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Methadone conversion in infants and children: Retrospective cohort study of 199 pediatric inpatients

Alexandra Fife1, Andrea Postier2, Andrew Flood3

  • 1Children's Hospitals and Clinics of Minnesota, Minneapolis, Minnesota.

Journal of Opioid Management
|May 20, 2016
PubMed

Insights

Pediatric methadone conversion ratios are lower than adult guidelines, with over 40% of children undermedicated. Safe and effective pediatric methadone dosing requires further investigation through prospective studies.

Area of Science:

  • Pediatric Anesthesiology
  • Pain Management
  • Pharmacology

Background:

  • Methadone use is increasing in pediatric care.
  • Current equianalgesic dose ratios are often based on adult data.
  • Accurate dosing is crucial for effective pain management and sedation in children.

Purpose of the Study:

  • To determine an appropriate equianalgesic dose ratio for methadone in pediatric patients.
  • To evaluate the efficacy and safety of methadone conversion from other opioids.
  • To compare pediatric methadone dosing to established adult conversion guidelines.

Main Methods:

  • Retrospective chart review of 199 hospitalized pediatric patients (0-18 years).
  • Patients were converted from morphine, hydromorphone, or fentanyl to methadone.
  • Assessed methadone dose corrections, signs of withdrawal, unrelieved pain, or oversedation within six days post-conversion.

Main Results:

  • The mean oral morphine to oral methadone conversion ratio was 23.7:1 (median 18.8:1).
  • 57.8% of patients had adequate conversion, while 41.7% appeared undermedicated.
  • No significant associations found between conversion ratios and initial morphine dose or duration of therapy.

Conclusions:

  • Pediatric methadone conversion dosing at this institution was lower than adult ratios.
  • A significant proportion of pediatric patients were undermedicated with methadone.
  • Further prospective research is necessary to establish safe and effective pediatric methadone conversion rates.
Abstract

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