Use of salivary concentrations in the prediction of serum caffeine and theophylline concentrations in premature infants

Khanna, Narinder N.; Bada, Henrietta S.; Somani, Satu M.

doi:10.1016/s0022-3476(80)80708-6

Cited by 34 publications

(27 citation statements)

References 17 publications

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“…[65] While some studies of caffeine reported good correlation between measurements in saliva and blood, both had some drawbacks with methodology. [66,67] If well-designed studies can establish a good correlation between plasma and salivary caffeine concentrations, the latter could become the standard of care and avoid unnecessary blood wastage in the premature infant.…”

Section: Mechanism Of Actionmentioning

confidence: 99%

Treatment of Apnea of Prematurity

Bhatt‐Mehta

Schumacher

2003

Pediatric Drugs

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In the last decade, knowledge regarding the neurodevelopment and functional aspects of the respiratory centers during postnatal maturation has increased substantially. However, an increase in such knowledge has not provided a basis for change in practice. The diagnosis of apnea of prematurity (AOP) is one of exclusion. All causes of secondary apnea must be ruled out before initiating treatment for AOP. Treatment will depend on the etiology as well as effectiveness and tolerability of the treatment by the patient. The primary goal of any treatment of AOP is to prevent the frequency of apnea lasting >20 seconds, and/or those that are shorter, but associated with cyanosis and bradycardia. The clinical management of AOP is not much different today than it was two decades ago, with pharmacologic and nonpharmacologic treatment options remaining the mainstay of therapy. Methylxanthines are still the most widely used pharmacologic agents. Due to the wider therapeutic index of caffeine and ease of once daily administration, it should be the preferred agent. Doxapram, or nonpharmacologic treatment measures such as nasal continuous positive airway pressure, may be considered in infants who are unresponsive to methylxanthine treatment alone. Treatment should be continued until there is complete resolution of apnea, and for some time thereafter. The choice of method for weaning treatment remains one of individual physician preference. Discharge from hospital after apnea requires close monitoring and some infants will require home apnea monitors. The decision to provide a home apnea monitor should be individualized for each patient, depending on the effectiveness of treatment and clinical response.

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Section: Mechanism Of Actionmentioning

confidence: 99%

Treatment of Apnea of Prematurity

Bhatt‐Mehta

Schumacher

2003

Pediatric Drugs

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“…Effect ofcimetidine treatment on thepharmacokinetics of a single dose of caffeine Table 1 shows that cimetidine pre-treatment reduces the rate of elimination of caffeine. Relationship between plasma and salivary caffeine concentrations Salivary caffeine elimination has been used to determine caffeine pharmacokinetics in adults (Parsons & Neims, 1978) and neonates (Khanna, Bada & Somani, 1980). A t-statistic was calculated by subtracting the post-treatment mean value from the pre-treatment mean value and dividing this difference by the standard error of the difference of means.…”

Section: Reproducibility Ofestimates Ofpharmacokinetic Parameters Ofcmentioning

confidence: 99%

Decreased systemic clearance of caffeine due to cimetidine.

Broughton¹,

Rogers²

1981

Brit J Clinical Pharma

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1 Five normal subjects received pre-treatment with cimetidine 200 mg three times daily and 400 mg at night for 6 days, or matching placebo. 2 Caffeine (300 mg) was given orally before any treatment and at the beginning of the last day of each treatment course. Treatments were randomly allocated and separated by at least one week. 3 A significant reduction occurred in the systemic clearance of caffeine and the half-life was prolonged as determined from measurement of caffeine in plasma and saliva. No change occurred in the apparent volume of distribution. 4 The oral bioavailability of caffeine was found to be complete in the one subject studied. 5 It is suggested that cimetidine inhibits the microsomal metabolism of caffeine. Although the steady state plasma caffeine would increase by approximately 70%, it is unlikely that this would produce adverse clinical effects.

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“… study, just 3 years later Khanna et al . reported a correlation value as low as 0.7 compared to Toback's 0.98. Both studies were similar in their use of high‐pressure liquid chromatography (HPLC) for analysis, no stimulation, a similar time period for sample collection following intravenous (IV) administration and assessed a similar number of premature neonates.…”

Section: Resultsmentioning

confidence: 90%

A descriptive systematic review of salivary therapeutic drug monitoring in neonates and infants

Hutchinson

Sinclair

Reid

et al. 2018

Brit J Clinical Pharma

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AIMSSaliva, as a matrix, offers many benefits over blood in therapeutic drug monitoring (TDM), in particular for infantile TDM. However, the accuracy of salivary TDM in infants remains an area of debate. This review explored the accuracy, applicability and advantages of using saliva TDM in infants and neonates. METHODSDatabases were searched up to and including September 2016. Studies were included based on PICO as follows: P: infants and neonates being treated with any medication, I: salivary TDM vs. C: traditional methods and O: accuracy, advantages/disadvantages and applicability to practice. Compounds were assessed by their physicochemical and pharmacokinetic properties, as well as published quantitative saliva monitoring data. RESULTSTwenty-four studies and their respective 13 compounds were investigated. Four neutral and two acidic compounds, oxcarbazepine, primidone, fluconazole, busulfan, theophylline and phenytoin displayed excellent/very good correlation between blood plasma and saliva. Lamotrigine was the only basic compound to show excellent correlation with morphine exhibiting no correlation between saliva and blood plasma. Any compound with an acid dissociation constant (pKa) within physiological range (pH 6-8) gave a more varied response. CONCLUSIONThere is significant potential for infantile saliva testing and in particular for neutral and weakly acidic compounds. Of the properties investigated, pKa was the most influential with both logP and protein binding having little effect on this correlation. To conclude, any compound with a pKa within physiological range (pH 6-8) should be considered with extra care, with the extraction and analysis method examined and optimized on a case-by-case basis.

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Use of salivary concentrations in the prediction of serum caffeine and theophylline concentrations in premature infants

Cited by 34 publications

References 17 publications

Treatment of Apnea of Prematurity

Treatment of Apnea of Prematurity

Decreased systemic clearance of caffeine due to cimetidine.

A descriptive systematic review of salivary therapeutic drug monitoring in neonates and infants

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