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Utility of transdermal fentanyl for prevention of iatrogenic opioid abstinence syndrome in children

Peter N. Johnson, PharmD, BCPS, Donald Harrison, PhD, Christine Allen, MD


Background: Iatrogenic opioid abstinence syndrome (IOAS) can occur in critically ill infants/ children following abrupt discontinuation of opioids. There are no standard guidelines for the prevention of IOAS. Transdermal fentanyl (TF) has been infrequently used at our institution for the prevention of IOAS.
Methods: This was a retrospective, descriptive study of children less than 18 years of age receiving TF for the prevention of IOAS. Baseline demographics, IV sedative/analgesic regimen, TF regimen, and IOAS symptoms were collected. The primary objective was to describe the TF regimen. The secondary objectives were to classify the number/type of withdrawal symptoms and to identify the number of intermittent opioids administered for withdrawal symptoms.
Results: Fifteen patients were identified with a median age of 7 years (0.3-17); the median cumulative IV fentanyl dose prior to initiation of TF was 1,356 μg kg−1 (164.1-9595.8). The median initial dose of TF was 1.9 μg kg−1 h−1 (0.4-6.1) or 25 μg h−1 (12.5-500); TF was continued for a median duration of 16 days (5-27). To provide the desired dose, the TF patch was partially covered with Tegaderm™ in eight patients. Eighty-six intermittent opioid doses were administered during TF therapy with 51 (59 percent) administered within 5 days of TF initiation. Seven patients (46.7 percent) had IOAS. No significant differences in IOAS symptoms were observed between patients whose patch was partially covered versus not covered, 3 versus 4, respectively (p > 0.05). There was no correlation between the number of opioid doses administered and IOAS symptoms from days 1 to 5, correlation coefficient 0.347 (p = 0.206).
Conclusions: In this cohort, most patients required additional opioids for IOAS symptoms during the first 5 days of TF. TF therapy cannot be routinely recommended for the prevention of IOAS until further prospective studies can confirm these results. This pilot study highlights future directions to standardize documentation and to educate clinicians on IOAS symptoms.


children, transdermal fentanyl, opioid withdrawal

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