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Pharmacokinetic modeling and simulation to understand diamorphine dose-response in neonates, children, and adolescents

Morse, James D; Anderson, Brian J; Gastine, Silke; Wong, Ian CK; Standing, Joseph F; (2022) Pharmacokinetic modeling and simulation to understand diamorphine dose-response in neonates, children, and adolescents. Paediatric Anaesthesia , 32 (6) pp. 716-726. 10.1111/pan.14425. Green open access

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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^{−1} was similar to that after intranasal diamorphine 5 mg in adults. A target concentration of morphine 30 μg.L^{−1} can be achieved by a diamorphine intravenous infusion in neonates 14 μg.kg^{−1}.h^{−1}, in a 5-year-old child 42 μg.kg^{−1}.h^{−1} and in an 15 year-old-adolescent 33 μg.kg^{−1}.h^{−1}.

Type: Article
Title: Pharmacokinetic modeling and simulation to understand diamorphine dose-response in neonates, children, and adolescents
Location: France
Open access status: An open access version is available from UCL Discovery
DOI: 10.1111/pan.14425
Publisher version: https://doi.org/10.1111/pan.14425
Language: English
Additional information: This version is the author accepted manuscript. For information on re-use, please refer to the publisher's terms and conditions.
Keywords: analgesia, children, diacetylmorphine, equianalgesia, heroin, opioids, pharmacokinetics
UCL classification: UCL
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > UCL GOS Institute of Child Health > Infection, Immunity and Inflammation Dept
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > UCL GOS Institute of Child Health
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Life Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Life Sciences > UCL School of Pharmacy > Practice and Policy
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Life Sciences > UCL School of Pharmacy
URI: https://discovery.ucl.ac.uk/id/eprint/10145422
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