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Measurement of plasma disopyramide as a guide to paediatric use
Insights
Pediatric patients may require higher disopyramide doses for effective arrhythmia treatment. Higher doses were not associated with adverse effects, emphasizing the need for plasma concentration monitoring.
Area of Science:
- Cardiology
- Pediatric Pharmacology
Background:
- Disopyramide is an antiarrhythmic drug used in treating cardiac arrhythmias.
- Optimizing disopyramide dosage in pediatric patients is crucial for efficacy and safety.
Purpose of the Study:
- To investigate the relationship between age, daily dose, plasma concentration, and clinical efficacy of disopyramide in pediatric patients.
- To determine if higher disopyramide doses in children are associated with toxicity.
Main Methods:
- Oral disopyramide treatment was administered to 15 pediatric patients (12 with ventricular, 3 with supraventricular arrhythmias).
- Dosage was adjusted to achieve a pre-dose plasma concentration greater than 2 mg/L.
- Clinical efficacy and adverse effects were monitored.
Main Results:
- Seven patients responded to disopyramide treatment based on clinical criteria.
- No symptoms or signs of toxicity were observed, even with doses exceeding normal adult ranges.
- Younger children generally required higher doses, but dose prediction based on age, weight, or surface area was not feasible.
Conclusions:
- High doses of disopyramide may be necessary to achieve therapeutic plasma concentrations in children.
- Effective disopyramide therapy in pediatric patients can be achieved without adverse effects.
- Plasma concentration monitoring is essential to guide disopyramide therapy and prevent premature discontinuation.
Abstract:
We have studied the relationship between age, daily dose, plasma concentration and clinical efficacy of disopyramide in a group of paediatric patients. Twelve children with ventricular and 3 with supraventricular arrhythmias were treated with oral disopyramide. The initial dose was 3-6 mg/kg per day. This was adjusted until a pre-dose plasma concentration greater than 2 mg/I was achieved. Seven patients were judged to have responded to the treatment on clinical criteria. No symptoms or signs of toxicity were observed. In some of the children the dose of disopyramide required to achieve a plasma concentration greater than 2 mg/l was greatly in excess of the normal adult dose. Generally the youngest children required the highest dose, but the variation was wide. The dose could not be predicted from the age, the body weight or the surface area of the patient. In children high doses of disopyramide may be needed to achieve effective plasma concentrations of the drug; such doses are not associated with adverse effects. Measurement of the plasma concentration is necessary to guard against premature termination of therapy.