Dexmedetomidine for opioid and benzodiazepine withdrawal in pediatric patients

Alexandra Oschman, Tara McCabe, Robert J. Kuhn

Research output: Contribution to journalReview articlepeer-review

33 Scopus citations

Abstract

Purpose. The published literature on the use of dexmedetomidine as an adjunct to sedation and analgesia in the management of pediatric narcotic withdrawal was reviewed. Summary. Pediatric narcotic withdrawal syndromes are reported to be increasingly frequent in pediatric intensive care units. A number of tools specifically designed for assessment of withdrawal in newborns and infants are in current use, including the widely used Finnegan Scoring System. A limited number of studies and case reports suggest that dexmedetomidine, an a2-receptor agonist with a mechanism of action similar to that of clonidine but with greater a2-receptor specificity, might have a role in the treatment of pediatric withdrawal (by blunting withdrawal symptoms without causing respiratory depression and by permitting shorter narcotic tapering schedules) and also in the prevention of pediatric narcotic withdrawal (by reducing narcotic requirements). Potential adverse effects associated with dexmedetomidine use in pediatric patients are generally associated with use of bolus doses and mainly involve central nervous system effects (e.g., hypotension, bradycardia), with no hemodynamic manifestations. When bolus doses are used, strategies described in published reports entail a loading dose of 0.5-1.0 mg/kg administered over 5-10 minutes, followed by a continuous infusion at 0.1-1.4 mg/kg/hr for a period of 1-16 days. More research is needed to define the optimal use of dexmedetomidine in the management of pediatric narcotic withdrawal. Conclusion. A limited body of published evidence from retrospective studies and case reports suggests a potential role for dexmedetomidine as an adjunct therapy to provide sedation and analgesia to reduce narcotic withdrawal symptoms in pediatric patients.

Original languageEnglish
Pages (from-to)1233-1238
Number of pages6
JournalAmerican Journal of Health-System Pharmacy
Volume68
Issue number13
DOIs
StatePublished - Jul 1 2011

Keywords

  • Benzodiazepines
  • Dexmedetomidine hydrochloride
  • Dosage
  • Drug withdrawal
  • Hospitals
  • Mechanism of action
  • Opiates
  • Pediatrics
  • Sympathomimetic agents
  • Toxicity

ASJC Scopus subject areas

  • Pharmacology
  • Health Policy

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