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Psychoactive drugs in children
1Johns Hopkins University School of Medicine, Baltimore, Maryland.
Insights
Routine monitoring of anticonvulsant drugs is likely unnecessary for most patients. High-risk groups, including those with metabolic disorders or neurodegenerative diseases, may still benefit from monitoring.
Area of Science:
- Pharmacology and Therapeutics
- Pediatric Medicine
- Clinical Drug Monitoring
Background:
- Anticonvulsant drug monitoring may not be universally required.
- Specific patient populations may necessitate closer monitoring.
- Pediatric sedation practices involve midazolam and analgesics.
Purpose of the Study:
- To evaluate the necessity of routine anticonvulsant drug monitoring.
- To review pharmacokinetic differences in children versus adults.
- To assess the safety and efficacy of midazolam and analgesics for pediatric sedation.
Main Methods:
- Literature review of studies on anticonvulsant drug monitoring.
- Analysis of pharmacokinetic data comparing pediatric and adult populations.
- Review of safety and kinetic data for midazolam and fentanyl in pediatric procedures.
Main Results:
- Plasma carnitine reduction by anticonvulsants is noted, but clinical significance is unclear.
- Midazolam and fentanyl are effective for pediatric procedural sedation, reducing anxiety and memory.
- Methylphenidate for hyperactivity and risks of tricyclic antidepressants in children were also reviewed.
Conclusions:
- Anticonvulsant drug monitoring is likely unnecessary for the general patient population.
- High-risk groups, including those with metabolic disorders, neurodegenerative diseases, or prior drug reactions, may require monitoring.
- Further research is needed to clarify the clinical significance of anticonvulsant-induced plasma carnitine reduction.
Abstract:
Monitoring anticonvulsant drugs may be unnecessary for many patients except those in high-risk groups such as those with metabolic disorders, neurodegenerative diseases, and history of past drug reactions. Several studies reviewed kinetic differences between children and adults. Plasma carnitine is often reduced by administration of anticonvulsants, although the clinical significance of this is uncertain. Midazolam and analgesics such as fentanyl have become popular for sedation for pediatric procedures. Several studies reviewed safety and kinetics of this method of sedation. The midazolam decreases memory for the procedure and reduces anticipatory anxiety. Several studies also reviewed use of methylphenidate for hyperactivity and risks of tricyclic antidepressants in children.