Dose:  0.10 mg/kg/dose PO (see comments and methadone weaning sheet)

Frequency: Q 6 to 24 hours           

Comments: Methadone is a narcotic analgesic that can be used for the treatment of neonatal abstinence syndrome, whether iatrogenic or caused by maternal use of narcotics during pregnancy (whether she is using opiod medications for pain relief, using methadone as part of a methadone maintenance program, or has used unprescribed opioids).  Babies with persistent pulmonary hypertension or complicated surgical procedures may receive high doses of narcotics (fentanyl or morphine) or a prolonged course of treatment with narcotics. Regardless of the method of exposure, physical dependence can occur, and withdrawal is miserable for the infants.   Replacement therapy eases symptoms.  Specific dosing recommendations can be found in  comments on methadone.   Methadone is slowly metabolized in the liver producing long periods of analgesia.  It can also be used for postoperative pain relief, and intractable pain relief. 

We have experience with probably a dozen patients annually in this situation.   Previously, dispensing guidelines individualized a separate preparation for each infant.   We still recommend this for patients who go home on therapy.    For hospitalized patients we standardize on two concentrations of each drug.    Our experience has shown that we can give a measureable, but not excessive dose volume throughout the course of weaning from the drug with these concentrations.  

Toxicity: The most common adverse effects are similar to those seen with morphine and include somnolence, nausea, vomiting, urinary retention, and constipation.  Common adverse effects of morphine and dependence and withdrawal.

Preparation: Methadone is in the dispensing cabinet as 100 mcg/ml and 500 mcg/ml in 1 ml oral liquid syringes. Stable at room temperature.

For home use, consider diluting the dose at discharge to a final volume of 1 ml. A spreadsheet/weaning guideline has been written to make a comprehensive calendar for the family to follow in gradually weaning the drug.

Methadone is a CONTROLLED SUBSTANCE.  Two concentrations of each drug are set up in PharmNet and the Omnis in both NICU North and NICU South.  There is no longer a need to label these for specific patients.   There is every need to take great care in diluting, packaging, labeling and stocking the cabinets to avoid mixing up the two concentrations.  The pharmacy prepares 60 ml diluted bulk bottles and 1 ml syringes which have 45 day expiration dates. NarcTracker requires that the volume of stock drug be signed out to compounding, and that the finished products be “purchased” into the software, then issued to NICU. Work with the Omni tech to see how many to dispense at a time.  They are hard to fit into the drawer.   

Methadone                        Methadone              Volume
Final concentration          Vol. 1 mg/ml                SW                               

100 mcg/ml                          6 ml                            54 ml

Compatibility: Parenteral form is compatible with normal saline only. It is incompatible with aminophylline, heparin, methacillin, phenobarbital, phenytoin, and sodium bicarbonate.