Methadone mothers

Senay EC Methadone maintenance treatment. Int J Addict 20 803—821, 1985 Senay EC, Dorus W, Goldberg F, et al Withdrawal from methadone maintenance rate of withdrawal and expectation. Arch Gen Psychiatry 34 361—367, 1977 Sharpe C, Kuschel C Outcomes of infants born to mothers receiving methadone for pain management in pregnancy. Arch Dis Child Fetal Neonatal Ed 89 F33—F36, 2004... 

The clinical characteristics of newborns exposed prenatally to PCP are similar to behavior patterns of infants born addicted to heroin and/or methadone. In 1973, Wilson et al. described the early development of infants of heroin-addicted mothers. The neuro-behavioral symptoms of the newborn included tremors, irritability,... 

The effects of PCP, heroin, and methadone upon the developing fetus may indeed be different. We have found that the PCP infants are more deviant in their development than the reported development of the heroin and methadone infants. Our concerns about stating that drug use by the mothers during pregnancy does not affect developmental outcome are great. 

Some P-gp inhibitors have been tested in clinical trials (e.g., GF120918, PSC 833) [88, 89], Shortly before birth, it is often desirable to expose the fetus to anti-HIV medications to prevent HIV transmission from the mother to the fetus during delivery. Preperfusion with P-gp inhibitors increased fetal penetration of the protease inhibitor saquinavir in in vitro placental models, and it has been hypothesized that P-gp may be responsible for limiting fetal exposure to HIV protease inhibitors, methadone, anthracyclines, and taxanes [90-93],... 

Methadone Significant (See heroin.) Under close physician supervision, breast-feeding can be continued. Signs of opioid withdrawal in the infant may occur if mother stops taking methadone or stops breast-feeding abruptly. 

Alcohol ingested by the pregnant woman reaches comparable levels in mother and fetus, but may disappear from the fetus at a much lover rate than from the mother because of accumulation in the amniotic fluid (refs. 60, 69, 70). Hutchings (ref. 49) found indications that prenatally administered methadone accumulated and persisted in neonatal rat brain and liver for long periods, while the half life of this substance in adult rat plasma was only a few hours. 

Exposure to methadone throughout gestation and lactation decreased shuttlebox performance in rats at the age of 6 weeks (ref. 154). Exposure to ethanol through the mother s milk on days 0-17 decreased shuttlebox acquisition of rats at the age of 75 days (ref. 155). 

The neonatal abstinence syndrome occurs in 30-80% of infants whose mothers have taken opiates during pregnancy. The incidence is higher in those whose mothers have a history of opioid dependence and are taking methadone maintenance than in those who are taking methadone for chronic pain (39). The methadone blood concentration may be a useful predictor of the likelihood of severe withdrawal requiring treatment, but clinical assessment by a standardized scoring system is still required to determine the need to treat the neonatal abstinence syndrome (40). 

A newborn girl born of an HIV-positive mother who took antiretroviral drugs and methadone during pregnancy developed a methadone abstinence syndrome at day 7 (43). She was HIV-negative and was treated symptomatically for 15 days with chlorpromazine. The platelet count was 1049 x 109/1 on day 17 and fell progressively to 290 x 109/1 at 8 weeks. The authors suggested that the thrombocytosis had been secondary to intrauterine methadone exposure. 

In a randomized controlled trial in 18 pregnant women in the second trimester, a change from short-acting morphine to methadone or buprenorphine was explored (44). The transition was accomplished without any adverse events in mother or fetus and with minimal withdrawal discomfort. 

Methadone maintenance treatment is considered to be a medically safe treatment with relatively few and minimal adverse effects. However, the danger of serious adverse effects and death with the increasing use of methadone as maintenance therapy in drug addicts has been highlighted. It must be emphasized that a daily maintenance dose of 50-100 mg is toxic in a non-tolerant adult and as little as 10 mg can be fatal in a child. There is an increasing number of reports of the deaths of children of mothers on maintenance therapy from inadvertent ingestion. 

Sharpe C, Kuschel C. Outcomes of infants bom to mothers receiving methadone for pain management in pregnancy. Arch Dis Child Fetal Neonatal Ed 2004 89 F33-F36. 

In 41 children bom to methadone-maintained mothers and 23 children from matched controls at 6 months of age, there was delayed motor development in methadone-exposed infants and greater vulnerability of males to adverse environmental conditions in adult male rats there was a correlation between early methadone exposure and behavioral abnormalities (SED-11,138) (81). 

Rosen TS, Johnson HL. Children of methadone-maintained mothers follow-up to 18 months of age. J Pediatr 1982 101(2) 192-6. 

In Austria, a 1997 evaluation reported that buprenorphine can be prescribed for pregnant women since babies born to mothers taking the substance do not demonstrate opiate-related abstinence syndromes as do babies of mothers taking methadone. 

Opioids (especially methadone and heroin) are the most common cause of serious neonatal drug withdrawal symptoms. Other dmgs for which a withdrawal syndrome has been reported include phencyclidine (POP), cocaine, amphetamines, tricyclic antidepressants, phenothiazines, benzodiazepines, barbiturates, ethanol, clonidine, diphenhydramine, lithium, meprobamate, and theophylline. A careful dmg history from the mother should include illicit drugs, alcohol, and prescription and over-the-counter medications, and whether she is breast-feeding. 

Some hours later, in the early afternoon, a nurse came into Josie s room with a syringe of methadone. Josie s mother mentioned the earlier directive that she had heard, about no narcotics, but the nurse replied that the order had been changed, and the drug was administered. 

Drag withdrawal A 2-year-old toddler developed buprenorphine withdrawal after having been given two-thirds of a 2-mg buprenorphine tablet daily from birth by its mother [202 ]. She was irritable and inconsolable and was imable to sleep. She had typical features of opioid withdrawal and was eventually maintained on methadone 1 mg/day. 

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