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Codeine in Mechanically Ventilated Neonates

Information source: Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD)
ClinicalTrials.gov processed this data on August 20, 2015
Link to the current ClinicalTrials.gov record.

Condition(s) targeted: Mechanically Ventilated Neonates,; Painful Procedures in Newborns

Intervention: Codeine (Drug)

Phase: Phase 1

Status: Recruiting

Sponsored by: Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD)

Official(s) and/or principal investigator(s):
Jacob V Aranda, MD, PhD, Principal Investigator, Affiliation: State University of New York Downstate

Overall contact:
Jacob V Aranda, MD, PhD, Phone: 718-270-3092, Email: jaranda@downstate.edu

Summary

The purpose of this study is to determine the absorption and bioavailability of codeine in relation to postnatal (PNA) and postconceptional (PCA) age; determine the parent drug (codeine), its active metabolites, their formation rates and their ratios in relation with PCA and PNA; and identify relevant genetic polymorphisms of opioid metabolism in the study population and their potential relationship to the biodisposition and pharmacodynamic effects of codeine. The study population is intubated and mechanically ventilated infants equal to or greater than 26 weeks gestational age at birth and less than 4 weeks postnatal age.

Clinical Details

Official title: Absorption and Metabolism of Oral Codeine in Mechanically Ventilated Neonates

Study design: Endpoint Classification: Pharmacokinetics Study, Intervention Model: Single Group Assignment, Masking: Open Label, Primary Purpose: Treatment

Primary outcome: The rate and extent of absorption of oral codeine, the ratios of the observed concentration of each metabolite to the observed concentration of parent drug and the formation and clearances of the metabolites.

Secondary outcome: Secondary outcomes include the additional PK parameters elimination half life, area under the curve and mean residence time.

Detailed description: This proposal has its origins in a larger initiative to elucidate the pharmacological basis for the interindividual differences observed in opioid responsiveness. Gaps in our knowledge related to opioid disposition in newborns need to be addressed to complete the design of the required overarching initiative in which age could be treated as a continuous variable within a context of PK, PD and PG determinants. This proposal is designed to generate preliminary data that addresses two issues. First, can newborns absorb enterally administered codeine and is this ability determined by PCA or PNA age? The second relates to the ability of newborn infants to catalyze those reactions required to metabolically activate both codeine and morphine. The latter will also be evaluated within the context of PCA versus PNA age. These data will not only fill an information gap that must be addressed before the larger initiative moves forward, but they also provide a platform for serious study of the ontogeny of certain pharmacokinetic processes that may prove critical to our understanding of newborn drug disposition. In this way, codeine can provide important insights concerning the ontogeny of drug disposition and permit the determination of the relative importance of PCA versus PNA ages to the functional expression of these processes.

Eligibility

Minimum age: N/A. Maximum age: 30 Days. Gender(s): Both.

Criteria:

Inclusion Criteria:

- Neonates ≥ 26 weeks PCA receiving mechanical ventilation and painful procedure will

be eligible for participation in the study

- Subject's parent/legal guardian must give written informed consent prior to study

participation

- Subject is receiving opioid analgesia therapy based on caregiver determination. The

ideal patient will not be receiving morphine.

- Must be able to receive an enteral dose of codeine.

Exclusion Criteria:

- Known hypersensitivity to morphine, fentanyl, or codeine

- Patients with ALT concentrations >2x upper limit of normal for age or clinical

evidence of hepatic failure

- Patients with serum creatinine concentrations >2x upper limit of normal for age or

clinical evidence of renal failure

- Patients who are NPO

- Babies born to maternal drug abuse.

- Total serum bilirubin level of > 10 mg/dl or 170 umol/L.

Locations and Contacts

Jacob V Aranda, MD, PhD, Phone: 718-270-3092, Email: jaranda@downstate.edu

State University of New York Downstate, Brookyln, New York 11203, United States; Recruiting
Additional Information

Starting date: August 2008
Last updated: February 7, 2012

Page last updated: August 20, 2015

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