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Neonatal abstinence syndrome: use of clonazepam?

Journal of Perinatology volume 35, page 891 (2015)Cite this article

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We read with interest the article entitled ‘Methadone versus morphine for treatment of neonatal abstinence syndrome: a prospective randomized clinical trial’.1 However, we were perplexed when clonazepam was referred to as a first-line adjunct treatment for the treatment of neonatal abstinence syndrome (NAS) when phenobarbital and clonidine are typically used as the standard of practice. The reference given2 cites the use of clonazepam from the adult literature describing the utility of benzodiazepines in the treatment of narcotic withdrawal, yet provides no explanation for its use in neonates.

Furthermore, upon investigating pediatric dosing of clonazepam for the treatment of seizure disorders (0.1 to 0.5 mg/kg/day daily in 2 to 3 divided doses)3 and clonidine for the treatment of NAS (0.5 to 1 μg/kg every 4 to 6 h),4, 5, 6 the dose of 0.005 mg/kg/dose given every 8 h does not seem to elucidate which agent was used, although the dosing may fall in line with pediatric dosing of clonazepam for the treatment of seizure disorders.

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References

  1. Brown MS, Hayes MJ, Thornton LM . Methadone versus morphine for treatment of neonatal abstinence syndrome: a prospective randomized clinical trial. J Perinatol 2015; 35 (4): 278–283.

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  2. Lintzeris N, Nielsen S . Benzodiazepines, methadone and buprenorphine: interactions and clinical management. Am J Addict 2010; 19: 59–72.

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  3. Lexicomp Online, Pediatric & Neonatal Lexi-Drugs. Lexi-Comp, Inc.: Hudson, OH, USA, 2015.

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  6. Agthe AG, Kim GR, Mathias KB, Hendrix CW, Chavez-Valdez R, Jansson L et al. Clonidine as an adjunct therapy to opioids for neonatal abstinence syndrome: a randomized, controlled trial. Pediatrics 2009; 123 (5): e849–e856.

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Authors and Affiliations

  1. Mylan School of Pharmacy, Duquesne University, Pittsburgh, PA, USA

    C Henderson & C Karnack

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  1. C Henderson
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  2. C Karnack
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Correspondence to C Henderson.

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Henderson, C., Karnack, C. Neonatal abstinence syndrome: use of clonazepam?. J Perinatol 35, 891 (2015). https://doi.org/10.1038/jp.2015.49

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