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Buprenorphineinsatz bei Kindern

Eine klinisch-pharmakologische Übersicht

Buprenorphine in children

A clinical and pharmacological review

  • Schwerpunkt: Kinderschmerztherapie
  • Published:
Der Schmerz Aims and scope Submit manuscript

Zusammenfassung

Die Datenlage zur Anwendung von Buprenorphin bei Kindern ist unbefriedigend, insbesondere hinsichtlich länger dauernder Anwendung bei chronischem Schmerz. Es fehlen pharmakokinetische und -dynamische Daten nach sublingualer Mehrfachapplikation und transdermaler Verabreichung. Nach Einzelgabe scheinen körpergewichtsbezogene Clearance höher und Wirkdauer länger zu sein als beim Erwachsenen. Schwer vorhersehbar bleibt das atemdepressorische Potenzial bei Anwendung in Kombination mit anderen Opioiden oder zentral wirkenden Substanzen und bei Kumulation des Metaboliten Norbuprenorphin. Die klinische Relevanz eines beim Erwachsenen nicht einheitlich nachgewiesenen Ceilingeffekts der Atemdepression für das Kindesalter bleibt noch unklar. Seine multiplen Applikationsformen zusammen mit einer beträchtlichen Wirkdauer und dem von der Nierenfunktion unabhängigen Metabolismus machen Buprenorphin zu einem im Kindesalter interessanten Analgetikum nicht nur für die postoperative Analgesie. Prinzipiell andere (Neben)Wirkungen als im Erwachsenenalter sind nicht zu erwarten.

Abstract

There is a paucity of relevant pediatric data on buprenorphine, especially with respect to the long-term application in children suffering chronic pain¸ or to pediatric pharmacokinetic as well as pharmacodynamic data after repeated sublingual or long-term transdermal administration. Compared to adults, after single-dose buprenorphine, children seem to exhibit a larger clearance related to body weight and a longer duration of action. If combined with other opioids or sedatives or if the metabolite norbuprenorphine cumulates, it is difficult to estimate the risk of respiratory depression. Clear-cut evidence is missing that in children there is a ceiling of buprenorphine-induced respiratory depression. Due to its various application routes, long duration of action, and metabolism largely independent of renal function buprenorphine is of special clinical interest in pediatrics, especially for postoperative pain and cancer pain control. There is no reason to expect effects fundamentally different from those in adults.

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Danksagung

B. Zernikow wird von der Peter- und Ruth-Wirts- und der Vodafone-Stiftung Deutschland GmbH unterstützt.

Interessenkonflikt:

Der korrespondierende Autor weist auf eine Verbindung mit folgender Firma/Firmen hin: Boris Zernikow hat honorierte Tätigkeiten (Vorträge, etc.) für AstraZeneca GmbH, Aventis Pharma GmbH, Boots Healthcare GmbH, Bristol-Myers-Squibb GmbH, Cephalon GmbH, Grünenthal GmbH, Janssen Cilag GmbH, Mundipharma GmbH, Pfizer GmbH geleistet.

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Authors and Affiliations

  1. Kinderklinik, Klinikum Konstanz

    E. Michel

  2. Vodafone Stiftungsinstitut für Kinderschmerztherapie und Pädiatrische Palliativmedizin, Vestische Kinder- und Jugendklinik — Universität Witten/Herdecke, Datteln

    B. Zernikow

  3. Kinderklinik, Klinikum Konstanz, Luisenstraße 7, 78464 , Konstanz

    E. Michel

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  1. E. Michel
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Correspondence to E. Michel.

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Michel, E., Zernikow, B. Buprenorphineinsatz bei Kindern. Schmerz 20, 40–50 (2006). https://doi.org/10.1007/s00482-005-0456-1

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  • DOI: https://doi.org/10.1007/s00482-005-0456-1

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