Journal of Pediatric Pharmacology and Therapeutics最新文献

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Caution: ChatGPT Doesn't Know What You Are Asking and Doesn't Know What It Is Saying. 注意:ChatGPT 不知道您在问什么,也不知道自己在说什么。
Journal of Pediatric Pharmacology and Therapeutics Pub Date : 2024-10-01 Epub Date: 2024-10-14 DOI: 10.5863/1551-6776-29.5.558
S Casey Laizure
{"title":"Caution: ChatGPT Doesn't Know What You Are Asking and Doesn't Know What It Is Saying.","authors":"S Casey Laizure","doi":"10.5863/1551-6776-29.5.558","DOIUrl":"https://doi.org/10.5863/1551-6776-29.5.558","url":null,"abstract":"","PeriodicalId":37484,"journal":{"name":"Journal of Pediatric Pharmacology and Therapeutics","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11472406/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142476801","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Efficacy of Levetiracetam vs Phenobarbital as First Line Therapy for the Treatment of Neonatal Seizures. 左乙拉西坦与苯巴比妥作为治疗新生儿癫痫发作的一线疗法的疗效对比。
Journal of Pediatric Pharmacology and Therapeutics Pub Date : 2024-10-01 Epub Date: 2024-10-14 DOI: 10.5863/1551-6776-29.5.482
Destini Long, Courtney Sutton, Jennifer Hale
{"title":"Efficacy of Levetiracetam vs Phenobarbital as First Line Therapy for the Treatment of Neonatal Seizures.","authors":"Destini Long, Courtney Sutton, Jennifer Hale","doi":"10.5863/1551-6776-29.5.482","DOIUrl":"https://doi.org/10.5863/1551-6776-29.5.482","url":null,"abstract":"<p><strong>Objective: </strong>Seizures are one of the most common neurologic complications seen in a neonate. Historically, phenobarbital has been the agent of choice, but can lead to adverse neurologic outcomes, which has contributed to the use of other agents. Levetiracetam has proven great efficacy with an excellent safety profile in older patients, causing interest of its use in neonates. The objective of this study was to determine if levetiracetam would provide similar neonatal seizure resolution rates as phenobarbital.</p><p><strong>Methods: </strong>The study was a single-center, retrospective, cohort study from August 1, 2020 to August 31, 2022 investigating the efficacy and safety of using levetiracetam compared with phenobarbital as a first line treatment for neonatal seizures. The primary outcome was to assess overall seizure resolution after administration of levetiracetam or phenobarbital, without addition of a second antiseizure medication.</p><p><strong>Results: </strong>There were 87 patients included in the study. Fifteen neonates (27.78%) achieved seizure resolution with phenobarbital compared with 9 neonates (27.27%) who received levetiracetam first line (p = 0.959). Neonates who received phenobarbital had higher rates of adverse effects. Neonates who received a benzodiazepine prior to administration of levetiracetam had lower seizure resolution rates (p = 0.021).</p><p><strong>Conclusions: </strong>These findings suggest there is no difference in using phenobarbital over levetiracetam to achieve complete seizure resolution in a neonate. Higher rates of adverse events were seen in the phenobarbital group. The use of a benzodiazepine prior to administration of levetiracetam may reduce the efficacy of levetiracetam.</p>","PeriodicalId":37484,"journal":{"name":"Journal of Pediatric Pharmacology and Therapeutics","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11472408/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142476804","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Pediatric Lead Chelation Managed During Critical Medication Shortages: Case Report and Literature Review. 关键药物短缺期间的小儿铅螯合治疗:病例报告和文献综述。
Journal of Pediatric Pharmacology and Therapeutics Pub Date : 2024-10-01 Epub Date: 2024-10-14 DOI: 10.5863/1551-6776-29.5.544
Mahi K Singh, Jason M Kane, Sana J Said
{"title":"Pediatric Lead Chelation Managed During Critical Medication Shortages: Case Report and Literature Review.","authors":"Mahi K Singh, Jason M Kane, Sana J Said","doi":"10.5863/1551-6776-29.5.544","DOIUrl":"https://doi.org/10.5863/1551-6776-29.5.544","url":null,"abstract":"<p><p>Lead poisoning in children has the potential for devastating neurodevelopmental consequences. There is significant socioeconomic disparity in children with lead poisoning. Specific lead chelation regimens have been approved for children by the US Food and Drug Administration, however in the United States, there has been a recent national shortage of the primary therapy, edetate calcium disodium (CaNa2 EDTA). This case report presents a 23-month-old child with severe symptomatic lead poisoning during a national shortage of CaNa2 EDTA to highlight the need for advocacy regarding critical medication shortages, especially for antidote therapy. The infant's initial blood lead level was 364 mcg/dL and he received a continuous infusion of CaNa2 EDTA (1000 mg/m<sup>2</sup>/day), as well as dimercaprol (4 mg/kg intramuscularly every 4 hours). The supply of CaNa2 EDTA was exhausted on day 3 of therapy so he was transitioned to enteral succimer monotherapy. Initial parenteral therapy of 72 hours achieved a lead level of 72 mcg/dL; he then completed his enteral course of succimer along with environmental mitigation. However, elevated blood lead levels persisted and he subsequently required 3 more courses of enteral succimer, and he continues to have detectable blood lead levels 2 years after initial presentation. In the face of medication shortages including CaNa2 EDTA, and now also dimercaprol, clinicians must create and study alternative chelation therapy regimens for pediatric lead toxicity. Furthermore, public policy initiatives, including the development of a national supply stockpile of chelation agents, must be created in order to minimize supply chain disruption and ensure adequate and equitable antidote therapy for lead poisoning outbreaks.</p>","PeriodicalId":37484,"journal":{"name":"Journal of Pediatric Pharmacology and Therapeutics","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11472411/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142476754","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Effect of Targeted Single-Dose Antibiotics to Reduce the Occurrence of Pediatric Central Line-Associated Bloodstream Infections Post Alteplase Administration. 单剂量靶向抗生素对减少阿替普酶用药后儿科中心静脉相关血流感染发生率的效果。
Journal of Pediatric Pharmacology and Therapeutics Pub Date : 2024-10-01 Epub Date: 2024-10-14 DOI: 10.5863/1551-6776-29.5.508
Patrick Watchorn, Robert Kavanagh, Kevin Mulieri, Theodore DeMartini, Gary Ceneviva, Lindsay Trout
{"title":"Effect of Targeted Single-Dose Antibiotics to Reduce the Occurrence of Pediatric Central Line-Associated Bloodstream Infections Post Alteplase Administration.","authors":"Patrick Watchorn, Robert Kavanagh, Kevin Mulieri, Theodore DeMartini, Gary Ceneviva, Lindsay Trout","doi":"10.5863/1551-6776-29.5.508","DOIUrl":"https://doi.org/10.5863/1551-6776-29.5.508","url":null,"abstract":"<p><strong>Objective: </strong>Previous studies have shown an association between alteplase for line clearance and central line-associated bloodstream infections (CLABSIs). The objective of this study was to evaluate the use of post-alteplase antibiotics as a CLABSI reduction strategy in pediatric intensive care unit (PICU) patients.</p><p><strong>Methods: </strong>This was a single center, retrospective, observational study evaluating PICU patients from -January 1, 2014, through August 1, 2021, conducted at a tertiary academic PICU. Included in this study were critically ill patients who had 1 or more central venous lines (CVLs) requiring alteplase for line clearance. The primary objective was incidence of CLABSI occurrence post alteplase administration for CVL clearance, with or without targeted single-dose antibiotics (piperacillin-tazobactam or vancomycin) post alteplase. Secondary outcomes included evaluation of total alteplase administrations and risk factors associated with CLABSI occurrence.</p><p><strong>Results: </strong>Two hundred fifty patients were included, with 156 receiving alteplase only, 82 piperacillin--tazobactam, and 12 vancomycin, and with median ages of 2.8, 3.8, and 3.8 years, respectively. Seven -CLABSIs occurred in the alteplase-only group, with 0 incidences in both the piperacillin-tazobactam (exact OR, 0.12; exact 95% CI, <0.01-0.59; p < 0.01) and vancomycin (exact OR, 1.20; exact 95% CI, 0.03-9.80; p = 1.00) groups. Patients in the piperacillin-tazobactam group achieved statistical significance for CLABSI risk factors that may benefit by decreasing CLABSI incidence (p values <0.01-0.02).</p><p><strong>Conclusions: </strong>Alteplase use has been associated with CLABSIs. Providing a single dose of post-alteplase antibiotics targeting the most likely site-specific pathogens may reduce the incidence of CLABSIs.</p>","PeriodicalId":37484,"journal":{"name":"Journal of Pediatric Pharmacology and Therapeutics","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11472401/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142476803","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Cost-Benefit Analysis of a Pediatric ICU Sedation Weaning Protocol. 儿科重症监护室镇静剂断药方案的成本效益分析。
Journal of Pediatric Pharmacology and Therapeutics Pub Date : 2024-10-01 Epub Date: 2024-10-14 DOI: 10.5863/1551-6776-29.5.501
Chiara Velez, Jessica J Anderson, J Jackson Resser, Dandan Liu, Kristina A Betters
{"title":"Cost-Benefit Analysis of a Pediatric ICU Sedation Weaning Protocol.","authors":"Chiara Velez, Jessica J Anderson, J Jackson Resser, Dandan Liu, Kristina A Betters","doi":"10.5863/1551-6776-29.5.501","DOIUrl":"https://doi.org/10.5863/1551-6776-29.5.501","url":null,"abstract":"<p><strong>Objective: </strong>A risk stratified sedation weaning protocol improved patient outcomes in a pediatric intensive care unit (PICU). We sought to determine the protocol effect on medication costs.</p><p><strong>Methods: </strong>This was a retrospective observational cohort study in an academic tertiary care children's hospital PICU (2018-2020) comparing the cost when weaning benzodiazepine, alpha agonist, and/or opioid infusions in intubated children <18 years of age.</p><p><strong>Results: </strong>There were 84 total sedation weaning instances (pre-protocol n = 41 and post-protocol n = 41); 2 patients had 2 encounters, 1 in each phase. The total cost (in 2022 United States Dollars) of sedation weaning was $400,328.87 ($15,994.44/kg) pre-protocol compared with $170,458.85 ($11,227.52/kg) post-protocol. The median cost of sedation wean per patient for pre-protocol patients was $3197.42 (IQR: $322.66-$12,643.29) and post-protocol patients was $1851.44 (IQR: $425.05-$5355.85; p = 0.275). A linear regression model estimated the expected cost of sedation wean for post-protocol patients to be $5173.20 lower than for pre-protocol patients of the same weight and overall drug risk (p = 0.036). The proportion of withdrawal symptoms in the pre-protocol patients (16%) was not significantly different from the proportion in the post-protocol patients (14%; p = 0.435).</p><p><strong>Conclusions: </strong>Implementation of a PICU sedation weaning protocol in a single-center conferred cost benefit without negatively impacting patient outcomes. A larger multicenter study would provide insight to the applicability to PICUs in varied settings with differing patient populations.</p>","PeriodicalId":37484,"journal":{"name":"Journal of Pediatric Pharmacology and Therapeutics","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11472412/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142476802","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Serum Carnitine Concentrations and Cardiac Function in Pediatric, Adolescent and Young Adult Oncology Patients Receiving High-Dose Anthracyclines. 接受大剂量蒽环类药物治疗的儿童、青少年和青年肿瘤患者的血清肉碱浓度和心脏功能。
Journal of Pediatric Pharmacology and Therapeutics Pub Date : 2024-10-01 Epub Date: 2024-10-14 DOI: 10.5863/1551-6776-29.5.475
Christine Lin, Hari K Narayan, Erin Trovillion, Saro Armenian, Lawrence Alejandro, Dennis John Kuo
{"title":"Serum Carnitine Concentrations and Cardiac Function in Pediatric, Adolescent and Young Adult Oncology Patients Receiving High-Dose Anthracyclines.","authors":"Christine Lin, Hari K Narayan, Erin Trovillion, Saro Armenian, Lawrence Alejandro, Dennis John Kuo","doi":"10.5863/1551-6776-29.5.475","DOIUrl":"https://doi.org/10.5863/1551-6776-29.5.475","url":null,"abstract":"<p><strong>Objective: </strong>Anthracycline chemotherapy agents have significant dose-dependent cardiotoxic effects. -Carnitine, a non-essential amino acid, is involved in long chain fatty acid oxidation, and carnitine deficiency can result in cardiomyopathy and cardiac arrhythmias. If administered concurrently with chemotherapy, carnitine supplementation could be a potential strategy to prevent cardiotoxicity. However, the association between serum carnitine concentrations and anthracycline cardiotoxicity during cancer treatment in the childhood, adolescent, and young adult (CAYA) age range has not been established.</p><p><strong>Methods: </strong>This prospective pilot cohort study characterized changes in serum carnitine concentrations and cardiac function before, during, and approximately 1 year after large-dose anthracycline therapy in newly diagnosed CAYA cancer patients.</p><p><strong>Results: </strong>Among 21 patients with a mean cumulative anthracycline dose exposure of 409 mg/m<sup>2</sup> of -doxorubicin equivalents, left ventricular ejection fraction and relative wall thickness decreased, indicating an overall decline in cardiac function. A reversible decrease in serum carnitine concentrations was also observed. A non-statistically significant positive correlation was observed; for every 1 mmol/L decrease in serum carnitine concentration, there was a 0.09% decrease in LVEF (p = 0.2).</p><p><strong>Conclusions: </strong>These findings from this small pilot study suggest that there may be a relationship between serum carnitine concentrations and cardiac function after anthracycline therapy that should be evaluated in larger studies.</p>","PeriodicalId":37484,"journal":{"name":"Journal of Pediatric Pharmacology and Therapeutics","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11472407/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142476757","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Gabapentin for Delirium in Infants in the Neonatal Intensive Care Unit. 加巴喷丁治疗新生儿重症监护病房婴儿的谵妄。
Journal of Pediatric Pharmacology and Therapeutics Pub Date : 2024-10-01 Epub Date: 2024-10-14 DOI: 10.5863/1551-6776-29.5.487
Eugenie Chang, Avery Parman, Peter N Johnson, Katy Stephens, Stephen Neely, Nalini Dasari, Netsanet Kassa, Jamie L Miller
{"title":"Gabapentin for Delirium in Infants in the Neonatal Intensive Care Unit.","authors":"Eugenie Chang, Avery Parman, Peter N Johnson, Katy Stephens, Stephen Neely, Nalini Dasari, Netsanet Kassa, Jamie L Miller","doi":"10.5863/1551-6776-29.5.487","DOIUrl":"https://doi.org/10.5863/1551-6776-29.5.487","url":null,"abstract":"<p><strong>Objective: </strong>A protocol was developed for neonatal intensive care unit (NICU) delirium: Step 1, gabapentin for pain or melatonin for sleep; Step 2, add on other Step 1 agent; Step 3, antipsychotics. The purpose of this study was to describe the utility and dosing of gabapentin for NICU delirium.</p><p><strong>Methods: </strong>Retrospective evaluation of NICU patients from January 1, 2021-December 31, 2022 who received >1 dose of gabapentin based on the delirium protocol. Data collection included demographics, gabapentin regimen, and concomitant sedatives and analgesics. The primary objective was to identify the number of patients receiving gabapentin for Step 1 or Step 2. Secondary objectives included identifying the number of patients requiring antipsychotics (Step 3), the gabapentin regimen, comparison of Échelle de Douleur et d'Inconfort du Nouveau-né (EDIN), Cornell Assessment of Pediatric Delirium (CAPD), and Withdrawal Assessment Tool-1 (WAT-1) scores 72 hours pre- and post-gabapentin initiation, and comparison of opioids, clonidine, and melatonin 24 hours pre- and 72 hours post-gabapentin initiation. Wilcoxon signed rank tests were employed with significance defined at p < 0.05.</p><p><strong>Results: </strong>Twenty-nine patients were studied. The majority (n = 22; 75.9%) received gabapentin for Step 1; no patients required Step 3. The median initial dose was 14.4 mg/kg/day divided every 8 hours. Twelve (41.4%) required increase to a median of 16.9 mg/kg/day. A significant decrease in EDIN and WAT-1 scores was noted, but there was no change in CAPD scores or opioid, clonidine, or melatonin doses pre- versus post-gabapentin.</p><p><strong>Conclusion: </strong>The majority received gabapentin at a median dose of 14 mg/kg/day as Step 1 for delirium. Gabapentin was associated with a significant decrease in pain and withdrawal scores.</p>","PeriodicalId":37484,"journal":{"name":"Journal of Pediatric Pharmacology and Therapeutics","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11472400/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142476806","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Management of Postural Orthostatic Tachycardia Syndrome in Pediatric Patients: A Clinical Review. 儿科患者体位性正位性心动过速综合征的治疗:临床回顾。
Journal of Pediatric Pharmacology and Therapeutics Pub Date : 2024-10-01 Epub Date: 2024-10-14 DOI: 10.5863/1551-6776-29.5.456
Peter Huynh, Alex Brown, Lauren Campisi, Allison Mruk, Tran Nguyen, Mike Raschka, Titilola Afolabi
{"title":"Management of Postural Orthostatic Tachycardia Syndrome in Pediatric Patients: A Clinical Review.","authors":"Peter Huynh, Alex Brown, Lauren Campisi, Allison Mruk, Tran Nguyen, Mike Raschka, Titilola Afolabi","doi":"10.5863/1551-6776-29.5.456","DOIUrl":"https://doi.org/10.5863/1551-6776-29.5.456","url":null,"abstract":"<p><p>Postural orthostatic tachycardia syndrome (POTS) is a chronic illness with unknown mortality and high morbidity, often diagnosed in the adolescent years. Published literature regarding POTS primarily focuses on the adult population, and guidance on treatment in pediatrics is sparse. The purpose of this clinical review is to evaluate the current literature on the management of POTS in pediatric patients. A search was conducted using the Cochrane database, Google Scholar, and PubMed. Studies were included if they evaluated the management of POTS, primarily in pediatric patients. Case reports and series were excluded. Eight published studies met the inclusion and exclusion criteria. To date, there are no US Food and Drug Administration-approved agents for the treatment of POTS. However, select pharmacological therapies have shown positive outcomes by addressing symptom origins, such as providing heart rate control, peripheral autonomic modulation, and targeting hypovolemia. Targeted pharmacological therapies studied in children and young adults include ivabradine, metoprolol, midodrine, pyridostigmine, intravenous crystalloid fluids, and fludrocortisone. Before adding pharmacotherapeutic interventions, non-pharmacologic interventions such as patient education, avoidance of symptom-triggering environments and medications, dietary fluid and sodium supplementation, exercise, and use of compression garments should be first attempted. Although the body of evidence for the management of POTS is expanding, additional research is needed to determine safe and efficacious dosing and establish clear guidelines for POTS in the pediatric population.</p>","PeriodicalId":37484,"journal":{"name":"Journal of Pediatric Pharmacology and Therapeutics","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11472415/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142476753","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Impact of Age and Concurrent Antiseizure Medication Use on Lacosamide Dose to Concentration Ratio and Dosing in Pediatric Patients. 年龄和同时使用抗癫痫药物对拉科酰胺剂量浓度比和小儿患者剂量的影响
Journal of Pediatric Pharmacology and Therapeutics Pub Date : 2024-10-01 Epub Date: 2024-10-14 DOI: 10.5863/1551-6776-29.5.514
Megan Woods, Stephanie J Phelps, Michael L Christensen, Bernd Meibohm, James W Wheless
{"title":"Impact of Age and Concurrent Antiseizure Medication Use on Lacosamide Dose to Concentration Ratio and Dosing in Pediatric Patients.","authors":"Megan Woods, Stephanie J Phelps, Michael L Christensen, Bernd Meibohm, James W Wheless","doi":"10.5863/1551-6776-29.5.514","DOIUrl":"https://doi.org/10.5863/1551-6776-29.5.514","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate age, adjunctive antiseizure medication (ASM), and specific ASMs on lacosamide (LCM) weight normalized dose-to-concentration ratio (DCR) and US Food and Drug Administration (FDA) dosing guidelines in pediatric patients.</p><p><strong>Methods: </strong>Patients 1 mo to ≤18 years with a LCM serum concentration between October 2009 and June 2017 were considered. Demographics, LCM DCR, and adjunctive ASM were recorded. LCM DCR/hr was used as a surrogate for clearance. Data were stratified by age (1 mo-< 2 yr; ≥ 2-6 yr; ≥ 6-12 yr; and ≥12-≤18 yr), FDA dosing weights, and ASM potential to interaction with LCM.</p><p><strong>Results: </strong>There were 646 sera (380 patients) with median dose 8.36 mg/kg/day (IQR, 5.92-11.16). 50.2% of doses were within FDA-weight guidelines; however, 40.4% exceeded recommendations. Most (81.3%) LCM concentrations were between 2 and 12 mg/L. A difference existed in DCR between ages, with those <2 years having the highest DCR (p < 0.001). Moving across age groups, the DCR decreases by 30.7%, 50.5%, and 63.4%. There was a weak (r<sup>2</sup> = 0.073) but significant (p < 0.001) negative correlation between DCR and age. 84.8% received adjunctive ASM consisting of at least one of 31 different ASMs. DCR was higher with adjunctive ASMs compared with monotherapy [0.061 (0.039-0.095) vs 0.043 (0.030-0.062)], respectively (p < 0.001) and was greatest with inducers. Phenobarbital increased DCR by 2.6-fold, topiramate by 72.1%, and clobazam by 32.6%. Inhibitors had no effect.</p><p><strong>Conclusions: </strong>The correlation between age and DCR was weak, accounting for 6% of variability. Strong inducers significantly increased DCR. Synergy may exist when multiple inducers are given. Weak inhibitors did not affect DCR. Those ≥6 to 11 kg, ≥30 to 50 kg, and those given strong inducers may require larger -initial LCM doses. Serum concentrations should be used to individualize dosing, especially in those receiving strong inducers.</p>","PeriodicalId":37484,"journal":{"name":"Journal of Pediatric Pharmacology and Therapeutics","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11472414/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142476807","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Successful Desensitization With ELX/TEZ/IVA. 使用 ELX/TEZ/IVA 成功脱敏。
Journal of Pediatric Pharmacology and Therapeutics Pub Date : 2024-10-01 Epub Date: 2024-10-14 DOI: 10.5863/1551-6776-29.5.539
Dilara Fatma Kocacik Uygun, Mehmet Akif Kaya, Betül Bankoglu, Abdurrahman Erdem Basaran, Ayşen Bingol
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