Re: hello and question
From: Rachel Hedin (nprapha@hotmail.com)
Tue May 31 13:26:42 2005
Thanks for the great references! I really appreciated the Dashe
article...will work on getting a copy of the Jarvis/Schnoll article as
well. It looks like you're right about us being outside the second
trimester window...Since she's at 10 mg now, would you see a benefit in
getting her down to 5mg at this point? Does anyone have clinical
experience with how low you'd go with the methadone dose before just
d/c'ing it completely? Thanks!
--Rachel RN MSN
At Tue, 31 May 2005, ainsron wrote:
>
>There is a good article in Obstetrics & Gynecology, Dec 2002, V100, #6,
>P1244-1249, "Relationship between maternal methadone dosage and neonatal
>withdrawal" By Dashe, et al. 2nd trimester seems to be the best time to
>taper, so you may already have passed through the window of opportunity.
>Another good article is "Methadone treatment during pregnancy by Jarvis &
>Schnoll, Journal of Psychoactive drugs, Apr-Jun 1994, V26(2), p. 155-161.
>
>-----Original Message-----
>From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of Rachel
>Hedin
>Sent: Tuesday, May 31, 2005 9:59 AM
>To: Multiple recipients of list OB-GYN-L
>Subject: hello and question
>
>Hi. I'm a family practice nurse practitioner working in women's
>health...currently also beginning studies for a second master's degree
>to get my CNM.
>We have a 32 y/o client at my clinic who just moved from out of state.
>She is 26 weeks pregnant (G2 P1, had a c. section for FTP in Sept 2004
>and is due again Sept 2005) She has struggled with drug addiction in the
>past, but has been sober for 8 years and currently is maintained on 10
>mg of methadone a day. She would like to discontinue the methadone
>completely but was advised by her previous provider to wait until after
>the birth. There are no methadone clinics/addictionists nearby for us
>to refer to. We found out legally that we CAN continue to prescribe for
>her during her pregnancy, so the group has asked that we do some
>research into what the best action plan is. Mom is very motivated to
>get off the methadone as she wants to prevent IUGR, withdrawl syndromes
>postnatally, etc. If anybody has any experience with this...or
>suggestions about how to taper mom off (and when) as well as any
>risks/pitfalls to look out for, I'd appreciate the input. FWIW mom is
>in a very structured living environment with lots of emotional support
>right now as she has voluntarily joined a live-in religious program for
>unwed moms. Thanks!
>Rachel RN MSN
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