Pharmacotherapy of apnea in the premature neonatological subpopulation – therapeutic opportunities, pharmacokinetic implications and recommendations for therapeutic drug monitoring
DOI:
https://doi.org/10.56782/pps.186Keywords:
caffeine citrate, theophylline, doxapram, apnea of prematurityAbstract
Apnea of prematurity (AOP) is a relatively common health problem among neonatal patients born prematurely. It involves stopping breathing, which is dangerous to a child's health and life. In addition to the classic non-pharmacological methods, apnea episodes are treated with methylxanthines and/or doxapram. The gold standard treatment for AOP is caffeine citrate, which has a more favourable safety profile than theophylline or the second-line drug, doxapram. Despite their obvious therapeutic benefits, methylxanthines have specific pharmacokinetics in newborns. In this group, pharmacotherapy requires particular individualization of drug dosing due to differences in the stage of metabolism and excretion of drugs from the body. The following mini-review of the literature aimed to characterise the therapeutic possibilities of AOP treatment using instrumental and pharmacological methods. Particular attention was paid to the pharmacokinetics of the drugs used and the individualisation of therapy based on therapy monitored by drug concentration in the blood. Toxic side effects, as well as the specificity of the interactions of methylxanthines and doxapram with other drugs, have been discussed. Additionally, attention has been drawn to the need to introduce the possibility of monitoring the concentrations of methylxanthines (in particular, caffeine citrate) in routine clinical practice. Unfortunately, currently, monitoring of pharmacological treatment for apnea in premature infants is based on instrumented methods and strict clinical observation of the patient under the supervision of an experienced doctor specialising in neonatology.
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