1
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Daboe M, Parlak C, Direm A, Alver Ö, Ramasami P. Interaction between escitalopram and ibuprofen or paracetamol: DFT and molecular docking on the drug-drug interactions. J Biomol Struct Dyn 2024; 42:672-686. [PMID: 37042928 DOI: 10.1080/07391102.2023.2195004] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 03/17/2023] [Indexed: 04/13/2023]
Abstract
A large number of drugs are introduced each year to treat different diseases. Most of the time, patients suffer from more than one health problem which makes it necessary to take multiple drugs. When drugs are combined, the problem of drug-drug interaction becomes relevant. In this work, we studied the drug-drug interaction between escitalopram and ibuprofen or paracetamol using density functional theory and quantum theory of atoms in molecules. The results suggest that following the interactions, the activity of drugs changes according to site of interaction. Most reactive and most stable interactions would be preferable for the purpose of use. The in silico drug-likeness studies show that escitalopram and paracetamol couple is more bioavailable than escitalopram and ibuprofen couple. Moreover, in order to gain additional insights into the mentioned drugs' interactions, the drugs were docked separately and jointly against the potential targets for antidepressants and NSAIDs, namely 6HIS and 2PXX. The molecular docking results showed a potential improvement of the effectiveness of the drugs after combining by forming hydrogen bonds, hydrophobic contacts and π…π stacking.Communicated by Ramaswamy H. Sarma.
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Affiliation(s)
- Musa Daboe
- Department of Physics, Science Faculty, Ege University, Izmir, Turkey
| | - Cemal Parlak
- Department of Physics, Science Faculty, Ege University, Izmir, Turkey
| | - Amani Direm
- Department of Matter Sciences, Faculty of Sciences and Technology, Abbes Laghrour University, Khenchela, Algeria
- Laboratory of Structures, Properties and Interatomic Interactions LASPI2A, Faculty of Sciences and Technology, Abbes Laghrour University, Khenchela, Algeria
| | - Özgür Alver
- Department of Physics, Science Faculty, Eskişehir Technical University, Eskişehir, Turkey
| | - Ponnadurai Ramasami
- Computational Chemistry Group, Department of Chemistry, Faculty of Science, University of Mauritius, Réduit, Mauritius
- Department of Chemistry College of Science, Engineering and Technology, University of South Africa, Pretoria, South Africa
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2
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Chamkouri N, Absalan F, Koolivand Z, Yousefi M. Nonsteroidal Anti-Inflammatory Drugs in Viral Infections Disease, Specially COVID-19. Adv Biomed Res 2023; 12:20. [PMID: 36926440 PMCID: PMC10012024 DOI: 10.4103/abr.abr_148_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 11/14/2021] [Accepted: 11/15/2021] [Indexed: 02/05/2023] Open
Abstract
During the current SARS-CoV-2 (COVID-19) pandemic, some reports were presented based on those nonsteroidal anti-inflammatory drugs (NSAIDs) and corticosteroids may exacerbate symptoms in COVID-19 patients. According to this, we aimed to collate information available in published articles to identify any evidence behind these statements with the aim of helping clinicians on how best to treat patients. We could not find published conclusive evidence for or against the use of NSAIDs in COVID-19 patients. Meanwhile, there appeared to be some evidence that corticosteroids may be beneficial if utilized in the early acute phase of infection, however, conflicting WHO (World Health Organization) evidence surrounding corticosteroid use in certain viral infections means this evidence is not conclusive. Given the current availability of literature, caution should be exercised until further evidence emerges surrounding the use of NSAIDs and corticosteroids in COVID-19 patients. However, the availability of reliable information for clinicians and patients is paramount.
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Affiliation(s)
- Narges Chamkouri
- Medical Faculty, Abadan University of Medical Sciences, Abadan, Iran
| | - Forouzan Absalan
- Medical Faculty, Abadan University of Medical Sciences, Abadan, Iran
| | - Zahra Koolivand
- Medical Faculty, Abadan University of Medical Sciences, Abadan, Iran
| | - Mahsa Yousefi
- Medical Faculty, Abadan University of Medical Sciences, Abadan, Iran
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3
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Juujärvi S, Saarela T, Pokka T, Hallman M, Aikio O. Intravenous paracetamol for neonates: long-term diseases not escalated during 5 years of follow-up. Arch Dis Child Fetal Neonatal Ed 2021; 106:178-183. [PMID: 32943529 DOI: 10.1136/archdischild-2020-319069] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 08/03/2020] [Accepted: 08/13/2020] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To evaluate the long-term adverse reactions of paracetamol in children who required intensive care shortly after birth. Paracetamol is a widely used analgesic in neonates, but the long-term studies are lacking. Previous epidemiological studies have reported associations between early paracetamol intake and diseases in childhood. DESIGN Five-year follow-up cohort of children who required intensive care shortly after birth. SETTING Single tertiary care hospital; neonatal and paediatric intensive care units. INTERVENTIONS Intravenous paracetamol was administered for pain and discomfort to the neonates during their intensive care, while for the control infants, it was not available. MAIN OUTCOME MEASURES The primary outcome was the incidence of asthma; secondary outcomes were neonatal diseases and long-term morbidities (atopic dermatitis, inflammatory bowel disease, autism, speech disorders, cerebral palsy). Long-term morbidities were adjusted based on antenatal and neonatal risk factors. RESULTS We screened all neonates admitted to the intensive care units soon after birth in Oulu University Hospital, Oulu, Finland, during 1 October 2007 to 31 December 2013. Altogether, 1552 infants needed intensive care. Of them, 735 (47%) were treated with intravenous paracetamol. We obtained their long-term data from the Finnish National Institute for Health and Welfare, including all physician-made diagnoses from all primary healthcare units and hospitals in Finland. We found no difference in the asthma incidence or in other long-term morbidities between paracetamol-treated and non-exposed infants. CONCLUSIONS Intravenous paracetamol given to neonates did not associate with childhood disorders compared with the non-exposed infants during the 5-year follow-up. The previous hypothesis that early paracetamol use causes childhood morbidities was not confirmed.
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Affiliation(s)
- Sanna Juujärvi
- PEDEGO Research Unit and MRC Oulu, University of Oulu, Oulu, Finland.,Department of Children and Adolescents, Oulu University Hospital, Oulu, Finland
| | - Timo Saarela
- PEDEGO Research Unit and MRC Oulu, University of Oulu, Oulu, Finland.,Department of Children and Adolescents, Oulu University Hospital, Oulu, Finland
| | - Tytti Pokka
- PEDEGO Research Unit and MRC Oulu, University of Oulu, Oulu, Finland.,Department of Children and Adolescents, Oulu University Hospital, Oulu, Finland
| | - Mikko Hallman
- PEDEGO Research Unit and MRC Oulu, University of Oulu, Oulu, Finland.,Department of Children and Adolescents, Oulu University Hospital, Oulu, Finland
| | - Outi Aikio
- PEDEGO Research Unit and MRC Oulu, University of Oulu, Oulu, Finland .,Department of Children and Adolescents, Oulu University Hospital, Oulu, Finland
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4
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Lebedev M, McEligot HA, Mutua VN, Walsh P, Carvallo Chaigneau FR, Gershwin LJ. Analysis of lung transcriptome in calves infected with Bovine Respiratory Syncytial Virus and treated with antiviral and/or cyclooxygenase inhibitor. PLoS One 2021; 16:e0246695. [PMID: 33600498 PMCID: PMC7891793 DOI: 10.1371/journal.pone.0246695] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Accepted: 01/22/2021] [Indexed: 12/15/2022] Open
Abstract
Bovine Respiratory Syncytial virus (BRSV) is one of the major infectious agents in the etiology of the bovine respiratory disease complex. BRSV causes a respiratory syndrome in calves, which is associated with severe bronchiolitis. In this study we describe the effect of treatment with antiviral fusion protein inhibitor (FPI) and ibuprofen, on gene expression in lung tissue of calves infected with BRSV. Calves infected with BRSV are an excellent model of human RSV in infants: we hypothesized that FPI in combination with ibuprofen would provide the best therapeutic intervention for both species. The following experimental treatment groups of BRSV infected calves were used: 1) ibuprofen day 3-10, 2) ibuprofen day 5-10, 3) placebo, 4) FPI day 5-10, 5) FPI and ibuprofen day 5-10, 6) FPI and ibuprofen day 3-10. All calves were infected with BRSV on day 0. Daily clinical evaluation with monitoring of virus shedding by qRT-PCR was conducted. On day10 lung tissue with lesions (LL) and non-lesional (LN) was collected at necropsy, total RNA extracted, and RNA sequencing performed. Differential gene expression analysis was conducted with Gene ontology (GO) and KEGG pathway enrichment analysis. The most significant differential gene expression in BRSV infected lung tissues was observed in the comparison of LL with LN; oxidative stress and cell damage was especially noticeable. Innate and adaptive immune functions were reduced in LL. As expected, combined treatment with FPI and Ibuprofen, when started early, made the most difference in gene expression patterns in comparison with placebo, especially in pathways related to the innate and adaptive immune response in both LL and LN. Ibuprofen, when used alone, negatively affected the antiviral response and caused higher virus loads as shown by increased viral shedding. In contrast, when used with FPI Ibuprofen enhanced the specific antiviral effect of FPI, due to its ability to reduce the damaging effect of prostanoids and oxidative stress.
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Affiliation(s)
- Maxim Lebedev
- Department of Pathology, Microbiology and Immunology, School of Veterinary Medicine, University of California Davis, Davis, California, United States of America
| | - Heather A. McEligot
- Department of Pathology, Microbiology and Immunology, School of Veterinary Medicine, University of California Davis, Davis, California, United States of America
| | - Victoria N. Mutua
- Department of Pathology, Microbiology and Immunology, School of Veterinary Medicine, University of California Davis, Davis, California, United States of America
| | - Paul Walsh
- Pediatric Emergency Medicine, Sutter Medical Center Sacramento, Sacramento, California, United States of America
| | - Francisco R. Carvallo Chaigneau
- Department of Biomedical Sciences & Pathobiology, Virginia-Maryland College of Veterinary Medicine, Virginia Tech., Blacksburg, VA, United States of America
| | - Laurel J. Gershwin
- Department of Pathology, Microbiology and Immunology, School of Veterinary Medicine, University of California Davis, Davis, California, United States of America
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5
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Capuano A, Scavone C, Racagni G, Scaglione F. NSAIDs in patients with viral infections, including Covid-19: Victims or perpetrators? Pharmacol Res 2020; 157:104849. [PMID: 32360482 PMCID: PMC7189871 DOI: 10.1016/j.phrs.2020.104849] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 04/20/2020] [Accepted: 04/20/2020] [Indexed: 12/31/2022]
Abstract
Taking anti-inflammatory drugs, including non-steroidal (NSAIDs), during Covid-19 infection, how much is risky? The French Minister of Health, who has raised an alarm on a possible risk deriving from the use of ibuprofen for the control of fever and other symptoms during the disease, opened the debate a few days ago. In this paper we examine available evidence from preclinical and clinical studies that had analysed the role of COX in the inflammatory process and the effects of NSAIDs in patients with infections. Most of the published studies that suggested not protective effects of NSAIDs were mainly performed in vitro or on animals. Therefore, their meaning in humans is to be considered with great caution. Based also on data suggesting protective effects of NSAIDs, we concluded that currently there is no evidence suggesting a correlation between NSAIDs and a worsening of infections. Further studies will be certainly needed to better define the role of NSAIDs and particularly COX2 inhibitors in patients with infections. In the meantime, we must wait for results of the revision started by the PRAC on May 2019 on the association ibuprofen/ketoprofen and worsening of infections. Since nowadays no scientific evidence establishes a correlation between NSAIDS and worsening of COVID-19, patients should be advice against any NSAIDs self-medication when COVID-19 like symptoms are present.
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Affiliation(s)
- Annalisa Capuano
- Department of Experimental Medicine, University of Campania "Luigi Vanvitelli", Naples, Italy; Regional Centre of Pharmacogilance, Campania Region, Naples, Italy.
| | - Cristina Scavone
- Department of Experimental Medicine, University of Campania "Luigi Vanvitelli", Naples, Italy; Regional Centre of Pharmacogilance, Campania Region, Naples, Italy
| | - Giorgio Racagni
- Department of Pharmacological and Biomolecular Sciences, University of Milan, Milan, Italy
| | - Francesco Scaglione
- Department of Oncology and Onco-Hematology, University of Milan, Milan, Italy; Clinical Pharmacology Unit, ASST-GOM Niguarda Hospital, Milan, Italy
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6
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Fu R, Shen M, Ding Y, Li M, Li L, Ren Z, Wu Q. Electrocatalytic Oxidation and Sensitive Determination of Paracetamol Based on Nanosheets Self‐assembled Lindgrenite Microflowers. ELECTROANAL 2020. [DOI: 10.1002/elan.201900504] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Affiliation(s)
- Rong Fu
- School of Material Science & Engineering, College of Science Shanghai University Shanghai 200444 P.R. China
| | - Mingju Shen
- School of Material Science & Engineering, College of Science Shanghai University Shanghai 200444 P.R. China
| | - Yaping Ding
- School of Material Science & Engineering, College of Science Shanghai University Shanghai 200444 P.R. China
- Shanghai Key Laboratory of High Temperature Superconductors Shanghai University Shanghai 200444 P.R. China
| | - Musen Li
- School of Material Science & Engineering, College of Science Shanghai University Shanghai 200444 P.R. China
| | - Li Li
- School of Material Science & Engineering, College of Science Shanghai University Shanghai 200444 P.R. China
| | - Zhongming Ren
- School of Material Science & Engineering, College of Science Shanghai University Shanghai 200444 P.R. China
| | - Qingsheng Wu
- School of Chemical Science and Engineering Tongji University Shanghai 200092 P.R. China
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7
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Allegaert K, Tibboel D, van den Anker J. Narcotic-Sparing Approaches and the Shift Toward Paracetamol in Neonatal Intensive Care. Handb Exp Pharmacol 2020; 261:491-506. [PMID: 30879201 DOI: 10.1007/164_2019_207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Effective analgesia in neonates is relevant not only because of ethical aspects or empathy, but it is a crucial and integral part of medical and nursing care. However, there is also emerging evidence - although mainly in animal models - on the relation between the exposure to narcotics and impaired neurodevelopmental outcome, resulting in a CATCH-22 scenario. Consequently, a balanced approach is needed with the overarching intention to attain adequate pain management with minimal side effects. Despite the available evidence-based guidance on narcotics in ventilated neonates, observations on drug utilization still suggest an overall increase in exposure with extensive variability between units. This increased exposure over time and the extensive variability is concerning given the limited evidence of benefits and potential harm.Implementation strategies are effective to reduce exposure to narcotics but result in increased paracetamol exposure. We therefore summarized the evidence on paracetamol use in procedural pain management, in minor to moderate as well as major pain syndromes in neonates. While there are sufficient data on short-term safety, there are still concerns on long-term side effects. These concerns relate to neurobehavioral outcome, atopy or fertility, and are at present mainly driven by epidemiological perinatal observations, together with postulated mechanisms.We conclude that future clinical research objectives should still focus on the need to develop better assessment tools to quantify pain and on the need for high-quality data on long-term outcome of therapeutic interventions - also for paracetamol - and exploration of the mechanisms involved.
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Affiliation(s)
- Karel Allegaert
- Department of Pediatrics, Division of Neonatology, Erasmus MC Sophia Children's Hospital, Rotterdam, The Netherlands.
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium.
- Neonatal Intensive Care Unit, University Hospital, Leuven, Belgium.
| | - Dick Tibboel
- Intensive Care, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands
- Department of Pediatric Surgery, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - John van den Anker
- Intensive Care, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands
- Division of Pediatric Pharmacology and Pharmacometrics, University Children's Hospital, Basel, Switzerland
- Division of Clinical Pharmacology, Children's National Health System, Washington, DC, USA
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8
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Allegaert K. A Critical Review on the Relevance of Paracetamol for Procedural Pain Management in Neonates. Front Pediatr 2020; 8:89. [PMID: 32257982 PMCID: PMC7093493 DOI: 10.3389/fped.2020.00089] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Accepted: 02/21/2020] [Indexed: 12/28/2022] Open
Abstract
Effective and safe pain relief in neonates matters. This is not only because of ethical constraints or human empathy, but even more because pain treatment is an important and crucial part of contemporary medical, paramedical, and nursing care to improve the outcome in neonatal intensive care graduates. Paracetamol (acetaminophen) is likely one of the pharmacological tools to attain this, with data on prescription practices suggesting that paracetamol is somehow the "rising star" in neonatal pain management. Besides very rare topical clinical scenarios like peripartal asphyxia and subsequent whole body hypothermia or the use of cardiorespiratory support devices, data on paracetamol pharmacokinetics and metabolism were reported throughout neonatal age or weight ranges, and we have summarized these data. In this review, we subsequently aimed to provide the reader with the currently available observations on the use of paracetamol as analgesic for different pain syndromes (major surgery, minor surgery or trauma, and procedural pain), with focus on the limitations of paracetamol when prescribed for neonatal procedural pain management. We hereby intentionally will not discuss other indications (patent ductus arteriosus and fever) for paracetamol administration in neonates. Based on the available evidence, paracetamol has opioid-sparing effects for major pain syndromes, is effective to treat minor to moderate pain syndromes, but fails for effective procedural pain management in neonates. This efficacy failure for procedural pain management should stimulate us to continue to search for more effective interventions, including non-pharmacological interventions and preventive strategies. Furthermore, there are also upcoming association type of epidemiological studies on the relation between exposure to analgesics-including paracetamol-and the negative short- or long-term outcome characteristics (neuro-behavioral, atopy, and fertility). Consequently and in addition to the search for effective alternatives to prevent or treat pain, studies on long-term outcome following paracetamol exposure are needed to inform all stakeholders on the full effect-side effect balance of the different strategies to treat pain.
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Affiliation(s)
- Karel Allegaert
- Development and Regeneration, KU Leuven, Leuven, Belgium.,Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium.,Clinical Pharmacy, Erasmus MC Rotterdam, Rotterdam, Netherlands
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9
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Allegaert K, Mian P, Lapillonne A, van den Anker JN. Maternal paracetamol intake and fetal ductus arteriosus constriction or closure: a case series analysis. Br J Clin Pharmacol 2019; 85:245-251. [PMID: 30300944 PMCID: PMC6303200 DOI: 10.1111/bcp.13778] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Revised: 09/05/2018] [Accepted: 09/30/2018] [Indexed: 01/15/2023] Open
Abstract
Recent case reports describe an association between maternal paracetamol intake and fetal ductus arteriosus constriction or closure. To put these cases into perspective and explore causality, a structured literature search was conducted. The World Health Organization Uppsala Monitoring Centre (WHO-UMC) causality tool was applied to the cases retrieved. The search resulted in 12 papers with 25 case descriptions, of which one case was classified as unlikely, nine as possible, 11 as probable and four as certain. Consequently, we concluded that a causal relationship between maternal paracetamol intake and fetal ductus arteriosus constriction or closure is likely. These findings suggest that pharmacovigilance studies on paracetamol safety during pregnancy are warranted to quantify the event and put the current findings into clinical perspective. Although analgesia during pregnancy and during the peripartum period is of obvious relevance, alternative analgesics such as opioids or other nonsteroidal anti-inflammatory drugs also have side effects.
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Affiliation(s)
- Karel Allegaert
- Intensive Care and Department of Pediatric SurgeryErasmus MC–Sophia Children's HospitalRotterdamthe Netherlands
- Department of Pediatrics, Division of NeonatologyErasmus MC–Sophia Children's HospitalRotterdamthe Netherlands
- Department of Development and Regeneration KU LeuvenLeuvenBelgium
| | - Paola Mian
- Intensive Care and Department of Pediatric SurgeryErasmus MC–Sophia Children's HospitalRotterdamthe Netherlands
| | - Alexandre Lapillonne
- Department of NeonatologyHôpital Universitaire Necker Enfants Malades, Assistance Publique‐Hôpitaux de ParisParisFrance
- Paris Descartes UniversityParisFrance
| | - John N. van den Anker
- Intensive Care and Department of Pediatric SurgeryErasmus MC–Sophia Children's HospitalRotterdamthe Netherlands
- Division of Pediatric Pharmacology and PharmacometricsUniversity Children's Hospital BaselBasel, Switzerland
- Division of Clinical PharmacologyChildren's National Health SystemWashingtonDCUSA
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10
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Allegaert K, van den Anker JN. Perinatal and neonatal use of paracetamol for pain relief. Semin Fetal Neonatal Med 2017; 22:308-313. [PMID: 28720398 DOI: 10.1016/j.siny.2017.07.006] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Paracetamol (acetaminophen) is the most widely used drug to treat pain or fever in pregnant women or neonates, but its pharmacokinetics (PK) and pharmacodynamics (PD) warrant a focused analysis. During pregnancy, there is an important increase in paracetamol clearance. Consequently, it is reasonable to anticipate that the analgesic effect of paracetamol will decrease faster, whereas higher doses may result in even higher oxidative toxic metabolites. Therefore, most peripartal PD data relate to multimodal analgesia strategies. In neonates, weight/size is the most relevant covariate of paracetamol PK. This resulted in proposed dosing regimens containing higher doses than currently prescribed in the label for term neonates. Using adequate dosing, paracetamol is a poor procedural analgesic, is effective for mild-to-moderate pain, and has morphine-sparing effects. Short-term safety has been well documented, and there is active research investigating the potential association between paracetamol exposure and atopy, fertility, and neurobehavior.
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Affiliation(s)
- Karel Allegaert
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium; Intensive Care and Department of Pediatric Surgery, Erasmus MC - Sophia Children's Hospital, Rotterdam, The Netherlands.
| | - John N van den Anker
- Intensive Care and Department of Pediatric Surgery, Erasmus Medical Center - Sophia Children's Hospital, Rotterdam, The Netherlands; Division of Clinical Pharmacology, Department of Pediatrics, Children's National Health System, Washington DC, USA; Division of Paediatric Pharmacology and Pharmacometrics, University of Basel Children's Hospital, Basel, Switzerland
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11
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Wang JZ, Du WT, Xu YL, Cheng SZ, Liu ZJ. Gut microbiome-based medical methodologies for early-stage disease prevention. Microb Pathog 2017; 105:122-130. [DOI: 10.1016/j.micpath.2017.02.024] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2017] [Revised: 02/14/2017] [Accepted: 02/14/2017] [Indexed: 12/17/2022]
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12
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Coppini R, Simons SHP, Mugelli A, Allegaert K. Clinical research in neonates and infants: Challenges and perspectives. Pharmacol Res 2016; 108:80-87. [PMID: 27142783 DOI: 10.1016/j.phrs.2016.04.025] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Accepted: 04/26/2016] [Indexed: 12/25/2022]
Abstract
To date, up to 65% of drugs used in neonates and infants are off-label or unlicensed, as they were implemented in clinical care without the usual regulatory phases of pharmacological drug development. Pharmacotherapy in this age group is still mainly based on the individual clinical expertise of specialized pediatricians. Pharmacological trials involving neonates are indeed more difficult to perform: appropriate dosing is hampered by the rapid physiological changes occurring at this stage of development, and the selection of proper end-points and biomarkers is complicated by the limited knowledge of the pathophysiology of the specific diseases of infancy. Moreover, there are many ethical challenges in planning and conducting drug studies in pediatric patients (especially in newborns and infants). In the current review, we address some challenges and discuss possible perspectives to stimulate scientific and clinical pharmacological research in neonates and infants. We hereby aim to illustrate the add on value of the regulatory framework for model-based neonatal medicinal development currently used in Europe and the United States. We provide several examples of successful recent pharmacological trials performed in neonates and infants. In these examples, success was ensured by the implementation of specific pharmacokinetic assessments, thanks to accurate drug dosing achieved with a combination of dose validation, population pharmacokinetics and mathematical models of drug clearance and distribution; moreover, age-specific pharmacodynamics was considered via appropriate evaluations of drug efficacy with end-points adapted to the peculiar pathophysiology of diseases in this age group. These "pharmacological" challenges add to the ethical challenges that are always present in planning and conducting clinical studies in neonates and infants and support the opinion that clinical research in pediatrics should be evaluated by ad hoc ethical committees with specific expertise.
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Affiliation(s)
- Raffaele Coppini
- Department of Neuroscience, Drug Research and Child's Health (NeuroFarBa), Division of Pharmacology, University of Florence, Italy.
| | - Sinno H P Simons
- Department of Pediatrics, Division of Neonatology, Erasmus MC Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Alessandro Mugelli
- Department of Neuroscience, Drug Research and Child's Health (NeuroFarBa), Division of Pharmacology, University of Florence, Italy
| | - Karel Allegaert
- Intensive Care and Department of Pediatric Surgery, Erasmus MC Sophia Children's Hospital, Rotterdam, The Netherlands; Department of Development and Regeneration, KU Leuven, Belgium
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