Pediatric drug dosage is crucial in their pharmacotherapy. The pharmacology in children is determined by drug pharmacokinetics and pharmacodynamics. The metabolic rate is high in pediatrics when compared to adults, but drug metabolism varies based on their age group. Drug metabolism plays a major role in liver enzymes. The neonates and infants have immature liver enzymes, so drug metabolism is very low.
The body water content is high in children compared to adults, leading to a high volume of distribution. Water-soluble drugs have a higher volume of distribution, while lipophilic drugs have a lower volume of distribution (Vd).
Pediatric renal functions are lower compared to adults, gradually improving as the child grows. Drug absorption in the gastrointestinal tract depends on gastric pH, motility, and surface area. Infants with slow gastric emptying may experience reduced drug absorption.
The key challenges in pediatric pharmacology include:
Age and Weight-Related Issues
Children undergo physiological changes, including organ functions, weight, and metabolic rate. These factors determine the drug dosage, with a particular emphasis on the child’s weight, especially in emergencies and parenteral preparations.
Limited Pediatric Research
Clinical trials primarily involve testing medications on adults, resulting in limited information on the safety and efficacy of these drugs in children. Specific pediatric clinical trials are necessary to ensure safety and efficacy.
Off-Label Use
Off-label drug use involves using drugs for unapproved indications. In pediatrics, this practice is limited due to the lack of drug approvals and guidelines. Off-label drug use may be necessary but should be carefully considered for safety.
Pediatric Formulations
Most pediatric formulations are in liquid dosage form. Some drugs have a bitter taste, and they may not mask well with flavoring or masking agents, potentially leading to inadequate dosage administration. Not all medications can be made in liquid form, requiring the crushing of tablets in a suitable medium, which can lead to medication errors.
These challenges in pediatric pharmacology require collaboration among pediatricians, pharmacists, and other healthcare providers for the safety and efficacy of treatments. Drug regulatory agencies encourage pharmaceutical companies to conduct research programs and studies to enhance pediatric pharmacotherapy.
