Pharmacometric Evaluation of Umbilical Cord Blood Concentration-Based Early Initiation of Treatment in Methadone-Exposed Preterm Neonates
| Autor: | Tamara van Donge, Karel Allegaert, Samira Samiee-Zafarghandy, John N. van den Anker |
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| Přispěvatelé: | Pharmacy, Pediatric Surgery |
| Rok vydání: | 2021 |
| Předmět: |
Drug
Pediatrics medicine.medical_specialty business.industry media_common.quotation_subject lcsh:RJ1-570 Gestational age neonatal abstinence syndrome lcsh:Pediatrics Umbilical cord Article dosing methadone medicine.anatomical_structure Opioid Pharmacokinetics preterm neonate Pediatrics Perinatology and Child Health medicine Dosing business Prospective cohort study medicine.drug Methadone media_common |
| Zdroj: | Children Children, 8(3):174. Multidisciplinary Digital Publishing Institute (MDPI) Volume 8 Issue 3 Children, Vol 8, Iss 174, p 174 (2021) |
| ISSN: | 2227-9067 |
| Popis: | In methadone-exposed preterm neonates, early identification of those at risk of severe neonatal abstinence syndrome (NAS) and use of a methadone dosing regimen that can provide effective and safe drug exposure are two important aspects of optimal care. To this end, we reviewed 17 methadone dosing recommendations in the international guidelines and literature and explored their variability in key dosing strategies. We selected three of the reviewed dosing regimens for their pharmacokinetics (PK) characteristics and their exposure-response relationship in three gestational age groups of preterm neonates (28, 32 and 36 gestational age weeks) at risk for development of severe NAS (defined as an umbilical cord methadone concentration of ≤60 ng/mL, following fetal exposure). We applied early (12 h after birth) vs. typical (36 h after birth) initiation of treatment. We observed that use of universally recommended dosing regimens in preterm neonates can result in under- or over-exposure. Use of a PK-guided dosing regimen resulted in effective target exposures within 24 h after birth with early initiation of treatment (12 h after birth). Future prospective studies should explore the incorporation of umbilical cord methadone concentrations for early identification of preterm neonates at risk of developing severe NAS and investigate the use of a PK-guided methadone dosing regimen, so that treatment failure, prolonged length of stay and opioid over-exposure can be avoided. ispartof: CHILDREN-BASEL vol:8 issue:3 ispartof: location:Switzerland status: published |
| Databáze: | OpenAIRE |
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