dc.contributor.author |
Morse, James D |
|
dc.contributor.author |
Anderson, Brian J |
|
dc.contributor.author |
Gastine, Silke |
|
dc.contributor.author |
Wong, Ian CK |
|
dc.contributor.author |
Standing, Joseph F |
|
dc.coverage.spatial |
France |
|
dc.date.accessioned |
2022-07-28T03:27:59Z |
|
dc.date.available |
2022-07-28T03:27:59Z |
|
dc.date.issued |
2022-06 |
|
dc.identifier.citation |
(2022). Paediatric Anaesthesia, 32(6), 716-726. |
|
dc.identifier.issn |
1155-5645 |
|
dc.identifier.uri |
https://hdl.handle.net/2292/60621 |
|
dc.description.abstract |
Pharmacokinetic-pharmacodynamic modeling and simulation can facilitate understanding and prediction of exposure-response relationships in children with acute or chronic pain. The pharmacokinetics of diamorphine (diacetylmorphine, heroin), a strong opioid, remain poorly quantified in children and dose is often guided by clinical acumen. This tutorial demonstrates how a model to describe intranasal and intravenous diamorphine pharmacokinetics can be fashioned from a model for diamorphine disposition in adults and a model describing morphine disposition in children. Allometric scaling and maturation models were applied to clearances and volumes to account for differences in size and age between children and adults. The utility of modeling and simulation to gain insight into the analgesic exposure-response relationship is demonstrated. The model explains reported observations, can be used for interrogation, interpolated to determine equianalgesia and inform future clinical studies. Simulation was used to illustrate how diamorphine is rapidly metabolized to morphine via its active metabolite 6-monoacetylmorphine, which mediates an early dopaminergic response accountable for early euphoria. Morphine formation is then responsible for the slower, prolonged analgesic response. Time-concentration profiles of diamorphine and its metabolites reflected disposition changes with age and were used to describe intravenous and intranasal dosing regimens. These indicated that morphine exposure in children after intranasal diamorphine 0.1 mg.kg<sup>-1</sup> was similar to that after intranasal diamorphine 5 mg in adults. A target concentration of morphine 30 μg.L<sup>-1</sup> can be achieved by a diamorphine intravenous infusion in neonates 14 μg.kg<sup>-1</sup> .h<sup>-1</sup> , in a 5-year-old child 42 μg.kg<sup>-1</sup> .h<sup>-1</sup> and in an 15 year-old-adolescent 33 μg.kg<sup>-1</sup> .h<sup>-1</sup> . |
|
dc.format.medium |
Print-Electronic |
|
dc.language |
eng |
|
dc.publisher |
Wiley |
|
dc.relation.ispartofseries |
Paediatric anaesthesia |
|
dc.rights |
Items in ResearchSpace are protected by copyright, with all rights reserved, unless otherwise indicated. Previously published items are made available in accordance with the copyright policy of the publisher. |
|
dc.rights.uri |
https://researchspace.auckland.ac.nz/docs/uoa-docs/rights.htm |
|
dc.subject |
Humans |
|
dc.subject |
Morphine |
|
dc.subject |
Morphine Derivatives |
|
dc.subject |
Heroin |
|
dc.subject |
Analgesics, Opioid |
|
dc.subject |
Administration, Intranasal |
|
dc.subject |
Adolescent |
|
dc.subject |
Adult |
|
dc.subject |
Child, Preschool |
|
dc.subject |
Infant, Newborn |
|
dc.subject |
analgesia |
|
dc.subject |
children |
|
dc.subject |
diacetylmorphine |
|
dc.subject |
equianalgesia |
|
dc.subject |
opioids |
|
dc.subject |
pharmacokinetics |
|
dc.subject |
Clinical Research |
|
dc.subject |
Pediatric Research Initiative |
|
dc.subject |
Pediatric |
|
dc.subject |
Science & Technology |
|
dc.subject |
Life Sciences & Biomedicine |
|
dc.subject |
Anesthesiology |
|
dc.subject |
Pediatrics |
|
dc.subject |
POPULATION CLINICAL-PHARMACOLOGY |
|
dc.subject |
BLOOD-BRAIN-BARRIER |
|
dc.subject |
PLASMA-CONCENTRATIONS |
|
dc.subject |
INTRAVENOUS MORPHINE |
|
dc.subject |
CANCER PAIN |
|
dc.subject |
METABOLITES |
|
dc.subject |
PHARMACODYNAMICS |
|
dc.subject |
INTRANASAL |
|
dc.subject |
CLEARANCE |
|
dc.subject |
1114 Paediatrics and Reproductive Medicine |
|
dc.title |
Pharmacokinetic modeling and simulation to understand diamorphine dose-response in neonates, children, and adolescents. |
|
dc.type |
Journal Article |
|
dc.identifier.doi |
10.1111/pan.14425 |
|
pubs.issue |
6 |
|
pubs.begin-page |
716 |
|
pubs.volume |
32 |
|
dc.date.updated |
2022-06-15T03:43:29Z |
|
dc.rights.holder |
Copyright: The author |
en |
dc.identifier.pmid |
35212432 (pubmed) |
|
pubs.author-url |
https://www.ncbi.nlm.nih.gov/pubmed/35212432 |
|
pubs.end-page |
726 |
|
pubs.publication-status |
Published |
|
dc.rights.accessrights |
http://purl.org/eprint/accessRights/RestrictedAccess |
en |
pubs.subtype |
Review |
|
pubs.subtype |
Journal Article |
|
pubs.elements-id |
884824 |
|
pubs.org-id |
Medical and Health Sciences |
|
pubs.org-id |
Medical Sciences |
|
pubs.org-id |
School of Medicine |
|
pubs.org-id |
Anaesthesiology |
|
dc.identifier.eissn |
1460-9592 |
|
pubs.record-created-at-source-date |
2022-06-15 |
|
pubs.online-publication-date |
2022-06 |
|