Correction to: Pharmacokinetics of Fentanyl and Its Derivatives in Children: A Comprehensive Review

Abstract

Fentanyl and its derivatives sufentanil, alfentanil, and remifentanil are potent opioids. A comprehensive review of the use of fentanyl and its derivatives in the pediatric population was performed using the National Library of Medicine PubMed. Studies were included if they contained original pharmacokinetic parameters or models using established routes of administration in patients younger than 18 years of age. Of 372 retrieved articles, 44 eligible pharmacokinetic studies contained data of 821 patients younger than 18 years of age, including more than 46 preterm infants, 64 full-term neonates, 115 infants/toddlers, 188 children, and 28 adolescents. Underlying diagnoses included congenital heart and pulmonary disease and abdominal disorders. Routes of drug administration were intravenous, epidural, oral-transmucosal, intranasal, and transdermal. Despite extensive use in daily clinical practice, few studies have been performed. Preterm and term infants have lower clearance and protein binding. Pharmacokinetics was not altered by chronic renal or hepatic disease. Analyses of the pooled individual patients' data revealed that clearance maturation relating to body weight could be best described by the Hill function for sufentanil (R 2 = 0.71, B max 876 mL/min, K 50 16.3 kg) and alfentanil (R 2 = 0.70, B max (fixed) 420 mL/min, K 50 28 kg). The allometric exponent for estimation of clearance of sufentanil was 0.99 and 0.75 for alfentanil clearance. Maturation of remifentanil clearance was described by linear regression to bodyweight (R 2 = 0.69). The allometric exponent for estimation of remifentanil clearance was 0.76. For fentanyl, linear regression showed only a weak correlation between clearance and bodyweight in preterm and term neonates (R 2 = 0.22) owing to a lack of data in older age groups. A large heterogeneity regarding study design, clinical setting, drug administration, laboratory assays, and pharmacokinetic estimation was observed between studies introducing bias into the analyses performed in this review. A limitation of this review is that pharmacokinetic data, based on different modes of administration, dosing schemes, and parameter estimation methods, were combined.The online version of the original article can be found under

Rapidly maturing fentanyl clearance in preterm neonates

“…With the sparse available evidence from literature,8 36 it seems difficult to give dosage advices for fentanyl in preterm infants, especially as target concentrations are still lacking. Furthermore, target concentrations might vary between different indications such as acute pain relief during painful procedures or continuous analgesia 8 37.…”

Opioids and alpha-2-agonists for analgesia and sedation in newborn infants: protocol of a systematic review

“…Morphine has the longest duration of onset, half-life, and elimination time, followed by fentanyl and remifentanil [10][11][12]. Remifentanil is a short-acting opioid with ultra-rapid onset and very fast elimination profile, very suitable for rapid painful procedures such as tracheal intubations [13].…”

Analgesics and Sedatives in Critically Ill Newborns and Infants: The Impact on Long‐Term Neurodevelopment

“…Its half-life time is short compared to morphine (ranging between 188 and 570 minutes in infants and neonates vs 219 minutes in adults 33 ), but longer than its derivatives sufentanil, alfentanil, and remifentanil. 33 In the search for optimal dosing, using population PK approaches, large variations were observed in the dose of fentanyl used across studies (ranging between 1 and 5 μg/kg). In 4 studies, neonates were included (range, 1-71 days) with weight ranging between 1.4 kg and 4.0 kg.…”

“…Intravenous bolus administration was used in most studies (n = 5) followed by continuous infusion (n = 2), whereas 1 study only applied continuous infusion . Only limited PK data are available in preterm neonates, which warrants future research.…”