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Iatrogenic Opiate Withdrawal in Pediatric Patients: Implementation of a Standardized Methadone Weaning Protocol and
Ryan A Walters1, Michael Izquierdo1, Juan Carlos Rodriguez1
1Department of Pharmacy, 23454Joe DiMaggio Children's Hospital, Hollywood, FL, USA.
Insights
Implementing a standardized methadone weaning protocol significantly reduced methadone exposure in pediatric patients. This protocol helps manage opiate withdrawal symptoms effectively.
Area of Science:
- Pediatric pharmacology
- Pain management
- Clinical protocol development
Background:
- Methadone is used to manage opiate withdrawal symptoms.
- Lack of standardized weaning strategies can lead to prolonged narcotic exposure and withdrawal.
- Pediatric patients receiving continuous opiate infusions require effective weaning protocols.
Purpose of the Study:
- To evaluate the impact of a standardized methadone weaning protocol and withdrawal assessment tool.
- To quantify changes in methadone exposure and opiate withdrawal in pediatric patients.
- To compare outcomes before and after protocol implementation.
Main Methods:
- A pre- and post-intervention study design was used.
- Pediatric patients receiving continuous morphine or fentanyl infusions for >=5 days were included.
- The post-intervention group received a standardized methadone wean (5 or 10 days) and withdrawal monitoring (WAT-1).
Main Results:
- Total methadone duration significantly decreased from 17 days to 5 days (P=.00001).
- No significant change in the number of morphine boluses administered (P=0.45).
- Significant reductions in overall methadone exposure were observed post-intervention.
Conclusions:
- A standardized methadone weaning protocol effectively reduces methadone exposure in pediatric patients.
- The protocol aids in managing opiate withdrawal symptoms.
- Standardized protocols are crucial for optimizing medication use in pediatric care.
Abstract:
Methadone is frequently used to prevent withdrawal symptoms secondary to intended therapeutic opiate exposure. Absence of a standardized dose weaning strategy potentially results in increased exposure to narcotics and/or withdrawal symptoms. We sought to quantify the effect of implementing a standardized methadone weaning protocol and withdrawal assessment tool on methadone exposure and opiate withdrawal in pediatric patients receiving 5 or more days of continuous morphine or fentanyl infusions. The preintervention phase included patients weaned off of opiate infusions before implementation of a standardized weaning protocol and withdrawal symptom scoring tool. Patients in the postintervention phase were started on a standardized methadone wean based on total duration and dose of continuous opiate infusion exposure in the 24 hours preceding methadone initiation. Patients received either a 5- or 10-day wean, with the total daily methadone dose reduced by 20% daily or every other day, respectively. Patients in the postintervention phase were monitored for withdrawal using the withdrawal assessment tool (WAT-1). Postintervention patients were compared to preintervention patients treated with methadone. Total methadone duration decreased significantly from a median of 17 (13-22 interquartile range [IQR]) to 5 (5-10 IQR) days (P = .00001) after implementation of the methadone weaning protocol. Number of morphine boluses administered increased from a median of 3 (0-6 IQR) to 4 (0-5 IQR) doses per patient (P = .45). Demographic data were similar between both groups. Patients in the postintervention phase had significant reductions in methadone exposure after implementation of a standardized methadone weaning protocol and assessment tool.
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