Dosing and monitoring of methadone in pregnancy: literature review.

Filed under: Methadone Treatment

Can J Hosp Pharm. 2012 Sep; 65(5): 380-6
Shiu JR, Ensom MH

The pharmacokinetics of methadone is altered during pregnancy, but the most appropriate dosing and monitoring regimen has yet to be identified.To review dosing and monitoring of methadone therapy in pregnancy.A literature search was performed in several databases (PubMed, MEDLINE, Embase, International Pharmaceutical Abstracts, and the Cochrane Database of Systematic Reviews) from inception to May 2012. The search terms were “methadone”, “pregnancy”, “pharmacokinetic”, “clearance”, “metabolism”, “therapeutic drug monitoring”, and “methadone dosing”. Additional papers were identified by searching the bibliographies of primary and review articles. All English-language primary articles related to methadone pharmacokinetics in pregnancy were included. Articles not related to maternal outcomes were excluded.The literature search yielded 1 case report and 10 studies discussing use of methadone by pregnant women. Methadone pharmacokinetics in pregnancy has been studied in 3 pharmacokinetic trials, and split dosing of methadone in pregnant women has been described in 1 case report and 3 dosing trials. Only 4 trials evaluated monitoring of methadone concentration in pregnancy. The studies included in this review confirm that methadone pharmacokinetics is altered in pregnancy and is potentially correlated with increases in maternal withdrawal symptoms. Insufficient evidence is available to warrant routine monitoring of serum methadone concentrations in pregnant women with opioid dependence.Few studies of methadone pharmacokinetics and therapeutic drug monitoring are available for pregnant women with opioid dependence. Although it is known that methadone pharmacokinetics is altered in pregnancy, there is insufficient evidence to guide dosage adjustments and serum concentration monitoring. Until further studies are available, regular follow-up of maternal withdrawal symptoms and empiric dosage adjustments throughout pregnancy are still recommended.
HubMed – Methadone

Buprenorphine May Not Be as Safe as You Think: A Pediatric Fatality From Unintentional Exposure.

Filed under: Methadone Treatment

Pediatrics. 2012 Nov 5;
Kim HK, Smiddy M, Hoffman RS, Nelson LS

Buprenorphine is a partial ?-opioid receptor agonist that is approved for the treatment of opioid dependency. It is generally believed to be safer than methadone because of its ceiling effect on respiratory depression. As more adults in US households use buprenorphine, an increasing number of children are being exposed. We report a fatal exposure to buprenorphine in a small child that occurred after ingestion of a caretaker’s buprenorphine/naloxone. Postmortem toxicology analysis showed free serum concentrations of 52 ng/mL and 39 ng/mL for buprenorphine and norbuprenorphine, respectively. No other drugs were detected. Autopsy did not find signs of injury or trauma. The theoretical safety provided by the ceiling effect in respiratory depression from buprenorphine may not apply to children, and buprenorphine may cause dose-dependent respiratory depression.
HubMed – Methadone

Profiles of quality of life in opiate-dependent individuals after starting methadone treatment: A latent class analysis.

Filed under: Methadone Treatment

Int J Drug Policy. 2012 Nov 2;
De Maeyer J, van Nieuwenhuizen C, Bongers IL, Broekaert E, Vanderplasschen W

BACKGROUND: This study aimed to identify classes of quality of life (QoL) among opiate-dependent individuals five to ten years after starting methadone treatment in order to tailor services to the needs of this population. METHODS: A cross-sectional study of 159 opiate-dependent individuals who started outpatient methadone treatment in the region of Ghent, Belgium, between 1997 and 2002. A face-to-face structured interview was administered based on the Lancashire Quality of Life Profile, the EuropASI, Brief Symptom Inventory and the Verona Service Satisfaction Scale for Methadone Treatment. Latent class analysis was used to determine patterns of QoL. Analyses of variance and chi-square tests were used to test whether class membership was related to socio-demographic, health- and drug-related variables. RESULTS: Based on fit criteria, a three-class model was selected. Class Low (14.5%), ‘opiate-dependent individuals living in marginal conditions’, is characterised by low QoL scores on all domains. Class Intermediate (25.8%), ‘stabilized, but socially excluded opiate-dependent individuals’ shows high scores on the domains ‘safety’ and ‘living situation’, but low scores on all other QoL domains. Class High (59.7%), ‘socially included opiate-dependent individuals’, is characterised by high QoL scores on all domains, except ‘finances’. CONCLUSION: The findings of this study illustrate the existence of different profiles of QoL among opiate-dependent individuals after starting methadone maintenance treatment and demonstrate the need for a continuing care approach. Insight into distinct classes of QoL can be used to design person-centred support, relevant to an individual’s personal life.
HubMed – Methadone

Andy Warhol’s “Trash” 1970 – Welfare scene – Andy Warhol’s “Trash” 1970 – Welfare scene Directed and written by filmmaker Paul Morrissey. The movie stars Joe Dallesandro, transsexual Holly Woodlawn and Jane Forth. The movie follows Joe (Dallesandro), a heroin addict, throughout his quest to score more drugs. The episodic plot occurs over a single day and centers around Joe’s problematic relationship with his on-off, sexually frustrated girlfriend (Woodlawn). During the course of the day, Joe overdoses in front of an upper-class couple, attempts to fool Welfare into approving his methadone treatment by having Holly fake a pregnancy, and frustrates the women in his life with his drug-induced impotence.

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