Which statement about methadone in pediatric PCA is true?

• A. Methadone is not typically used for PCA because it is not available in parenteral form in the United States
• B. Methadone is the most commonly prescribed PCA drug
• C. Methadone is ineffective for pediatric pain
• D. Methadone is a topical analgesic

Answer: (A)

In pediatric PCA, the analgesic used must be available in a parenteral form that a PCA pump can deliver and titrate safely. Methadone is not typically used for PCA in children because, in the United States, there isn’t a readily accessible parenteral formulation approved for analgesia suitable for PCA dosing. Without a parenteral option, it’s not practical to administer methadone through a PCA pump, and its long, variable half-life adds safety concerns for accumulation with self-touring doses. For these reasons, methadone isn’t a standard PCA agent in pediatrics. It isn’t a topical analgesic, and it isn’t accurate to say it’s the most commonly prescribed PCA drug or that it’s ineffective; the clinical practice generally relies on other parenteral opioids such as morphine or fentanyl for pediatric PCA.