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Switching a baby from IV levomethadone to IV fentanyl

Hans Ulrich Bender1, Hans-Georg Muench2, Claudia Franziska Nussbaum2

  • 1Center for Pediatric Palliative Care, Dr. von Hauner Children's Hospital, University of Munich Medical Center, Ludwig-Maximilians-University, Munich, Germany.

Journal of Opioid Management
|April 23, 2021
PubMed

Insights

This case study details switching a preterm infant from levomethadone to fentanyl for opioid withdrawal. It suggests a conversion ratio and highlights critical steps for neonates during opioid rotation.

Area of Science:

  • Pediatric intensive care
  • Neonatal pharmacology
  • Pain management

Background:

  • Levomethadone is used for iatrogenic opioid withdrawal in pediatric intensive care units.
  • Limited data exists on opioid rotation from methadone in pediatric patients.
  • Switching opioids in critically ill neonates requires careful consideration.

Purpose of the Study:

  • To report the successful switch from intravenous levomethadone to intravenous fentanyl in a critically ill preterm infant.
  • To identify a potential conversion ratio for this specific opioid rotation in neonates.
  • To emphasize critical steps for safe opioid rotation in unstable infants.

Main Methods:

  • Case report of a preterm infant in unstable condition undergoing opioid withdrawal management.
  • Switch from intravenous levomethadone to intravenous fentanyl.
  • Careful titration and dose adjustment based on clinical response.

Main Results:

  • A possible levomethadone to fentanyl conversion ratio of 6.0-4.5:1 was identified.
  • Successful transition to fentanyl was achieved, managing the infant's condition.
  • Critical steps included ensuring equipotency and dose reduction for incomplete cross-tolerance.

Conclusions:

  • This case provides initial data on levomethadone to fentanyl conversion in neonates.
  • Equipotency and dose reduction are crucial for safe opioid rotation in unstable infants.
  • These observations may guide clinical practice when managing opioid withdrawal in neonates.

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