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Related Experiment Videos

Pain control: non-steroidal anti-inflammatory agents.

Evelyne Jacqz-Aigrain1, Brian J Anderson

  • 1Department of Paediatric Pharmacology, Robert Debré Hospital, 48 Boulevard Sérurier, 75019 Paris, France. evelyne.jacqz-aigrain@rdb.aphp.fr

Seminars in Fetal & Neonatal Medicine
|May 9, 2006
PubMed
Summary

Common pain relievers like NSAIDs and acetaminophen have limited data in infants. Clearance and distribution vary significantly in neonates, impacting safe dosing and toxicity risks.

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Area of Science:

  • Pharmacology
  • Neonatal Medicine
  • Drug Metabolism

Background:

  • Non-steroidal anti-inflammatory drugs (NSAIDs) and acetaminophen (paracetamol) are widely used analgesics in neonates and infants.
  • Limited pharmacodynamic data exists for these common drugs in this population.
  • Both drug classes inhibit cyclooxygenase enzymes.

Purpose of the Study:

  • To review the pharmacodynamics and safety profiles of NSAIDs and acetaminophen in neonates and infants.
  • To highlight age-specific clearance and volume of distribution trends.
  • To discuss toxicity concerns and adverse effects in neonatal populations.

Main Methods:

  • Literature review of pharmacodynamic data for NSAIDs and acetaminophen in neonates.
  • Analysis of pharmacokinetic parameters including clearance and volume of distribution.

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  • Review of reported adverse effects and toxicity data.

    • Main Results:

    • Neonatal acetaminophen clearance is significantly lower in premature infants, increasing towards adult rates within the first year.
    • NSAID clearance follows similar age-dependent trends.
    • Increased volume of distribution is noted in neonates.
    • Acetaminophen hepatotoxicity appears less frequent in neonates compared to older individuals.
    • NSAID use for patent ductus arteriosus closure in premature neonates is associated with a 20% reduction in renal function.
    • No significant differences in cerebral blood flow or oxygenation were observed between ibuprofen and placebo in neonates.

    Conclusions:

    • Dosing of NSAIDs and acetaminophen in neonates requires careful consideration due to altered pharmacokinetics and potential toxicities.
    • Further research is needed to establish age and pathology-specific concentration-response relationships for these analgesics.