Asenapine pharmacokinetics and tolerability in a pediatric population

Transdermal Asenapine for Agitation and Irritability in a Child With Complete Intravenous Dependence

Atypical antipsychotics are often effective for managing behavioral disturbances in children with neurodevelopmental disabilities; however, limited evidence-based pharmacologic therapies exist for those dependent upon intravenous and transdermal routes. Transdermal asenapine is US Food and Drug Administration (FDA) approved for adult schizophrenia, but lacks data regarding pediatric use and tolerability. To our knowledge, there are no reports of transdermal asenapine use in children.1,2 Sublingual asenapine is FDA approved for pediatric bipolar mania monotherapy (ages 10-17 years), but was found to lack efficacy for schizophrenia in adolescents.1,3-5 Reportedly, its pediatric tolerability profile resembles those of other second-generation antipsychotics, with pharmacokinetic and safety data comparable to those in adults.3,6,7 We present the case of a 5-year-old child for whom transdermal asenapine effectively and safely managed agitation and improved tolerance of medical therapies and quality of life. Our case suggests that this may be an effective, well-tolerated pharmacologic option for agitation management in a subset of children. Guardian informed consent was obtained prior to publication.

Clinical pharmacokinetics of antipsychotics in pediatric populations: a scoping review focusing on dosing regimen

INTRODUCTION

Achieving optimal clinical responses and minimizing side effects through precision dosing of antipsychotics in children and adolescents with psychiatric disorders remains a challenge. Identifying patient characteristics (covariates) that affect pharmacokinetics can inform more effective dosing strategies and ultimately improve patient outcomes. This review aims to provide greater insight into the impact of covariates on the clinical pharmacokinetics of antipsychotics in pediatric populations.

AREAS COVERED

A comprehensive literature search was conducted, and the main findings regarding the effects of the covariates on the pharmacokinetics of antipsychotics in children and adolescents are presented.

EXPERT OPINION

Our study highlights significant covariates, including age, sex, weight, CYP2D6 phenotype, co-medication, and smoking habits, which affect the pharmacokinetics of antipsychotics. However, the findings were generally limited by the small sample sizes of naturalistic, open-label, observational studies, and the homogeneous subgroups. Dosing based on weight and preemptive genotyping could prove beneficial for optimizing the dosing regimen in pediatric populations. Future research is needed to refine dosing recommendations and establish therapeutic reference ranges critical for precision dosing and Therapeutic Drug Monitoring (TDM). The integration of individual patient characteristics with TDM can further optimize the efficacy and safety of antipsychotics for each patient.

Current Status of Pharmacokinetic Research in Children: A Systematic Review of Clinical Trial Records

BACKGROUND

Many medications have different pharmacokinetics in children than in adults. Knowledge about the safety and efficacy of medications in children requires research into the pharmacokinetic profiles of children's medicines. By analysing registered clinical trial records, this study determined how frequently pharmacokinetic data is gathered in paediatric drug trials.

METHODS

We searched for the pharmacokinetic data from clinical trial records for preterm infants and children up to the age of 16 from January 2011 to April 2022. The records of trials involving one or more drugs in preterm infants and children up to the age of 16 were examined for evidence that pharmacokinetic data would be collected.

RESULTS

In a total of 1483 records of interventional clinical trials, 136 (9.17%) pharmacokinetic data involved adults. Of those 136 records, 60 (44.1%) records were pharmacokinetics trials involving one or more medicines in children up to the age of 16.20 (33.3%) in America, followed by 19 (31.6%) in Europe. Most trials researched medicines in the field of infection or parasitic diseases 20 (33.3%). 27 (48.2%) and 26 (46.4%) trials investigated medicines that were indicated as essential medicine.

CONCLUSION

The pharmacokinetic characteristics of children's drugs need to be better understood. The current state of pharmacokinetic research appears to address the knowledge gap in this area adequately. Despite slow progress, paediatric clinical trials have experienced a renaissance as the significance of paediatric trials has gained international attention. The outcome of paediatric trials will have an impact on children's health in the future. In recent years, the need for greater availability and access to safe child-size pharmaceuticals has received a lot of attention.

New Atypical Antipsychotics in the Treatment of Schizophrenia and Depression

Schizophrenia and depression are heterogeneous disorders. The complex pathomechanism of the diseases imply that medication responses vary across patients. Many psychotropic drugs are available but achieving optimal therapeutic effect can be challenging. The evidence correlates well with clinical observations, suggesting that new atypical antipsychotic drugs are effective against negative and cognitive symptoms of schizophrenia, as well as against affective symptoms observed in depression. The purpose of this review presents the background and evidence for the use of the new second/third-generation antipsychotics (aripiprazole, cariprazine, lurasidone, asenapine, brexpiprazole, lumateperone, pimavanserin) in treatment of schizophrenia and depression. We have first provided a brief overview of the major neurobiological underpinnings of schizophrenia and depression. We then shortly discuss efficacy, safety and limitations of ongoing pharmacotherapy used in depression and schizophrenia. Mainly, we have focused this review on the therapeutic potential of new atypical antipsychotic drugs—currently existing—to be effective in psychotic, as well as in affective disorders.