FUROSEMIDE PHARMACOKINETICS IN VERY LOW BIRTH-WEIGHT INFANTS
FUROSEMIDE PHARMACOKINETICS IN VERY LOW BIRTH-WEIGHT INFANTS
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DOI：
10.1016/s0022-3476(88)80192-6
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发表时间：
1988-04-01
影响因子：
5.1
通讯作者：
RAYE, JR
中科院分区：
文献类型：
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作者：
MIROCHNICK, MH;MICELI, JJ;RAYE, JR
对10例极低出生体重儿合并支气管肺发育不良患儿进行了长期纵向给药过程中速尿的药物动力学研究。婴儿的平均出生体重为829。+-。217g，出生时平均胎龄26.6±-。2.9周，治疗开始时的平均出生后年龄为2.4±-。1.0周。在长期治疗2周至3个月期间连续测定呋塞米的药代动力学参数。小于31周(孕期+出生后)的婴儿血浆半衰期延长，经常超过24小时。所有怀孕后不到29周的婴儿，其给药计划为每12小时一次，速尿累积到潜在的耳毒性水平。随着妊娠后年龄的增加，速尿的肾清除量增加，血浆半衰期减少。在受孕后不到31周的患者中，速尿的分泌清除率非常低，导致依赖肾小球滤过将药物输送到Henle环管腔内的主要作用部位。因此，可能需要升高血浆水平，以确保这些分泌清除率低的婴儿有足够的腔内分娩和足够的利尿。然而，目前速尿的剂量计划(每12小时一次)应该修改为每24小时一次，以避免可能的毒性影响。
The pharmacokinetics of furosemide were studied longitudinally during long-term administration in 10 very low birth weight infants with bronchopulmonary dysplasia. Mean birth weight of the infants was 829 .+-. 217 g, mean gestational age at birth was 26.6 .+-. 2.9 weeks, and mean postnatal age at the start of therapy was 2.4 .+-. 1.0 weeks. Serial determinations of furosemide pharmacokinetic parameters were performed during 2 weeks to 3 months of long-term therapy. Plasma half-life was prolonged in infants less than 31 weeks postconceptional age (gestational + postnatal age), frequently exceeding 24 hours. All infants less than 29 weeks postconceptional age whose dosing schedule was once every 12 hours accumulated furosemide to potentially ototoxic levels. Furosemide renal clearance increased and plasma half-life decreased in association with increasing postconceptional age. Furosemide secretory clearance was very low in patients less than 31 weeks postconceptional age, resulting in a reliance on glomerular filtration to deliver drug to its main site of action within the lumen of the loop of Henle. Thus elevated plasma levels may be required to ensure adequate luminal delivery and adequate diuresis in these infants with low secretory clearance. Nevertheless, the current dosing schedule (once every 12 hours) of furosemide should be modified to once every 24 hours in infants of low postconceptional age to avoid possible toxic effects.