Switching a baby from IV levomethadone to IV fentanyl

Hans Ulrich Bender, MD; Hans-Georg Muench, MD; Claudia Franziska Nussbaum, MD

doi:10.5055/jom.2021.0627

Authors

Hans Ulrich Bender, MD
Hans-Georg Muench, MD
Claudia Franziska Nussbaum, MD

DOI:

https://doi.org/10.5055/jom.2021.0627

Keywords:

child, opioid rotation, levomethadone, fentanyl, neonatal intensive care

Abstract

Methadone, or in Germany levomethadone, may be used for the treatment of iatrogenic opioid withdrawal syndrome in pediatric intensive care units. The limited literature on opioid rotation in children does not provide data for the switch from methadone to another opioid. We report switching a very ill preterm baby in an unstable condition from IV levomethadone to IV fentanyl identifying a possible conversion ratio of 6.0-4.5:1 emphasizing critical steps as equipotency appropriate for neonates and dose reduction for incomplete cross-tolerance. If clinical deterioration occurs in infants on opioid tapering with levomethadone, we hope that our observations may be helpful.

Author Biographies

Hans Ulrich Bender, MD

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

Hans-Georg Muench, MD

Neonatology and Neonatal Intensive Care, Dr. von Hauner Children’s Hospital, University of Munich Medical Center, Ludwig-Maximilians-University, Munich, Germany

Claudia Franziska Nussbaum, MD

Neonatology and Neonatal Intensive Care, Dr. von Hauner Children’s Hospital, University of Munich Medical Center, Ludwig-Maximilians-University, Munich, Germany

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