TY - JOUR
T1 - Growing up with midazolam in the neonatal and pediatric intensive care
AU - Swart, Eleonora L.
AU - Slort, Pauline R.
AU - Plötz, Frans B.
PY - 2012/7
Y1 - 2012/7
N2 - A variety of developmental changes is of influence on the pharmacokinetics and pharmacodynamics of midazolam in neonatal and pediatric intensive care patients. However, dosing regimens in children are based upon rather empirical extrapolations from the dosing regimens in adults. Based on current available studies it appears that with the rising of age, the pharmacokinetics of intravenously administered midazolam alter, resulting in a shorter half-life due to a higher hepatic clearance in older children as compared to newborn. Also, with the rising of age, the pharmacodynamics of intravenously administered midazolam may alter due to a decrease in density of receptors, possibly leading to a decreased clinical response. These findings implicate opposite effects and it is uncertain which of these effects are predominant. In conclusion, there is a large interindividual variability in the response to midazolam in children, which may be caused by differences in pharmacokinetics and pharmacodynamics. Both are subject to considerable developmental changes. It remains remarkable that high-quality evidence to support the use of midazolam for continuous sedation in the neonatal and pediatric intensive care setting is lacking. © 2012 Bentham Science Publishers.
AB - A variety of developmental changes is of influence on the pharmacokinetics and pharmacodynamics of midazolam in neonatal and pediatric intensive care patients. However, dosing regimens in children are based upon rather empirical extrapolations from the dosing regimens in adults. Based on current available studies it appears that with the rising of age, the pharmacokinetics of intravenously administered midazolam alter, resulting in a shorter half-life due to a higher hepatic clearance in older children as compared to newborn. Also, with the rising of age, the pharmacodynamics of intravenously administered midazolam may alter due to a decrease in density of receptors, possibly leading to a decreased clinical response. These findings implicate opposite effects and it is uncertain which of these effects are predominant. In conclusion, there is a large interindividual variability in the response to midazolam in children, which may be caused by differences in pharmacokinetics and pharmacodynamics. Both are subject to considerable developmental changes. It remains remarkable that high-quality evidence to support the use of midazolam for continuous sedation in the neonatal and pediatric intensive care setting is lacking. © 2012 Bentham Science Publishers.
UR - https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=84863678855&origin=inward
UR - https://www.ncbi.nlm.nih.gov/pubmed/22452456
U2 - https://doi.org/10.2174/138920012800840347
DO - https://doi.org/10.2174/138920012800840347
M3 - Article
C2 - 22452456
SN - 1389-2002
VL - 13
SP - 760
EP - 766
JO - Current drug metabolism
JF - Current drug metabolism
IS - 6
ER -