title: Theoretical pharmacokinetic drug alterations in pediatric celiac disease.
abstract: BACKGROUND
  The incidence of pediatric celiac disease has risen and many of these children will receive medications at some time in their life. However, the absorption of drugs in pediatric patients with celiac disease has never been studied. The few studies that do exist have only been performed in adults and indicate that drug concentrations can be altered for some drugs. It is also noteworthy that few researchers have conducted studies to determine if the distribution, metabolism, and excretion of drugs are altered in celiac disease.
  
  
  METHODS
  The pharmacokinetics of drugs greatly differ between children and adults. Combined with the pathophysiological changes known to occur with celiac disease, there is compelling evidence to support that drug exposure in pediatric celiac disease may be altered. Relevant characteristics of celiac disease that may affect drug disposition include intestinal atrophy, hypoalbuminemia, reduced CYP3A enzymes, and thyroid dysfunction.
  
  
  CONCLUSIONS
  The safety and efficacy of drug dosing in children with celiac disease can be enhanced with additional pharmacokinetic studies of commonly prescribed drugs in this population. Ideally, these studies should include drugs that have high bioavailability, are highly protein bound, undergo extensive CYP3A enzyme metabolism, and/or have a narrow therapeutic range.
authors.affiliation: a 1 St. John's University, College of Pharmacy and Health Sciences , 8000 Utopia Parkway, St. Albert Hall, Room 114, Queens, NY 11439, USA +1 202 957 4306 ; +1 718 990 1986 ; trant1@stjohns.edu.|b 2 Clinical Pharmacy Manager,NewYork-Presbyterian Hospital/Columbia University Medical Center , New York, NY, USA.
authors.forename: Tran H
authors.initials: TH
authors.lastname: Tran
authors.affiliation: c 3 St. John's University College of Pharmacy and Health Sciences, Chair, Clinical Pharmacy Practice Department , Queens, NY 11439, USA.
authors.forename: Candace
authors.initials: C
authors.lastname: Smith
authors.affiliation: d 4 St. John's University , Queens, NY 11439, USA.
authors.forename: Robert A
authors.initials: RA
authors.lastname: Mangione
mesh_terms: D002446:Celiac Disease / Q000503:physiopathology*; D002648:Child; D051544:Cytochrome P-450 CYP3A / Q000378:metabolism; D006801:Humans; D004364:Pharmaceutical Preparations / Q000008:administration & dosage / Q000378:metabolism*; D010599:Pharmacokinetics
chemical_list: D004364:Pharmaceutical Preparations; D051544:Cytochrome P-450 CYP3A
keywords: celiac disease; celiac sprue; children; coeliac disease; drug absorption; gluten sensitive enteropathy; intestinal villous atrophy; malabsoprtion; pediatric; pharmacokinetics