A Literature Review of the Pharmacokinetics and Pharmacodynamics of Dobutamine in Neonates.
Since its discovery in 1975 dobutamine has been used off-label for treating hemodynamic insufficiency in newborns and children. We present a structured literature review of pharmacokinetic and pharmacodynamic data for dobutamine in the pediatric population. Structured searches were conducted to identify relevant articles according to pre-defined inclusion criteria. Where possible, results for the pharmacodynamic and pharmacokinetic effect of dobutamine were reported as pooled data. Forty-six papers met the inclusion criteria. With regard to pharmacodynamic data a number of studies reported significant increases in a number of clinical parameters such as heart rate, blood pressure, cardiac output across a wide range of pediatric populations. With regard to pharmacokinetic data studies reported that the infusion rate was positively correlated to plasma dobutamine concentration. There was great variability with regard to dobutamine clearance between individuals and as to whether it followed first- or zero-order elimination kinetics. While the pharmacodynamic effects of dobutamine appear to reflect the pharmacological profile of the drug, the pharmacokinetic data are difficult to interpret due to inhomogeneity between study populations ages, comorbidities, dobutamine dosages and methodologies. High-quality prospective pharmacokinetic and pharmacodynamic data especially in newborns are urgently required prior to a large randomized study.
Academic Department of Paediatrics, Brighton and Sussex Medical School, Royal Alexandra Children's Hospital, Level 6, Room 663, Eastern Road, Brighton, BN2 5BE, UK. liam.mahoney@bsuh.nhs.uk.
Liam
L
Mahoney
Academic Department of Paediatrics, Brighton and Sussex Medical School, Royal Alexandra Children's Hospital, Level 6, Room 663, Eastern Road, Brighton, BN2 5BE, UK.
Geetika
G
Shah
Clinical Investigation and Research Unit, Royal Sussex County Hospital, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK.
David
D
Crook
Academic Department of Paediatrics, Brighton and Sussex Medical School, Royal Alexandra Children's Hospital, Level 6, Room 663, Eastern Road, Brighton, BN2 5BE, UK.
Hector
H
Rojas-Anaya
Academic Department of Paediatrics, Brighton and Sussex Medical School, Royal Alexandra Children's Hospital, Level 6, Room 663, Eastern Road, Brighton, BN2 5BE, UK.
Heike
H
Rabe
D001794:Blood Pressure / Q000187:drug effects; D002302:Cardiac Output / Q000187:drug effects; D002648:Child; D004280:Dobutamine / Q000493:pharmacokinetics* / Q000494:pharmacology*; D004305:Dose-Response Relationship, Drug; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D007022:Hypotension / Q000188:drug therapy*; D007223:Infant; D007231:Infant, Newborn; D013566:Sympathomimetics / Q000493:pharmacokinetics* / Q000494:pharmacology*
D013566:Sympathomimetics; D004280:Dobutamine
Dobutamine; Hypotension; Neonate; Pediatric; Pharmacodynamic; Pharmacokinetic