Clinical Pharmacology of Furosemide in Neonates: A Review

Pacifici, Gian Maria

doi:10.3390/ph6091094

Cited by 52 publications

(39 citation statements)

References 134 publications

(266 reference statements)

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“…The outcome of the NEMO trial is unfortunate but is in line with already available observations on furosemide related hearing impairments [6]. While the aforementioned mechanism has only been reported recently, the epidemiological data between loop diuretics and hearing impairment have been reported decades ago, using much lower doses of bumetanide.…”

Section: A Mechanism To Explain Ototoxicity In Neonatessupporting

confidence: 74%

A Mechanism to Explain Ototoxicity in Neonates Exposed to Bumetamide: Lessons to Help Improve Future Product Development in Neonates

2016

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Section: A Mechanism To Explain Ototoxicity In Neonatessupporting

confidence: 74%

A Mechanism to Explain Ototoxicity in Neonates Exposed to Bumetamide: Lessons to Help Improve Future Product Development in Neonates

2016

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“…Among factors that can mitigate this risk, the short-term administration of drugs with nephrotoxic potential, such as aminoglycosides and diuretics, is recognized [25, 26]. …”

Section: Discussionmentioning

confidence: 99%

Pattern of drug use among preterm neonates: results from an Italian neonatal intensive care unit

et al. 2017

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BackgroundDrug use in preterm neonates admitted to Neonatal Intensive Care Unit (NICU) has been investigated, so far, in terms of unauthorized or off-label use; very little is known on the use of combinations of different active substances, which is frequently required in this population (prophylaxis of infections, treatment of concomitant diseases). The aim of this study was to describe the most common patterns of drug use in an Italian NICU, focusing on those with nephrotoxic potential.MethodsMedical records of preterm neonates (<37 weeks of gestational age) weighing less than 1,500 g at birth and admitted to an Italian NICU were scrutinized in a 3-year retrospective investigation. Analysis included drug exposure, duration of therapies, co-administration of drugs with potential renal side effects; also daily protein supplement was calculated from parenteral nutrition.ResultsA cohort of 159 preterm neonates was selected; 68 were born weighing less than 1,000 g (extremely low birth weight infants, ELBW, Group A), 91 weighed between 1,000 and 1,500 g at birth (Group B). Compared to Group B, neonates of Group A were more likely to receive pharmacological treatments: the most used drugs were antibiotics (especially ampicillin and amikacin, p = .07 and p < .001, respectively), antifungals (especially fluconazole, p < .001), and diuretics (especially furosemide, p < .001). Analysis of co-administration of drugs with potential nephrotoxicity showed ampicillin and amikacin as the most reported combination (94.1% of Group A and 31.9% of Group B), the combination of furosemide with antibacterials (ampicillin or amikacin) was also frequently reported, with average period of combination shorter than 2 days.ConclusionsELBW infants were exposed to a higher number of drugs compared to other neonates and were more likely to receive associations of drugs with nephrotoxic potential (e.g. furosemide and amikacin), though only for short cycles. Further studies should evaluate the safety profile (especially potential renal side effects) related to most commonly used combinations.

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“…Mirochnick et al reported an average oral bioavailability of 84% when furosemide is delivered to children of 39 weeks gestational age. Whether this higher bioavailability originates from higher intestinal paracellular permeability remains to be confirmed as other explanations cannot be excluded .…”

Section: Age‐mediated Changes In Physiological Processes Determining mentioning

confidence: 98%

Oral drug absorption in pediatrics: the intestinal wall, its developmental changes and current tools for predictions

Nicolas

Bouzom

Chanteux

et al. 2017

Biopharm & Drug Disp

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The dissolution, intestinal absorption and presystemic metabolism of a drug depend on its physicochemical characteristics but also on numerous physiological (e.g. gastrointestinal pH, volume, transit time, morphology) and biochemical factors (e.g. luminal enzymes and flora, intestinal wall enzymes and transporters). Over the past decade, evidence has accumulated indicating that these factors may differ in children and adults resulting in age‐related changes in drug exposure and drug response. Thus, drug dosage may require adjustment for the pediatric population to ensure the desired therapeutic outcome and to avoid side‐effects. Although tremendous progress has been made in understanding the effects of age on intestinal physiology and function, significant knowledge gaps remain. Studying and predicting pharmacokinetics in pediatric patients remains challenging due to ethical concerns associated with clinical trials in this vulnerable population, and because of the paucity of predictive in vitro and in vivo animal assays. This review details the current knowledge related to developmental changes determining intestinal drug absorption and pre‐systemic metabolism. Supporting experimental approaches as well as physiologically based pharmacokinetic modeling are also discussed together with their limitations and challenges. © 2016 UCB Biopharma sprl. Biopharmaceutics & Drug Disposition Published by John Wiley & Sons, Ltd.

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Clinical Pharmacology of Furosemide in Neonates: A Review

Cited by 52 publications

References 134 publications

A Mechanism to Explain Ototoxicity in Neonates Exposed to Bumetamide: Lessons to Help Improve Future Product Development in Neonates

A Mechanism to Explain Ototoxicity in Neonates Exposed to Bumetamide: Lessons to Help Improve Future Product Development in Neonates

Pattern of drug use among preterm neonates: results from an Italian neonatal intensive care unit

Oral drug absorption in pediatrics: the intestinal wall, its developmental changes and current tools for predictions

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