Favié, Laurent M. A.;
de Haan, Timo R.;
Bijleveld, Yuma A.;
Rademaker, Carin M. A.;
Egberts, Toine C. G.;
Nuytemans, Debbie H. G. M.;
Mathôt, Ron A. A.;
Groenendaal, Floris;
Huitema, Alwin D. R.
Prediction of Drug Exposure in Critically Ill Encephalopathic Neonates Treated With Therapeutic Hypothermia Based on a Pooled Population Pharmacokinetic Analysis of Seven Drugs and Five Metabolites
You can manage bookmarks using lists, please log in to your user account for this.
Media type:
E-Article
Title:
Prediction of Drug Exposure in Critically Ill Encephalopathic Neonates Treated With Therapeutic Hypothermia Based on a Pooled Population Pharmacokinetic Analysis of Seven Drugs and Five Metabolites
Contributor:
Favié, Laurent M. A.;
de Haan, Timo R.;
Bijleveld, Yuma A.;
Rademaker, Carin M. A.;
Egberts, Toine C. G.;
Nuytemans, Debbie H. G. M.;
Mathôt, Ron A. A.;
Groenendaal, Floris;
Huitema, Alwin D. R.
Published:
Wiley, 2020
Published in:
Clinical Pharmacology & Therapeutics, 108 (2020) 5, Seite 1098-1106
Language:
English
DOI:
10.1002/cpt.1917
ISSN:
0009-9236;
1532-6535
Origination:
Footnote:
Description:
Drug dosing in encephalopathic neonates treated with therapeutic hypothermia is challenging; exposure is dependent on body size and maturation but can also be influenced by factors related to disease and treatment. A better understanding of underlying pharmacokinetic principles is essential to guide drug dosing in this population. The prospective multicenter cohort study PharmaCool was designed to investigate the pharmacokinetics of commonly used drugs in neonatal encephalopathy. In the present study, all data obtained in the PharmaCool study were combined to study the structural system specific effects of body size, maturation, recovery of organ function, and temperature on drug clearance using nonlinear mixed effects modeling. Data collected during the first 5 days of life from 192 neonates treated with therapeutic hypothermia were included. An integrated population pharmacokinetic model of seven drugs (morphine, midazolam, lidocaine, phenobarbital, amoxicillin, gentamicin, and benzylpenicillin) and five metabolites (morphine‐3‐glucuronide, morphine‐6‐glucuronide, 1‐hydroxymidazolam, hydroxymidazolam glucuronide, and monoethylglycylxylidide) was successfully developed based on previously developed models for the individual drugs. For all compounds, body size was related to clearance using allometric relationships and maturation was described with gestational age in a fixed sigmoidal Hill equation. Organ recovery after birth was incorporated using postnatal age. Clearance increased by 1.23%/hours of life (95% confidence interval (CI) 1.03–1.43) and by 0.54%/hours of life (95% CI 0.371–0.750) for high and intermediate clearance compounds, respectively. Therapeutic hypothermia reduced clearance of intermediate clearance compounds only, by 6.83%/°C (95% CI 5.16%/°C–8.34%/°C). This integrated model can be used to facilitate drug dosing and future pharmacokinetic studies in this population.