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Published on: October 16, 2013
Inter-individual variation in midazolam clearance in children
Mohammed I Altamimi1, Helen Sammons1, Imti Choonara1
1Academic Division of Child Health, University of Nottingham, Derbyshire Children's Hospital, Derby, UK.
Midazolam clearance in children shows significant inter-individual variation, especially in critically ill patients across all age groups. This variability impacts drug dosing and patient outcomes.
Area of Science:
- Pharmacokinetics
- Pediatric Pharmacology
- Critical Care Medicine
Background:
- Midazolam is a commonly used sedative in pediatric patients.
- Understanding its clearance variability is crucial for safe and effective dosing.
Purpose of the Study:
- To quantify inter-individual variation in midazolam clearance in children.
- To identify factors contributing to this variability.
Main Methods:
- Systematic literature review of midazolam clearance studies in pediatric populations.
- Databases searched include Medline, Embase, and Cochrane Library.
- Analysis of plasma clearance range and coefficient of variation (CV).
Main Results:
- 25 articles were identified; 13 provided individual patient clearance data.
- Critically ill children exhibited higher CV (18%-170%) compared to non-critically ill (13%-54%).
- Significant variation observed across all pediatric age groups, particularly neonates and adolescents.
Conclusions:
- Substantial inter-individual variation in midazolam clearance is evident in critically ill pediatric patients.
- This variability is a significant concern in neonates, infants, children, and adolescents.
- Further research may be needed to optimize dosing strategies.
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