Methadone toxicity and possible induction and enhanced elimination in a premature neonate.
BACKGROUND
Reports describing methadone overdose in adult and pediatric patient populations are not uncommon. Reports in the preterm neonate patient population, however, are infrequent even though the utilization of methadone in that population continues to increase. Significant age-related pharmacokinetic differences complicate the management of methadone overdose in neonates, and literature involving methadone toxicokinetics and toxicodynamics in pediatric and neonate populations is largely limited.


METHODS
The clinical course and pharmacologic data of a massive methadone overdose in a 20-day-old male neonate is described, and a contemporary review of developmental pharmacology is presented.


CONCLUSIONS
As clinicians continue to use methadone in neonates, they should be aware of the many significant peculiarities regarding its toxicology and pharmacology in that patient population.
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Mathew
M
George
Joseph P
JP
Kitzmiller
Michele Burns
MB
Ewald
Katherine A
KA
O'Donell
Melissa Lai
ML
Becter
Steve
S
Salhanick
D051544:Cytochrome P-450 CYP3A / Q000378:metabolism; D062787:Drug Overdose / Q000628:therapy*; D006801:Humans; D007231:Infant, Newborn; D007362:Intensive Care Units; D008297:Male; D008691:Methadone / Q000097:blood / Q000493:pharmacokinetics* / Q000506:poisoning* / Q000652:urine; D010634:Phenobarbital / Q000627:therapeutic use; D011759:Pyrrolidines / Q000378:metabolism
D011759:Pyrrolidines; D051544:Cytochrome P-450 CYP3A; D008691:Methadone; D010634:Phenobarbital; C010724:2-ethylidene-1,5-dimethyl-3,3-diphenylpyrrolidine