Metadona

Febrero 2022

Dosis

Sindrome de Abstinencia neonatal

Dosis Inicial : 0.05 - 0.1 mg/kg/dosis oral cada 6 a 24 horas

Adjust dose (in 10% to 20% increments) and weaning schedule based on signs and symptoms of withdrawal.

Protocolo de Weaning

Gestational age, 34 weeks or more

Start at step 1 for infants with 3 consecutive Finnegan scores 8 or more or 2 consecutive

Finnegan scores 12 or more :

Step 1: 0.1 mg/kg orally every 6 hours for 4 doses

Step 2: 0.07 mg/kg orally every 12 hours for 2 doses

Step 3: 0.05 mg/kg orally every 12 hours for 2 doses

Step 4: 0.04 mg/kg orally every 12 hours for 2 doses

Step 5: 0.03 mg/kg orally every 12 hours for 2 doses

Step 6: 0.02 mg/kg orally every 12 hours for 2 doses

Step 7: 0.01 mg/kg orally every 12 hours for 2 doses

Step 8: 0.01 mg/kg orally every 24 hours for 1 dose

Weaning

Wean to the next step if the average Finnegan score is less than 8 for the past 24 hours

If the average Finnegan score is 8 to 12, do not wean

If the average Finnegan score is at least 12, consider an extra dose of methadone at the current step, or return to previous step

Escalation

If the infant fails step 1 (score of greater than 12), consider steps 1A through 1C

Step 1A: 0.1 mg/kg orally every 4 hours for 6 doses

Step 1B: 0.1 mg/kg orally every 8 hours for 3 doses

Step 1C: 0.1 mg/kg orally every 12 hours for 2 doses

Adjunct:

Consider adding phenobarbital if unable to wean for 2 consecutive days

Discharge

Observe for 72 hours from the last dose of step 8

Dose Adjustments

Liver Impairment: Consider lower initial dose and titrate slowly .

Renal Impairment: Consider lower initial dose with longer dosing interval and titrate slowly

Contraindications

Significant respiratory depression, in the absence of resuscitative equipment or in unmonitored settings

Acute or severe bronchial asthma in an unmonitored setting or in the absence of resuscitative equipment

Known or suspected paralytic ileus

Known or suspected gastrointestinal obstruction

Referencia

Neofax 2020