Drug disposition and therapy in adolescence: the effects of puberty

Puberty, a part of adolescence, is a time of rapid physical, psychological, and psychosocial changes. Variability in drug absorption, distribution, metabolism and excretion occurs due to physical and hormonal changes, as well as those of body composition. Environmental factors affecting nutrition and compliance in the pubescent individual also affect success in achieving desired pharmacologic effects while minimizing toxicities. Based on available data, pharmacologic research has been relatively inadequate in providing information about drug disposition during puberty. The majority of available studies have neglected to provide staging for pubescent adolescents or have altogether excluded this population from their investigations. However, data are available that describe the effects of puberty on the pharmacokinetics of agents such as theophylline, digoxin, carbamazepine, lamotragine, vigabatrin and benzodiazepines.To date, few clinically significant changes in drug disposition have been noted during puberty. However, factors such as compliance, concomitant drug use, and the potentially rebellious nature of adolescents must be taken into consideration in the medical management of the adolescent.