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Related Concept Videos

Pharmacokinetics in Pediatric Patients: Drug Metabolism01:24

Pharmacokinetics in Pediatric Patients: Drug Metabolism

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 a challenge in...
Pharmacokinetics in Pediatric Patients: Drug Distribution01:17

Pharmacokinetics in Pediatric Patients: Drug Distribution

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, compared...
Pharmacokinetics in Pediatric Patients: Overview and Drug Absorption01:23

Pharmacokinetics in Pediatric Patients: Overview and Drug Absorption

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...
Drug Dosing: Infants and Children01:29

Drug Dosing: Infants and Children

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...
Drug Concentrations: Measurements01:23

Drug Concentrations: Measurements

Drug concentration is the quantity of a drug present in a biological sample. Measuring drug amounts in biological samples allows the clinician to understand how a drug is absorbed, distributed, metabolized, and excreted. Samples can be obtained through invasive or non-invasive methods. Invasive techniques involve surgical or parenteral interventions to gather blood, cerebrospinal fluid, or tissue biopsy. Conversely, non-invasive approaches provide samples like urine, feces, and saliva.
Plasma —...
Nonlinear Pharmacokinetics: Dependence of Elimination Half-Life and Dose Clearance01:23

Nonlinear Pharmacokinetics: Dependence of Elimination Half-Life and Dose Clearance

The elimination half-life and drug clearance of drugs following nonlinear kinetics can vary with dosage. The Michaelis-Menten parameters and drug concentration influence these factors. As the dose increases, the elimination half-life tends to lengthen, resulting in a reduction in clearance and a disproportionately larger area under the curve. The total clearance can be derived from the Michaelis-Menten equation for drugs following a one-compartment model.
A study on guinea pigs examined the...

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Related Experiment Video

Updated: May 22, 2026

Comprehensive Evaluation of the Effectiveness and Safety of Placenta-Targeted Drug Delivery Using Three Complementary Methods
09:04

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Codeine and Metabolite Concentrations in the Breastfed Neonate.

Brian J Anderson1, Jacqueline A Hannam2

  • 1Department of Anaesthesiology, University of Auckland, Auckland, New Zealand.

Paediatric Anaesthesia
|May 21, 2026
PubMed
Summary

Codeine

Keywords:
breastmilkcodeinecompartment modeldrugsmorphinepharmacodynamicspharmacokineticspharmacology

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Area of Science:

  • Pharmacogenomics
  • Neonatal toxicology

Background:

  • Codeine's analgesic effect is mediated by its metabolite, morphine, via cytochrome P450 2D6 (CYP2D6) enzyme.
  • CYP2D6 gene polymorphism results in varied metabolizer phenotypes (poor, intermediate, normal, ultra-rapid).
  • Concerns exist regarding neonatal respiratory depression from morphine transfer via breastmilk in ultra-rapid metabolizer mothers.

Purpose of the Study:

  • To evaluate the risk of neonatal opioid toxicity from codeine via breastfeeding.
  • To assess predicted neonatal morphine concentrations in breastfed neonates.
  • To review current restrictions on codeine use in breastfeeding postpartum women.

Main Methods:

  • A pharmacokinetic compartment model was employed to simulate maternal codeine ingestion and neonatal morphine exposure.
  • Key factors analyzed included maternal genotype, milk-to-plasma ratio, and neonatal drug metabolism and clearance.
  • Predicted neonatal morphine plasma concentrations were calculated.

Main Results:

  • The pharmacokinetic model indicated that neonatal opioid toxicity from breastfeeding is implausible.
  • Predicted neonatal morphine concentrations were consistently below 1 µg/L, irrespective of maternal CYP2D6 genotype.
  • Current bans on codeine for breastfeeding postpartum women may warrant reconsideration.

Conclusions:

  • Maternal codeine use during breastfeeding is unlikely to cause neonatal toxicity.
  • The current prohibition of codeine for breastfeeding mothers requires review based on pharmacokinetic modeling.
  • Similar precautions as with other maternal opioids should be applied, with neonates monitored for adverse effects.