{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,14]],"date-time":"2026-03-14T05:27:03Z","timestamp":1773466023382,"version":"3.50.1"},"reference-count":34,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2012,1,24]],"date-time":"2012-01-24T00:00:00Z","timestamp":1327363200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["accpjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pharmacotherapy"],"published-print":{"date-parts":[[2012,2]]},"abstract":"<jats:p>Iatrogenic opioid abstinence syndrome (<jats:styled-content style=\"fixed-case\">IOAS<\/jats:styled-content>) is a common complication in critically ill infants and children receiving prolonged exposure to continuous infusions of opioids. Although no guidelines are available regarding management of <jats:styled-content style=\"fixed-case\">IOAS<\/jats:styled-content> in children, several treatment options are available, including clonidine, morphine, and methadone. Methadone is commonly prescribed due to its long half\u2010life and antagonism of the <jats:italic>N<\/jats:italic>\u2010methyl\u2010<jats:sc>d<\/jats:sc>\u2010aspartate receptor. Different approaches, such as weight\u2010based and formula\u2010based methods, have been used to determine the initial methadone dosing regimen. Because of the vast differences in the recommended dosing regimen from these sources, we conducted a literature search to identify articles evaluating the initial methadone dosing regimen for prevention and\/or treatment of <jats:styled-content style=\"fixed-case\">IOAS<\/jats:styled-content> in children. Specifically, we evaluated the reported frequency of withdrawal and oversedation after initiation of methadone treatment. Our literature search was limited to English\u2010language articles in the <jats:styled-content style=\"fixed-case\">MEDLINE<\/jats:styled-content> (1950\u2013March 2011), <jats:styled-content style=\"fixed-case\">EMBASE<\/jats:styled-content> (1988\u2013March 2011), International Pharmaceutical Abstracts (1970\u2013March 2011), and Cochrane Library (1996\u2013March 2011) databases. Relevant abstracts and reference citations were also reviewed. A total of eight reports representing 183 patients were included in the analysis. There was wide discrepancy in the initial methadone dosing regimen. Approximately one\u2010third of all patients experienced withdrawal after starting methadone, and there did not appear to be a difference between weight\u2010based and formula\u2010based regimens. Seven patients experienced oversedation; however, not all articles reported this complication. It appears that a standard approach to initial methadone dosing does not exist because withdrawal occurred despite the regimen started. Therefore, it seems best to begin with the lowest dose possible and titrate to the child's response to avoid complications such as oversedation. Routine monitoring should be performed in all patients to guide clinicians in the management of <jats:styled-content style=\"fixed-case\">IOAS<\/jats:styled-content>.<\/jats:p>","DOI":"10.1002\/phar.1001","type":"journal-article","created":{"date-parts":[[2012,9,5]],"date-time":"2012-09-05T03:56:31Z","timestamp":1346817391000},"page":"148-157","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":24,"title":["Selection of the Initial Methadone Regimen for the Management of Iatrogenic Opioid Abstinence Syndrome in Critically Ill Children"],"prefix":"10.1002","volume":"32","author":[{"given":"Peter N.","family":"Johnson","sequence":"first","affiliation":[{"name":"Department of Pharmacy Clinical and Administrative Sciences University of Oklahoma College of Pharmacy  Oklahoma City Oklahoma"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Krystal A.","family":"Boyles","sequence":"additional","affiliation":[{"name":"US Air 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