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Pharmacokinetics in Pediatric Patients: Drug Excretion01:26

Pharmacokinetics in Pediatric Patients: Drug Excretion

In pediatric medicine, understanding the renal function and drug elimination nuances is crucial for administering safe and effective treatments. Newborns, in particular, display markedly slower renal functions than adults, profoundly affecting how drugs are cleared from their bodies. This slower drug clearance requires clinicians to extend the dosing intervals for many medications to prevent drug accumulation and toxicity while ensuring therapeutic efficacy.One key area where these adjustments...
Pharmacokinetics in Pediatric Patients: Drug Metabolism01:24

Pharmacokinetics in Pediatric Patients: Drug Metabolism

In pediatric care, understanding the nuances of hepatic drug metabolism is crucial, as it significantly differs from that of adults. This divergence is primarily due to the developmental stage of drug-metabolizing enzymes, which affects how medications are processed in the body. In neonates, for instance, the activity of Phase I enzymes—critical for the initial breakdown of drugs—is markedly reduced, functioning at just 20–40% of the levels seen in adults. This reduction poses a challenge in...
Pharmacokinetics in Pediatric Patients: Overview and Drug Absorption01:23

Pharmacokinetics in Pediatric Patients: Overview and Drug Absorption

Understanding the physiological differences in the pediatric population is crucial for effective pharmacotherapy. Neonates, infants, and children exhibit significant variations in gastric pH, gastric emptying time, intestinal transit time, and biliary function. These variations profoundly affect oral drug absorption, necessitating a nuanced approach to pediatric dosing.Neonates present with a unique physiological profile, having a gastric pH greater than 4 and faster and more irregular gastric...
Pharmacokinetics in Pediatric Patients: Drug Distribution01:17

Pharmacokinetics in Pediatric Patients: Drug Distribution

Drug distribution in the pediatric population exhibits unique challenges and considerations due to the physiological differences between children, particularly neonates and infants, and adults. A crucial aspect of pediatric pharmacology is understanding how these differences impact the pharmacokinetics of various drugs, necessitating age-specific dosing strategies to ensure efficacy and safety.Neonates and infants have a higher total body water content, ~75%–90% of their body weight, compared...
Antiviral Nucleoside Inhibitors01:22

Antiviral Nucleoside Inhibitors

Antiviral Nucleoside InhibitorsAntiviral nucleoside inhibitors are structural analogs of natural nucleosides that interfere with viral DNA or RNA synthesis. These compounds selectively target viral polymerases due to their resemblance to host nucleosides, thereby disrupting viral genome replication.Mechanism of Acyclovir ActionAcyclovir is a guanosine analog with a three-carbon acyclic side chain. It selectively targets herpes simplex virus type 1 (HSV-1), herpes simplex virus type 2 (HSV-2),...
Dosage Regimens: Partial Pharmacokinetic Parameters01:01

Dosage Regimens: Partial Pharmacokinetic Parameters

It is not uncommon for complete drug pharmacokinetic profiles to remain elusive in pharmacokinetics. This necessitates certain educated assumptions by pharmacokineticists to determine appropriate dosage regimens without comprehensive pharmacokinetic data from animal or human studies. One prevalent assumption is setting the bioavailability factor, denoted as F, to 1 or 100%. This assumption caters to the scenario where a drug doesn't achieve full systemic absorption, resulting in the patient...

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Development of an IFN-&#947; ELISpot Assay to Assess Varicella-Zoster Virus-specific Cell-mediated Immunity Following Umbilical Cord Blood Transplantation
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Valacyclovir and acyclovir pharmacokinetics in immunocompromised children.

Lisa Bomgaars1, Patrick Thompson, Stacey Berg

  • 1Texas Children's Cancer Center, Baylor College of Medicine, Houston, Texas, USA. lbomgaars@txccc.org

Pediatric Blood & Cancer
|June 19, 2008
PubMed
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Oral valacyclovir demonstrates good bioavailability and tolerability in immunocompromised children, supporting its use for herpes zoster treatment. This study provides key pharmacokinetic data for pediatric patients.

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Published on: September 20, 2021

Area of Science:

  • Pharmacology and Therapeutics
  • Pediatric Infectious Diseases

Background:

  • Valacyclovir, an oral prodrug of acyclovir, is used for herpes simplex and zoster infections.
  • Limited pharmacokinetic and safety data exist for valacyclovir in pediatric populations.
  • This study addresses the need for data on acyclovir pharmacokinetics after valacyclovir administration in immunocompromised children.

Purpose of the Study:

  • To describe acyclovir pharmacokinetics following oral valacyclovir in immunocompromised pediatric patients.
  • To compare pharmacokinetic parameters of oral valacyclovir versus intravenous acyclovir.
  • To assess the efficacy of valacyclovir in treating active herpes zoster infections in children.

Main Methods:

  • Thirty-seven immunocompromised children were enrolled in two studies.
  • Pharmacokinetic data were collected from 32 patients after receiving oral valacyclovir (15 mg/kg).
  • Eleven patients also underwent pharmacokinetic sampling after intravenous acyclovir administration; three received valacyclovir for herpes zoster.

Main Results:

  • Mean C(max) for acyclovir after oral valacyclovir was 18.8 +/- 7 microM, with a total exposure of 4,106 +/- 1,519 microM min.
  • Acyclovir bioavailability from valacyclovir was approximately 64%.
  • The only reported toxicity was Grade 1 nausea and emesis in five patients; two of three herpes zoster patients showed complete lesion scabbing by day 9.

Conclusions:

  • Oral valacyclovir (15 mg/kg) was well-tolerated and showed excellent bioavailability in pediatric patients.
  • The findings support considering oral valacyclovir for treating herpes zoster in clinically stable pediatric oncology patients.
  • Further research into valacyclovir's use in pediatric populations is warranted.