Second-Line Medications for Neonatal Opioid Withdrawal Syndrome/Neonatal Abstinence Syndrome.

Nonpharmacologic management is the first-line therapy for infants experiencing neonatal opioid withdrawal syndrome (NOWS) and/or neonatal abstinence syndrome (NAS). Currently, the most prescribed first-line pharmacologic agent is an opioid, most often morphine, but methadone and buprenorphine are preferred by some providers. For some infants, an opioid, along with maximized nonpharmacologic strategies, does not provide adequate symptom relief and a second-line agent is needed. Phenobarbital and clonidine are two commonly prescribed second-line agents for the management of NOWS/NAS. This column will describe these two commonly prescribed second-line agents.