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Related Concept Videos

Drug Dosing: Infants and Children01:29

Drug Dosing: Infants and Children

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Pediatric patient dosages diverge from adults due to disparities in body surface area, total body water, and extracellular fluid per kilogram of body weight. The dosing regimen considers the variations in pharmacokinetics and pharmacology across distinct age groups, encompassing preterm newborns, infants, young children, older children, and adolescents. Calculation of pediatric patient doses is predicated on determining body surface area, which exhibits a superior correlation with the child's...
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Pharmacokinetics in Pediatric Patients: Drug Excretion01:26

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In pediatric medicine, understanding the renal function and drug elimination nuances is crucial for administering safe and effective treatments. Newborns, in particular, display markedly slower renal functions than adults, profoundly affecting how drugs are cleared from their bodies. This slower drug clearance requires clinicians to extend the dosing intervals for many medications to prevent drug accumulation and toxicity while ensuring therapeutic efficacy.One key area where these adjustments...
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Anticoagulant Drugs: Vitamin K Antagonists and Direct Oral Anticoagulants01:18

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Oral anticoagulants are vital tools in preventing and treating blood clotting disorders. This diverse class of medications can be categorized as vitamin K antagonists, exemplified by warfarin, and direct thrombin inhibitors (DTIs), such as dabigatran, as well as factor Xa inhibitors, including rivaroxaban.
Warfarin, a prominent vitamin K antagonist family member, exerts its effect by inhibiting the enzyme VKORC1 (vitamin K epoxide reductase complex 1). By hindering this enzyme, warfarin...
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Pharmacokinetics in Pediatric Patients: Drug Distribution01:17

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Drug distribution in the pediatric population exhibits unique challenges and considerations due to the physiological differences between children, particularly neonates and infants, and adults. A crucial aspect of pediatric pharmacology is understanding how these differences impact the pharmacokinetics of various drugs, necessitating age-specific dosing strategies to ensure efficacy and safety.Neonates and infants have a higher total body water content, ~75%–90% of their body weight,...
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Pharmacokinetics in Pediatric Patients: Drug Metabolism01:24

Pharmacokinetics in Pediatric Patients: Drug Metabolism

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In pediatric care, understanding the nuances of hepatic drug metabolism is crucial, as it significantly differs from that of adults. This divergence is primarily due to the developmental stage of drug-metabolizing enzymes, which affects how medications are processed in the body. In neonates, for instance, the activity of Phase I enzymes—critical for the initial breakdown of drugs—is markedly reduced, functioning at just 20–40% of the levels seen in adults. This reduction poses...
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Pharmacokinetics in Pediatric Patients: Overview and Drug Absorption01:23

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Understanding the physiological differences in the pediatric population is crucial for effective pharmacotherapy. Neonates, infants, and children exhibit significant variations in gastric pH, gastric emptying time, intestinal transit time, and biliary function. These variations profoundly affect oral drug absorption, necessitating a nuanced approach to pediatric dosing.Neonates present with a unique physiological profile, having a gastric pH greater than 4 and faster and more irregular gastric...
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Prophylactic-Dose Rivaroxaban Transfer Into Human Milk.

Ann M Bruno1, Kathleen M Job, Joseph E Rower

  • 1Department of Obstetrics & Gynecology, the Department of Pediatrics, the Center for Human Toxicology, and the Department of Hematology, University of Utah Health, Salt Lake City, and the Department of Pediatrics, Intermountain Health, Murray, Utah; and the Department of Obstetrics and Gynecology, Duke Health, Durham, North Carolina.

Obstetrics and Gynecology
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Summary
This summary is machine-generated.

Direct oral anticoagulants like rivaroxaban are increasingly used for preventing blood clots after surgery. This study found low transfer into human milk, suggesting a low risk for breastfeeding infants.

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Area of Science:

  • Pharmacology
  • Neonatal Health
  • Obstetrics

Background:

  • Direct oral anticoagulants (DOACs) are gaining traction for postoperative thromboprophylaxis.
  • Limited data exists on DOAC transfer into human milk, restricting their use in postpartum lactating individuals.

Purpose of the Study:

  • To evaluate the excretion of prophylactic-dose rivaroxaban into human milk.
  • To assess the safety of rivaroxaban use in breastfeeding individuals.

Main Methods:

  • 20 low-risk lactating individuals received prophylactic-dose rivaroxaban.
  • Maternal blood and milk samples were collected and analyzed for rivaroxaban concentrations using liquid chromatography-tandem mass spectrometry.
  • Pharmacokinetic metrics and relative infant dose (RID) were calculated.

Main Results:

  • Maternal plasma and milk rivaroxaban concentrations peaked approximately 2 hours after the second dose.
  • The maximum relative infant dose was calculated at 2.9%.
  • This RID is well below the established 10% safety threshold for drug use during lactation.

Conclusions:

  • Neonatal exposure to rivaroxaban via human milk is likely low risk.
  • Findings support the potential use of prophylactic-dose rivaroxaban in lactating individuals.
  • Further research may confirm safety and efficacy in this population.