title: Buprenorphine TTS for children--a review of the drug's clinical pharmacology.
abstract: OBJECTIVE
  The transdermal therapeutic system (TTS) with buprenorphine is currently being used 'off-label' to treat chronic pediatric pain. We compiled available pharmacokinetic (PK), pharmacodynamic (PD), and clinical pediatric data on buprenorphine to rationalize treatment regimens.
  
  
  METHODS
  We conducted a systematic biomedical literature review focusing on pediatric buprenorphine data.
  
  
  RESULTS
  There are few relevant pediatric buprenorphine data, particularly in children suffering chronic pain. There are no pediatric PK and PD data for children with chronic pain given sublingual or TTS formulations. Children given single dose buprenorphine have increased drug clearance referenced to bodyweight with a possible paradoxical longer duration of action. Buprenorphine metabolism is independent of renal function, which is advantageous in renal insufficiency. The risk of respiratory depression after buprenorphine is difficult to quantify. A concentration-response relationship for respiratory effects has not been described and it is unknown whether children have a ceiling effect similar to that described in healthy adult volunteers.
  
  
  CONCLUSIONS
  Buprenorphine is of interest in pediatric postoperative pain and cancer pain control because of its multiple administration routes, long duration of action, and metabolism largely independent of renal function. There is little reason to expect buprenorphine effects in children out of infancy are fundamentally different to those in adults. From the limited pediatric data available, it appears that buprenorphine has no higher adverse potential than the more commonly used opioids. There is an urgent need for focused PK, PD, and safety studies in children before use in children becomes more widespread.
authors.affiliation: Kinderklinik, NICU/PICU, Ortenau Klinikum Offenburg-Gengenbach, Offenburg, Germany.
authors.forename: Erik
authors.initials: E
authors.lastname: Michel
authors.forename: Brian J
authors.initials: BJ
authors.lastname: Anderson
authors.forename: Boris
authors.initials: B
authors.lastname: Zernikow
mesh_terms: D000279:Administration, Cutaneous; D000293:Adolescent; D000328:Adult; D000701:Analgesics, Opioid / Q000008:administration & dosage* / Q000009:adverse effects / Q000493:pharmacokinetics / Q000494:pharmacology* / Q000627:therapeutic use*; D002047:Buprenorphine / Q000008:administration & dosage* / Q000009:adverse effects / Q000493:pharmacokinetics / Q000494:pharmacology* / Q000627:therapeutic use*; D002648:Child; D016503:Drug Delivery Systems; D003875:Drug Eruptions / Q000473:pathology; D005260:Female; D006801:Humans; D008297:Male; D010146:Pain / Q000188:drug therapy; D010149:Postoperative Pain / Q000188:drug therapy; D017450:Receptors, Opioid, mu / Q000187:drug effects / Q000378:metabolism; D012131:Respiratory Insufficiency / Q000139:chemically induced; D013375:Substance Withdrawal Syndrome / Q000523:psychology; D055815:Young Adult
chemical_list: D000701:Analgesics, Opioid; D017450:Receptors, Opioid, mu; D002047:Buprenorphine