Buprenorphine poisoning in children: a 10-year-experience of Marseille Poison Center.
Analgesics, Opioid
/ poisoning
Antidotes
/ administration & dosage
Buprenorphine
/ poisoning
Child
Child, Preschool
Female
France
/ epidemiology
Hospitalization
/ statistics & numerical data
Humans
Infant
Male
Naloxone
/ administration & dosage
Narcotic Antagonists
/ administration & dosage
Poison Control Centers
/ statistics & numerical data
Severity of Illness Index
Tablets
buprenorphine
children
intoxication
Journal
Fundamental & clinical pharmacology
ISSN: 1472-8206
Titre abrégé: Fundam Clin Pharmacol
Pays: England
ID NLM: 8710411
Informations de publication
Date de publication:
Apr 2020
Apr 2020
Historique:
received:
28
06
2019
revised:
17
09
2019
accepted:
22
10
2019
pubmed:
2
11
2019
medline:
26
11
2020
entrez:
2
11
2019
Statut:
ppublish
Résumé
Buprenorphine is a µ-partial agonist and k-antagonist acting on central opioid receptors. Patented for analgesia in 1968, buprenorphine has been used as opioid substitutive therapy since the 1990s, as well as methadone. The aim was to document pediatric poisoning, to discover the severity, and to evaluate the treatment with naloxone. All pediatric poisonings reported to the poison control center Marseille (France)-from January 1, 2009 to December 31, 2018-were included. Analysis put value on gender, age, estimated quantity, symptoms and their delay, place of treatment, medical treatment, utilization of antidotes, severity of intoxications, and patients' outcome. Fifty-four infant poisonings with buprenorphine were recorded, doses varied between 1 and 36 mg, and children showed mainly neurological (somnolence, miosis…) and gastroenteric (vomiting) effects. Pulmonary effects were described for four children. According to the poisoning severity score, 8 intoxications were classified as 'no symptoms or signs', 37 as minor poisonings, 3 as moderate, none as severe or fatal and 6 were unknown. Medical care was required for 46 children, and four of them were treated with naloxone. Buprenorphine poisoning can cause neurological, gastroenteric, and respiratory symptoms. Even licking a tablet leads to intoxication because of maximal tablet's absorption while placing it under the tongue. Hospital admission is necessary even at small doses. Naloxone was efficient in the four described cases. Parents have to be aware of the poisoning risk with buprenorphine. Recently, commercialized instantly dissolving formulations could cause more severe intoxications.
Substances chimiques
Analgesics, Opioid
0
Antidotes
0
Narcotic Antagonists
0
Tablets
0
Naloxone
36B82AMQ7N
Buprenorphine
40D3SCR4GZ
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
265-269Informations de copyright
© 2019 Société Française de Pharmacologie et de Thérapeutique.
Références
Dahan A., Yassen A., Romberg R. et al. Buprenorphine induces ceiling in respiratory depression but not in analgesia. Br. J. Anaesth. (2006) 96 627e32.
Patel A.M., Wheeler D.C., Rose S.R., Nadpara P.A., Pakyz A.L., Carroll N.V. Prevalence and characteristics of pediatric opioid exposures and poisonings in the United States. J. Pediatr. (2019) 206 148-155.
Crane E.H. Emergency department visits involving the accidental ingestion of opioid pain relievers by children aged 1 to 5. The CBHSQ Report. Substance Abuse and Mental Health Services Administration (US), Rockville, MD, 2013-2017.
Schwartz L., Mercurio-Zappala M., Howland M.A., Hoffman R.S., Su M.K. Unintentional methadone and buprenorphine exposures in children: Developing prevention messages. J. Am. Pharm. Assoc. (2003) 2017 57(2S) S83-S86.
Pedapati E.V., Bateman S.T. Toddlers requiring pediatric intensive care unit admission following at-home exposure to buprenorphine/naloxone. Pediatr. Crit. Care Med. (2011) 12 e102-e107.
Hayes B.D., Klein-Schwartz W., Doyon S. Toxicity of buprenorphine overdoses in children. Pediatrics (2008) 121 e782-e786.
Wang G.S., Severtson S.G., Bau G.E., Dart R.C., Green J.L. Unit-dose packaging and unintentional buprenorphine-naloxone exposures. Pediatrics (2018) 141 e20174232.
Post S., Spiller H.A., Casavant M.J., Chounthirath T., Smith G.A. Buprenorphine exposures among children and adolescents reported to US poison control centers. Pediatrics (2018) 142 e20173652.
van Dorp E., Yassen A., Sarton E. et al. Naloxone reversal of buprenorphine-induced respiratory depression. Anesthesiology (2006) 105 51-57.
Mégarbane B., Buisine A., Jacobs F. et al. Prospective comparative assessment of buprenorphine overdose with heroin and methadone: clinical characteristics and response to antidotal treatment. J. Subst. Abuse Treat. (2010) 38 403-407.
Torrents R., Picot C., Glaizal M. et al. Child poisonings with methadone in France: A 6-year prospective national survey since the availability of capsules in 2008. Clin. Toxicol. (Phila) (2015) 53 819-822.