Pharmacological Treatment Options for NAS

MedicationMechanism of ActionDoseAdvantagesDisadvantages
MorphineNatural μ-receptor agonist0.05‒0.2 mg/kg/dose q 3‒4 hNo alcoholSedation
Increase by 0.05 mg/kgShort half-life (9 h)Apnea
Maximum dose: 1.3 mg/kg/day141Constipation
Frequent dosing
MethadoneSynthetic complete0.05‒0.1 mg/kg/dose q 12 h, increase by 0.05 mg/kg q 48 hLong half-life (26 h)Longer duration of treatment
μ-receptor agonistAlcohol 8%
N-methyl-d-aspartate antagonistMaximum dose: 1 mg/kg/d2112 hourly dosesFrequent follow-up needed
(Variable half-life)
Phenobarbitalγ-amino butyric acid agonistLoading dose: 16 mg/kgLong half-life (45‒100 h)Possible hyperactivity
Maintenance dose: 1‒4 mg/kg/dose q12 h150High treatment failure
Monitor levelAlcohol 15%
Drug-drug interactions
Clonidineα-adrenergic receptor agonistInitial dose: 0.5‒1 µg/kg, followed by 0.5‒1.25 µg/kg per dose q 4‒6 h153Nonnarcotic antagonistHypotension
No sedationAbrupt discontinuation may cause rapid rise of blood pressure and heart rate
No alcohol
Long half-life (44‒72 h)
Monitor level
BuprenorphineSemi-synthetic partial μ-receptor agonist, κ-receptor antagonistDose: 4‒5 µg/kg/dose q 8 hSublingual routeAlcohol 30%
Maximum dose: 60 µg/kg/d152Half-life (12 h)Adjuvant medications required
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