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Safety of sildenafil in infants*
Samira Samiee-Zafarghandy1, P Brian Smith, Johannes N van den Anker
11Division of Pediatric Clinical Pharmacology, Children's National Medical Center, George Washington University School of Medicine and Health Sciences, Washington, DC. 2Duke Clinical Research Institute, Durham, NC. 3Department of Pediatrics, Duke University, Durham, NC. 4Department of Pediatrics, Children's National Medical Center, George Washington University School of Medicine and Health Sciences, Washington, DC. 5Department of Pharmacology and Physiology, Children's National Medical Center, George Washington University School of Medicine and Health Sciences, Washington, DC. 6Intensive Care, Erasmus Medical Center-Sophia Children's Hospital, Rotterdam, The Netherlands. 7Department of Paediatric Pharmacology, University Children's Hospital Basel, Switzerland.
Insights
Sildenafil shows no serious adverse events in infants and remains a valuable treatment for pulmonary hypertension. Further research is needed to assess current safety concerns in this population.
Area of Science:
- Pediatric pharmacology
- Neonatology
- Cardiology
Background:
- Recent U.S. Food and Drug Administration (FDA) warnings have raised concerns about sildenafil use in pediatric patients.
- Sildenafil is a medication used to treat pulmonary hypertension.
Purpose of the Study:
- To provide an updated overview of sildenafil dosing and safety in infants.
- To evaluate the relevance of current pediatric safety concerns to the infant population.
Main Methods:
- Searched PubMed and Cochrane Database for studies on sildenafil in infants and children.
- Included studies with original clinical data on dosing, use, or safety in infants with pulmonary hypertension.
- Included 49 studies, predominantly case reports and series, involving 625 children, over 140 of whom were infants.
Main Results:
- The most common diagnoses were persistent pulmonary hypertension of the newborn and pulmonary hypertension associated with other conditions.
- No serious adverse events were reported in infants exposed to sildenafil.
- Sildenafil is a valuable treatment option for pulmonary hypertension in young infants.
Conclusions:
- Current safety concerns for pediatric sildenafil use require further investigation before application to infants.
- Prospective studies are recommended to include safety assessments for sildenafil therapy in infants.
- Sildenafil remains a crucial therapeutic option for infant pulmonary hypertension.
Objective:
In view of the recent U.S. Food and Drug Administration's warning against the use of sildenafil in pediatric patients, we aimed to provide an updated overview of the dosing and safety of sildenafil in infants and to explore the relevance of the present safety concerns to the infant population.
Data Source:
The National Library of Medicine PubMed and Cochrane Database of Systematic Reviews were searched using the following terms: Sildenafil AND (infant OR infants OR newborn OR newborns OR child OR children OR childhood OR pediatric OR pediatrics OR paediatric OR paediatrics).
Study Selection:
Studies presenting original clinical data regarding the dosing, use, or safety of sildenafil in infants with pulmonary hypertension would be included.
Data Extraction:
Of the 49 included studies, case reports and case series were the most common type of publications (n = 25). The identified trials included 625 children, with more than 140 infants. Persistent pulmonary hypertension of the newborn and pulmonary hypertension associated with other conditions were the most common underlying diagnoses.
Conclusion:
There is currently no evidence of serious adverse event in infants exposed to sildenafil. Present safety concerns regarding the use of sildenafil in pediatric patients should be further explored before being applied to infant population. Sildenafil remains a valuable option for the treatment of pulmonary hypertension in young infants. Prospective studies should be designed in such a way that they include a safety assessment to evaluate potential adverse outcomes of sildenafil therapy in this population.
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