Evaluating the Effectiveness of Naloxone Infusion Therapy for Opioid, Clonidine Ingestion in Children

Although naloxone can be used to treat both opioid and clonidine ingestions in children, the initial dosing and titration strategies vary and are often extrapolated from adult studies or based on a handful of pediatric case reports. A poster presented at the Pediatric Pharmacy Association’s 2022 Annual Meeting in Norfolk, Virginia examined the initial dosing range of naloxone continuous infusion for opioid and clonidine ingestions.

Investigators conducted a retrospective chart review of patients who were diagnosed with known or suspected opioid or clonidine ingestion and had received a continuous naloxone infusion for ingestion in the emergency department. Patients were younger than 18 years of age and had been treated at Nationwide Children’s Hospital in Columbus, Ohio.

Fourteen patients were included in the study cohort, 7 girls and 7 boys, with a median age of 1.4 years. Naloxone infusion was used for 11 cases of opioid ingestion and 3 cases of α-agonist ingestion. For the opioid cases, the median time of first titration was 1.65 hours and the median duration of treatment was 10 hours, with a symptom duration of 12 hours. The median initial rate (mcg/kg/hr) was 28, with a max rate of 50 (mcg/kg/hr) and a ratio of intermittent doses of 0.4.

For the cases of α-agonist ingestion, the median time of first titration was 1.47, with a duration of 4 hours and symptom resolution at a median of 20 hours. The median initial rate (mcg/kg/hr) was 28, with a max rate (mcg/kg/hr) and a ratio of intermittent doses was 0.4. The median initial rate (mcg/kg/hr) was 24 with a max rate of 50 (mcg/kg/hr) and a ratio of intermittent doses was 0.23. Therapies that were used concurrently included bagging/oxygen in 6 patients, intubation in 1 patient, fluids in 14 patients, and atropine in 1 patient.

Ingestion-related symptoms in this cohort included:

• Loss of consciousness: 4
• Central nervous system depression: 14
• Respiratory depression: 10
• Tachycardia: 2
• Bradycardia: 4
• Hypertension: 3
• Hypotension: 2
• Pinpoint pupil: 9

There was wide variation in initial and max rates, with 6 patients being given an initial infusion at about one-halfthe hourly intermittent dose. Naloxone found effective for all but 1 patient who had ingested clonidine and required intubation. No adverse effects due to the therapy were noted.

Reference

1. Bond C, Steinbrenner J. Naloxone continuous infusion dosing for opioid and clonidine ingestions in children. Presented at: Pediatric Pharmacy Association 2022 Annual Meeting; May 3-6, 2022; Norfolk, VA.