UMEM Educational Pearls

Category: Toxicology

Title: Buprenorphine/naloxone (Suboxone) exposure in pediatric population

Keywords: buprenorphine exposure, pediatrics, retrospective study (PubMed Search)

Posted: 10/26/2016 by Hong Kim, MD, MPH (Emailed: 10/27/2016)
Click here to contact Hong Kim, MD, MPH

Takeaways

Recently, a retrospective study of unintentional buprenorphine/naloxone exposure among pediatric population was published. All patients were evaluated by toxicologists at the time of initial hospital presentation (or transfer) at the study center.

 

Bottom line

  • 83% and 80% of the patients experienced respiratory and CNS depression, respectively.
  • Majority of the patients became symptomatic within 8 hours of exposure (range not available).
  • Naloxone reversed respiratory depression. Median dose for single naloxone dose: 0.09 mg/kg; median dose for multiple naloxone doses: 0.19 mg/kg.
  • The reported “ceiling effect” on respiratory depression in adult does not exist in pediatric population.
  • The optimal time of observation is unclear but it is prudent to observe pediatric buprenorphine exposure for up to 24 hours.

In-Depth

A retrospective study of single center/referral center’s toxicology consultation service.

88 patients were included. (median age: 24 months [range: 10 to 77 months]). Majority were transferred from other hospitals.

Sources of the medication were

  1. Primary caregiver (65%)
  2. Other relatives (17%)
  3. Parent’s friends (14%)

 

Clinical effects

  • Respiratory depression: 83%
  • SpO2 < 93%: 28%
  • CNS depression: 80%
  • Miosis: 77%
  • Emesis: 45%
  • Agitation: 5%

 

Naloxone

  • 55% of the patients received naloxone
  • Two patients received naloxone 8 – 12 hours and >12 hours after exposure due to respiratory depression.

The median hospital stay was 22 hours (7 - 248 hours).

  • 41% (n = 36) were admitted to ICU.
  • The reported exposure dose was the only factor that was significantly associated with length of stay in a multivariate analysis (other variables: sex, age and time to presentation)

 

 

References

 2016 Oct 19:1-6. [Epub ahead of print]

Clinical effects of unintentional pediatric buprenorphine exposures: experience at a single tertiary care center.