Improving pediatric dosing through pediatric initiatives: what we have learned.
OBJECTIVE
The goal was to review the impact of pediatric drug studies, as measured by the improvement in pediatric dosing and other pertinent information captured in the drug labeling.


METHODS
We reviewed the pediatric studies for 108 products submitted (July 1998 through October 2005) in response to a Food and Drug Administration written request for pediatric studies, and the subsequent labeling changes. We analyzed the dosing modifications and focused on drug clearance as an important parameter influencing pediatric dosing.


RESULTS
The first 108 drugs with new or revised pediatric labeling changes had dosing changes or pharmacokinetic information (n = 23), new safety information (n = 34), information concerning lack of efficacy (n = 19), new pediatric formulations (n = 12), and extended age limits (n = 77). A product might have had > or = 1 labeling change. We selected specific examples (n = 16) that illustrate significant differences in pediatric pharmacokinetics.


CONCLUSIONS
Critical changes in drug labeling for pediatric patients illustrate that unique pediatric dosing often is necessary, reflecting growth and maturational stages of pediatric patients. These changes provide evidence that pediatric dosing should not be determined by simply applying weight-based calculations to the adult dose. Drug clearance is highly variable in the pediatric population and is not readily predictable on the basis of adult information.
Rodriguez
William
W
Food and Drug Administration, 5600 Fisher Lane, Parklawn Building, Room 13B-45, Rockville, MD 20850, USA. william.rodriguez@fda.hhs.gov
Selen
Arzu
A
Avant
Debbie
D
Chaurasia
Chandra
C
Crescenzi
Terrie
T
Gieser
Gerlie
G
Di Giacinto
Jennifer
J
Huang
Shiew-Mei
SM
Lee
Peter
P
Mathis
Lisa
L
Murphy
Dianne
D
Murphy
Shirley
S
Roberts
Rosemary
R
Sachs
Hari Cheryl
HC
Suarez
Sandra
S
Tandon
Veneeta
V
Uppoor
Ramana S
RS
D000284:Administration, Oral; D000293:Adolescent; D000367:Age Factors; D001682:Biological Availability; D001830:Body Surface Area; D002648:Child; D002675:Child, Preschool; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D004341:Drug Evaluation; D004348:Drug Labeling / Q000331:legislation & jurisprudence / Q000592:standards*; D005069:Evaluation Studies as Topic; D005260:Female; D005544:Forecasting; D006207:Half-Life; D006801:Humans; D007223:Infant; D008297:Male; D020714:Maximum Tolerated Dose; D010372:Pediatrics / Q000592:standards*; D004364:Pharmaceutical Preparations / Q000008:administration & dosage*; D012042:Registries; D012680:Sensitivity and Specificity; D014481:United States; D014486:United States Food and Drug Administration
D004364:Pharmaceutical Preparations