelines for initiating enteral methadone, rapidly tapering and discontinuing fentanyl infusions, and tapering methadone were implemented in the PICU. Development of opioid abstinence syndrome was evaluated during fentanyl and methadone dosage reductions and for 72 hours thereafter.
  
  
  RESULTS
  Children received fentanyl by continuous infusion for 17.8 +/- 8.4 days. Peak fentanyl infusion rate was 5.9 +/- 3.8 microg/kg/hour, and the median cumulative dose was 1302 microg/kg (range 354-7535 microg/kg). Methadone 0.50 +/- 0.22 mg/kg/day was begun 1.6 +/- 1.9 days before tapering fentanyl. The fentanyl infusion rate on starting the taper was 5.0 +/- 3.6 microg/kg/hour. Fentanyl was tapered and discontinued in a median of 2.6 days (range 0-11.9 days). Twenty-one patients had no opioid abstinence syndrome during or after fentanyl taper. One patient experienced significant opioid withdrawal after fentanyl discontinuation, which resolved after reinstitution of fentanyl and increasing the dosage of methadone to 0.3 mg/kg every 6 hours. Overall, methadone was tapered and discontinued in 18.2 +/- 11.9 days without precipitating opioid abstinence syndrome.
  
  
  CONCLUSIONS
  Enteral administration of methadone may expedite fentanyl discontinuation and reduce the risk of withdrawal in critically ill children at high risk for opioid abstinence syndrome.
authors.affiliation: Department of Pharmacy Practice, College of Pharmacy, University of Utah, Salt Lake City 84112-5820, USA. rlugo@pharm.utah.edu
authors.forename: R A
authors.initials: RA
authors.lastname: Lugo
authors.forename: R
authors.initials: R
authors.lastname: MacLaren
authors.forename: J
authors.initials: J
authors.lastname: Cash
authors.forename: C G
authors.initials: CG
authors.lastname: Pribble
authors.forename: D D
authors.initials: DD
authors.lastname: Vernon
mesh_terms: D000293:Adolescent; D000701:Analgesics, Opioid; D002648:Child; D005283:Fentanyl / Q000009:adverse effects*; D006801:Humans; D015278:Intensive Care Units, Pediatric; D008691:Methadone / Q000008:administration & dosage*; D012189:Retrospective Studies; D013375:Substance Withdrawal Syndrome / Q000517:prevention & control*; D013997:Time Factors
chemical_list: D000701:Analgesics, Opioid; D008691:Methadone; D005283:Fentanyl