My child is unique; the pharmacokinetics are universal.
The pharmacokinetic (PK) parameters that are important for dosing (e.g., clearance and volume) are well known. They are used in universal mathematical formulae that describe the time course of drug concentration. Additional formulae can be used to describe major covariate effects in children, such as size and maturation. PK parameters describing the time-concentration profile of a drug after administration are those for a typical individual in a population. These parameters are associated with variability. Further, any one individual may not be typical of the population studied. While size and maturation are two important considerations in children and assist with dosing estimation, there are also a number of additional PK covariates (e.g., organ function, disease, drug interactions, pharmacogenetics), and identifying these sources of variability allows us to individualize drug dose. Pharmacology is not simply an application of PK, and determinants of drug dose also require an understanding of the variability associated with pharmacodynamic response and a balancing of beneficial effects against unwanted effects. Each child is unique in this respect.
Paediatric Intensive Care Unit, Auckland Children's Hospital, Auckland, New Zealand. briana@adhb.govt.nz
Brian J
BJ
Anderson
D000375:Aging / Q000502:physiology; D000758:Anesthesia; D000777:Anesthetics / Q000009:adverse effects / Q000493:pharmacokinetics*; D001835:Body Weight / Q000502:physiology; D002648:Child; D002675:Child, Preschool; D002940:Circadian Rhythm; D004194:Disease; D004347:Drug Interactions; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D015233:Models, Statistical; D010597:Pharmacogenetics; D057285:Precision Medicine
D000777:Anesthetics