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Published online February 29, 2008
PEDIATRICS Vol. 121 No. 3 March 2008, pp. 530-539 (doi:10.1542/peds.2007-1529)
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ARTICLE

Improving Pediatric Dosing Through Pediatric Initiatives: What We Have Learned

William Rodriguez, MD, PhD, Arzu Selen, PhD, Debbie Avant, RPh, Chandra Chaurasia, PhD, Terrie Crescenzi, RPh, Gerlie Gieser, PhD, Jennifer Di Giacinto, PharmD, Shiew-Mei Huang, PhD, Peter Lee, PhD, Lisa Mathis, MD, Dianne Murphy, MD, Shirley Murphy, MD, Rosemary Roberts, MD, Hari Cheryl Sachs, MD, Sandra Suarez, PhD, Veneeta Tandon, PhD, Ramana S. Uppoor, PhD

Food and Drug Administration, Rockville, Maryland

OBJECTIVE. The goal was to review the impact of pediatric drug studies, as measured by the improvement in pediatric dosing and other pertinent information captured in the drug labeling.

METHODS. We reviewed the pediatric studies for 108 products submitted (July 1998 through October 2005) in response to a Food and Drug Administration written request for pediatric studies, and the subsequent labeling changes. We analyzed the dosing modifications and focused on drug clearance as an important parameter influencing pediatric dosing.

RESULTS. The first 108 drugs with new or revised pediatric labeling changes had dosing changes or pharmacokinetic information (n = 23), new safety information (n = 34), information concerning lack of efficacy (n = 19), new pediatric formulations (n = 12), and extended age limits (n = 77). A product might have had ≥1 labeling change. We selected specific examples (n = 16) that illustrate significant differences in pediatric pharmacokinetics.

CONCLUSIONS. Critical changes in drug labeling for pediatric patients illustrate that unique pediatric dosing often is necessary, reflecting growth and maturational stages of pediatric patients. These changes provide evidence that pediatric dosing should not be determined by simply applying weight-based calculations to the adult dose. Drug clearance is highly variable in the pediatric population and is not readily predictable on the basis of adult information.

Key Words: pediatric dosing • safety • efficacy • labeling • exposure • bioavailability • pharmacology • pharmacokinetics • pharmacodynamics

Abbreviations: FDA—Food and Drug Administration • BSA—body surface area • ODT—orally disintegrating tablet • ADHD—attention-deficit/hyperactivity disorder

Accepted Aug 9, 2007.


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