NAS and phenobarbital

Will my baby withdraw? Is my baby addicted? Can I have an epidural on Suboxone? Will buprenorphine hurt my baby? Can I breast feed on Suboxone? What medication-assisted treatment is best?
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won
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NAS and phenobarbital

Post by won » Wed Mar 11, 2015 4:15 am

Hi,

my boy is born and actually healthy. But he suffered from NAS after 2 days and the docs gave him phenobarbital. I still have to give it to him 2 times daily 2,5 ml (10 mg). They say he will grow out of it and it can be stopped after 3 months or so. Anybody any experiences with this?

I actually dont understand why I cant reduce the dose already.

And I would like to hear the opinion of suboxdoc, please.

Have a good day,

Won

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Amy-Work In Progress
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Re: NAS and phenobarbital

Post by Amy-Work In Progress » Thu Mar 12, 2015 5:07 pm

Hi Won. Welcome!

I have never heard of NAS symptoms being treated with phenobarbital. And I don't know why he can't be weaned any faster. I assume since you're administering his doses that they let you take him home, which is great!

If suboxdoc doesn't reply within a few days, go ahead and PM him.

Amy
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Re: NAS and phenobarbital

Post by docm2 » Thu Mar 12, 2015 6:03 pm

NAS, if treated is with morphine.
●Our management approach, which is provided by a multidisciplinary team, includes the following (see 'Our approach' above):


•Initial treatment of all substance-exposed infants is supportive and directed to facilitate the infant’s efforts to promote physiologic stability and organization, and competency to interact with his/her environment. These efforts typically include decreasing sensory stimulation, providing adequate nutrition, and prevention of skin excoriation. (See 'Supportive care' above.)


•We suggest that the severity of NAS be assessed by using a clinically verified scoring system (form 1) (Grade 2C). (See 'Scoring systems' above.)


•Pharmacologic therapy is indicated for infants who, despite adequate supportive care, display significant NAS symptomatology that exceeds predetermined criteria (form 1).


•If pharmacologic treatment is used, we suggest that the initial drug of choice be an opioid agent (table 1) (Grade 2B). Although the choice of opioid therapy is clinician dependent, we do not recommend the use of paregoric, as it contains potentially harmful compounds (Grade 1A). (See 'Opioid therapy' above.)


•Second medications may be required if the infant’s display is not adequately controlled on single medication therapy (table 2). Choices for second line drugs include phenobarbital and clonidine. (See 'Second drug therapy' above.)

Me again - phenobarb is 2nd line and an add on to morphine or methadone for severe NAS.
You need to clarify why this was started, if not resolved get a second opinion from your pediatrician and perhaps it can be weaned much sooner. I would think it is quite rare that NAS from buprenorphine would need treatment (if needed) beyond a few day course of morphine. Was there prolonged exposure to benzodiazepines or other substances found on a tox screen done at delivery?
In the guidelines phenobarb may be used if multidrug exposure occurred.

won
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Re: NAS and phenobarbital

Post by won » Sun Mar 15, 2015 4:16 am

No, no other drugs ...

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Re: NAS and phenobarbital

Post by suboxdoc » Sun Mar 15, 2015 4:27 pm

I sent a PM, and agree with my colleague. Phenobarb is an anticonvulsant primarily used to treat seizures. I've seen it used in newborns who had seizures caused by a number of conditions, including withdrawal from benzos (valium, Xanax, Klonopin, etc). For opioid withdrawal, I assume that they are using it as a general sedative, to help your baby sleep and stay calm. It is not usually used for opioid withdrawal, unless a baby is very agitated-- or unless the baby is also coming off sedative drugs or alcohol.

Phenobarb has been around for a long time, so I think it is possible that some areas consider it a minor issue to give it to a baby, as a minor sedative. I remember an area pediatrician who would have moms of colicky babies give the baby a small amount of whiskey, mixed with sugar (?). There are so many bizarre practice patterns out there...

I don't know your personal situation, so I cannot give medical advice. BUT... if your baby had seizures, it is important to continue the phenobarb for however long they said. If your baby did NOT have seizures, and you did not use other drugs, they are probably recommending the phenobarb to help your baby deal with the lingering effects of opioid withdrawal. If the baby is agitated and not sleeping at all, phenobarb might be helpful. If the baby is acting like any other baby--- i.e. waking to feed every 4 hours but then going back to sleep at night, and having moments of calm and moments of crying... then the phenobarb probably isn't important. I recommend that you tell your pediatrician that you would like to taper off the phenobarb, to see how the baby does. I would think the pediatrician could taper it off over a few days without any problems.

won
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Re: NAS and phenobarbital

Post by won » Mon Mar 16, 2015 11:17 am

Today the pediatrician allowed us to stop the pheno. And no, no seizures and no other drugs or things like that. So I guess it is okay to just stop.

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