Perinatal Drug Abuse and Neonatal Drug Withdrawal Medication

Updated: Dec 09, 2020
  • Author: Marvin Wang, MD; Chief Editor: Dharmendra J Nimavat, MD, FAAP  more...
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Medication Summary

Opiate substitutes and phenobarbital are the mainstays of treatment. Other sedatives such as diazepam have not been shown to be effective. Many studies have compared opiates with phenobarbital alone. In general, opiates have been most effective. However, considerable data have shown that a combination treatment of opiates and phenobarbital significantly decreases hospital stay and decreases withdrawal severity. The drawback is that total duration of treatment (mostly as an outpatient on phenobarbital) is increased.



Class Summary

These are the treatment of choice for neonates known to be at risk of withdrawal from opiates. Morphine elixir is gaining more support over deodorized tincture of opium as the treatment of choice for a primarily opioid withdrawal syndrome.

Opium tincture

Use a 1:25 dilution. When ordering such a medication, be sure to emphasize that a dilute solution of the deodorized tincture is needed in a 1:25 ratio. Without this emphasis, the pharmacy may deliver undiluted DTO (used for adults) or the camphorated tincture of opium (Paregoric), which contains 45% alcohol, camphor, anise oil, and benzoic acid.


Increasing data shows that, although this is similar in effect to DTO, it may be a safer alternative because the morphine elixir avoids the effects of alcohol extracts in DTO. Morphine elixir may allow for better weight gain compared with DTO, as well.



Class Summary

Although barbiturates also are available for neonatal withdrawal syndrome, their optimal use is limited to several clinical situations, including the following:

1. The newborn with a nonopiate withdrawal

2. The newborn with a known polydrug withdrawal

3. The newborn with abstinence-related seizures

4. The newborn who has already received the maximum safe level of deodorized tincture of opium (DTO)

Phenobarbital (Luminal)

Interferes with transmission of impulses from thalamus to cortex of brain. Used as a sedative. As above, this is perhaps best used in combination with an opiate analog in reducing withdrawal severity.