Putting a child on chronic medication presents a logical dilemma to many parents when weighing up the compromise between the proposed drug benefits and the potential side-effects.
This decision is particularly difficult as there is much less research available on drug safety in children, and many drugs have only been authorised for adult use. Thus, doctors are often required to prescribe ‘off-label’, which means using their clinical judgment to create prescription guidelines.
However highly regarded the educated guess of a medical professional may be, it is guesswork nevertheless, which incites a myriad of potential risks.
According to a recent pharmaceutical journal article, prescription errors may affect approximately 13% of paediatric patients. These errors occur more frequently than adult prescription errors and are likely to cause three times more harm1.
Dosage accuracy: A continuous balancing act
Body weight impacts the dosing of drug prescription, and most medications are prescribed in milligrams per kilogram of body weight.
However, as growing children can display weight changes on a monthly basis, regular dose adjustments are necessary for both infants and teenagers on long-term treatment.
Inaccurate weight reporting from parents or the oversight of healthcare providers to routinely re-check their patients’ weight, may result in miscalculation of the correct dose. Hence, regular follow-ups and weigh-ins are always a necessary precaution within paediatric practice.
Overdosing and underdosing raise equal cause for concern
Overdosing may result in toxic side-effects or poisoning if a patient is unable to metabolise and eliminate drug constituents, whilst underdosing may simply render the treatment ineffective.
Protecting children through medical research
Traditional thinking may elicit the opinion that we should protect children from medical research. However, the opposing school of thought argues that children can be protected through research as well.
Whilst it remains reasonable for chemical scientists to develop paediatric prescriptions based on medications that have already been proven safe and effective for adults, the lag time between adult approval and paediatric approval can take more than a decade.2
There are numerous reasons for this confounding delay:
- Primarily, children in different age groups will respond differently to the same drug because the mechanisms of drug metabolism within the body change with age. Such changes include stomach acidity, organ size, and chemical clearance rate.
- Secondly, children of the same age group often display vast differences in physical and emotional maturity, both of which have a strong influence on pharmaceutical design.
Thus, determining an accurate drug protocol for children requires assessment across the full and extremely diverse development spectrum of childhood.3
The significance of emotional maturity extends to the fact that unlike adults, children may not be able to recognise or verbalise the signs of adverse effects, nor the ineffectiveness of treatment.
However, impressive advancements in genetic testing have opened the door to individual screening for medication efficacy and potential toxicity before prescription.
Pharmacogenomic testing can eliminate several areas of uncertainty
Genetics poses a fascinating, if not crucial element for consideration because drug metabolism can be contingent on genetic factors as well. This important angle can now be addressed at consumer level.
At the forefront of medical innovation, Next Biosciences delivers peace of mind with PharmaGene- the pharmacogenomics test that provides a safety net for medical prescriptions.
PharmaGene screens DNA samples against multiple drugs to determine the compatibility of various medications with individual genetic variants. This particular test incorporates various drug categories that are often prescribed for children, including pain medication, anticonvulsants, and ADHD medication.
One study published in the Journal of Paediatrics attributes the majority of dosing errors to three main drug classes, specifically anti-epileptics, asthma/allergy, and pain medication.
Understanding how a drug is utilised by the body assists both parents and healthcare providers in minimising dosing errors, prescription risks, and the associated stress of medicating children. Furthermore, DNA sample collection is non-invasive and can be done at home.
Insights offered by genetic testing:
- Genetic testing will pick up whether a patient’s metabolism of specific drugs is too fast:
If you are a rapid metaboliser, it means that your body breaks down and eliminates the drug faster than average. As a result, the medication will be less effective and may require a higher dose to achieve the desired therapeutic effect.
- Genetic testing will pick up whether a patient’s metabolism of specific drugs too slow:
If you are a slow metaboliser, it means that your body breaks down the drug more slowly than average. As a result, the medication will stay in your body for a longer period than expected. This may lead to higher than normal drug levels in your bloodstream and increase the risk of toxic side effects. Slow metabolisers may therefore require a lower dose to achieve the desired therapeutic effect.
Due to the risks of severe negative reactions, the South African Medical Association advises that the younger and smaller a patient is, the greater the caution should be employed when prescribing medication.
Thus, the groundbreaking alliance between genetics and pharmacokinetics has allowed for increased security of prescription advice. Seeing that pharmacogenomic testing can be initiated at any age, it is certainly worth exploring before starting any child (or adult) on chronic medication.
Moreover, as research on pharmacogenetics expands, the variety of drugs that will be suitable for genetic screening will surely multiply, as will the positive impact of precision medicine.
References:
- https://pharmaceutical-journal.com/article/ld/prescribing-errors-in-children-why-they-happen-and-how-to-prevent-them-2
- https://www.aamc.org/news/wish-pediatricians-more-medications-deemed-safe-kids
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3385045/