Pharmacology of Catecholamines in Children

Abstract

A safe use of catecholamine drugs in children with shock could improve the prognosis. In addition to the specific molecule, dosing regimen determines the effect. A good knowledge of properties of the four main catecholamine drugs (dopamine, dobutamine, epinephrine, and norepinephrine) is essential for the right choice of drug and dosing regimen. However, dose–effect relationships are nonlinear and variable between subjects. Given growth and maturation phenomena, this variability is greater in children. Pharmacokinetic–pharmacodynamic studies may explain this variability. Numerous studies on dopamine and dobutamine reported between subject variabilities, but failed to estimate it. Recent population studies on epinephrine and norepinephrine in children were able to quantify between subject variabilities and explain it by identifying covariates, namely weight, age, and severity of illness, that influence some pharmacologic parameters. The smaller the child, the higher dosing regimen should be employed. Dosing of catecholamine drugs in children should not be a linear extrapolation from adult recommendations.