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1.
J Child Adolesc Psychopharmacol ; 28(9): 615-619, 2018 11.
Article in English | MEDLINE | ID: mdl-30358422

ABSTRACT

OBJECTIVES: Clozapine is the drug of choice for treatment-resistant schizophrenia. While pediatric clozapine use is not contraindicated, the literature describing its clinical application is limited. The primary objective of this study was to assess the use of clozapine in a child and adolescent population by characterizing the documented safety and clinical benefits of the medication. METHODS: A multicenter retrospective study at sites in the United States and Australia included children and adolescents admitted to a psychiatric unit who were administered at least one dose of clozapine. Information related to demographics, patient history, past treatments, clozapine, and adverse events was collected. RESULTS: Eighty-two patients from eight sites were included in this study. Patients were predominantly clozapine naive (76.8%), and most had a discharge diagnosis of a primary psychotic disorder (61%) or bipolar disorder (25.6%). Four clozapine discontinuations occurred during hospitalization due to severe neutropenia, ileus, need for diagnostic clarification, and significant psychomotor retardation. The remainder (n = 78) were discharged on a mean clozapine dose of 218.1 ± 142.2 mg. Sedation (26.8%) and sialorrhea (17.1%) were the most common documented adverse events. The mean number of previously trialed antipsychotics before clozapine was 3.5 ± 1.4 (range 1-10). Improvement with clozapine was documented as significant (31.7%), moderate (32.9%), minimal (12.2%), no improvement (2.4%), and not described (20.7%). CONCLUSIONS: In this cohort, 95% of pediatric patients admitted with or started on clozapine during an acute psychiatric hospitalization were discharged on the medication. The high incidence of adverse events should reinforce to clinicians the need for vigilant monitoring. Pediatric guidelines recommend clozapine for refractory schizophrenia but stress the critical need to ensure an accurate diagnosis. Limited data exist for the use of clozapine in pediatric patients with other diagnoses.


Subject(s)
Antipsychotic Agents/therapeutic use , Bipolar Disorder/drug therapy , Clozapine/therapeutic use , Psychiatric Department, Hospital , Psychotic Disorders/drug therapy , Adolescent , Australia , Child , Clozapine/adverse effects , Female , Humans , Male , Neutropenia/chemically induced , Retrospective Studies , Sialorrhea/chemically induced
2.
J Pediatr Pharmacol Ther ; 22(2): 124-127, 2017.
Article in English | MEDLINE | ID: mdl-28469538

ABSTRACT

Infantile hemangiomas are prevalent in the first few months of life and can be associated with risks of scarring, blindness, ulcerations, and airway obstruction depending on the location of lesions. Options for therapy include surgery, laser therapy, or medications. Propranolol is the only US Food and Drug Administration-approved medication option. Propranolol is a nonselective beta-blocker that crosses the blood-brain barrier because of its high lipophilicity, which increases the likelihood of central nervous system effects. In this case, a preterm infant developed infantile hemangiomas on the left forearm, left trunk, left buttock, and nasal tip. The patient was treated with propranolol and concurrently required placement into a heated incubator and was subsequently unable to wean from the incubator. Upon discontinuation of propranolol, temperature instability resolved. Atenolol, a cardioselective beta-blocker that does not cross the blood-brain barrier, was then initiated for the infantile hemangiomas and displayed no adverse effect on the thermoregulation of the infant.

3.
J Pediatr Pharmacol Ther ; 18(3): 247-58, 2013 Jul.
Article in English | MEDLINE | ID: mdl-24052789

ABSTRACT

As a pharmacist, being asked to give advice about medication use during pregnancy or lactation can be daunting. This article reviews the principles of drug transfer across the placenta, into breast milk, and reviews the rating scales and different resources available. The Food and Drug Administration classification scale is reviewed and the upcoming changes are explained, along with recent labeling changes for specific medications or drug classes when appropriate. This article provides the pharmacist with a practical set of tools to review the information available and assess the risks of treating or withholding a medication for mother and infant.

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