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Pharmacokinetics of dopamine in infants and children
M K Eldadah1, P H Schwartz, R Harrison
1Division of Pediatric Intensive Care, Childrens Hospital Los Angeles, University of Southern California.
Insights
The pharmacokinetics of dopamine in children are variable and may be influenced by dobutamine. This study found that hepatic or renal function does not adversely affect dopamine disposition in pediatric patients.
Area of Science:
- Pharmacology
- Pediatric Critical Care
Background:
- Dopamine is a critical vasoactive agent used in pediatric intensive care.
- Understanding dopamine pharmacokinetics is essential for optimizing its use in children.
Purpose of the Study:
- To investigate the pharmacokinetics of dopamine in hemodynamically stable children.
- To explore factors influencing dopamine disposition, including co-administration with dobutamine and organ function.
Main Methods:
- Prospective clinical trial conducted in a Pediatric Intensive Care Unit.
- Dopamine plasma concentrations measured using high-performance liquid chromatography in children (3 months to 13 years) recovering from cardiac surgery or shock.
- Pharmacokinetic parameters including half-lives, volume of distribution, and clearance were determined.
Main Results:
- Dopamine exhibited variable pharmacokinetic parameters with distribution and elimination half-lives of 1.8 ± 1.1 and 26 ± 14 minutes, respectively.
- A linear relationship between dopamine dose and clearance was observed only in patients receiving dobutamine (r² = .76, p < .05).
- Hepatic and renal dysfunction did not significantly impact dopamine pharmacokinetics.
Conclusions:
- A potential interaction between dopamine and dobutamine may affect their disposition.
- Dopamine pharmacokinetics demonstrate significant variability in hemodynamically stable pediatric patients.
- Normal hepatic and renal function do not appear to be critical determinants of dopamine pharmacokinetics in this population.
Objective:
We studied the pharmacokinetics of dopamine in hemodynamically stable children.
Design:
Prospective clinical trial.
Setting:
Pediatric ICU.
Patients:
Children (age 3 months to 13 yrs) recovering from cardiac surgery or shock.
Intervention:
Plasma dopamine concentrations were measured at the steady state or at termination of infusion using high-performance liquid chromatography.
Results:
The half-lives of distribution and elimination were 1.8 +/- 1.1 and 26 +/- 14 (SD) mins, respectively. The apparent volume of distribution was 2952 +/- 2332 mL/kg. The clearance rate was 454 +/- 900 mL/kg.min. Dopamine clearance was linearly related to dose only in patients who were also receiving dobutamine (r2 = .76, p less than .05). Hepatic and renal dysfunction did not affect the pharmacokinetics of dopamine.
Conclusions:
A relationship between dopamine and dobutamine that affects the disposition of these two drugs may exist. The pharmacokinetics of dopamine are variable even in hemodynamically stable children. Hepatic or renal function does not adversely affect the pharmacokinetics of dopamine.