Neonatal Drug Therapy Manual


Disclaimer: Official controlled document is the CHEO and Ottawa Hospital online copy. It is the responsibility of user to ensure that any paper copy version is the same as the online version before use.

Alternate Name(s): 
Analgesic, Narcotic
Original Date: 
May 2009
Revised Date: 
June 2011
  • Neonatal Narcotic Abstinence Syndrome
  • Weaning from long-term narcotics: will facilitate wean from IV opioids to long acting oral opioids
  • PO
  • Neonatal Narcotic Abstinence Syndrome: 0.05 - 0.2 mg/kg/dose Q12H or Q24H.
    • Individualize dose and tapering schedule to control symptoms of withdrawal; usually taper dose by 10% to 20% per week over 1 to 1.5 months
  • Analgesia (stepdown from IV opioids): 0.1 mg/kg/dose
    • Dosing interval may range from Q4-12 H during initial therapy
    • Decrease in dose or frequency may be required (approximately 2-5 days after initiation of therapy or dosage increase) due to accumulation with repeated doses
Side Effects: 
  • CNS: CNS depression, elevated intracranial pressure
  • CVS: hypotension, bradycardia, peripheral vasolidation. prolongation of QT interval, torsade de pointes
  • Endocrine and metabolic: antidiuretic hormone release
  • Genitourinary: urinary tract spasm
  • GI: ileus and delayed gastric emptying, constipation, xerostomia
  • Ocular: miosis
  • Respiratory: respiratory depression
Parameters to Monitor: 
  • Respiratory, cardiovascular and mental status
  • Pain relief
  • Abstinence scoring system (if used for neonatal abstinence syndrome)
Reconstitution and Stability: 





**Restricted to physicians who have Methadone prescribing privileges per Health Canada


-Taketomo CK, Hodding JH, Kraus DM. Pediatric Dosage Handbook 16th Edition. Hudson: Lexi-Comp Inc.; 2009

-Young TE, Mangum B. Neofax®. 20th edition. Raleigh: Acorn Publishing; 2007

-Zenck KE, Sills JH, Koeppel RM. Neonatal Medications & Nutrition, 3rd edition. Santa Rosa, California; NICU INK Book Publishers, USA, 2003

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