• Alexandra Oschman, Tara McCabe, and Robert J Kuhn.
• Neonatal Intensive Care Unit, Clinical Pharmacist Specialist, Children’s Mercy Hospital and Clinics, Kansas City, MO 64108, USA. aoschman@cmh.edu
• Am J Health Syst Pharm. 2011 Jul 1;68(13):1233-8.

PurposeThe published literature on the use of dexmedetomidine as an adjunct to sedation and analgesia in the management of pediatric narcotic withdrawal was reviewed.SummaryPediatric 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 α(2)-receptor agonist with a mechanism of action similar to that of clonidine but with greater α(2)-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 μg/kg administered over 5-10 minutes, followed by a continuous infusion at 0.1-1.4 μg/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.ConclusionA 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.

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