Summary
Drug oxidations are catalyzed by the liver microsomal fraction of human fetuses but not by fetal livers from most experimental animals. In contrast, glucuronidation of some substrates is catalyzed by the rat fetal liver in late gestation but not in the human fetal liver. The deficient human fetal glucuronidation seems to be compensated for by early development of sulfation activity. The inconsistency of the results from animal fetuses and human fetuses shows that animal data have little relevance for the human fetus. No generalized statements can be made about drug disposition in the newborn infant as compared to adults. Although most drugs that are oxidized have prolonged plasma half-lives in the neonatal period there are examples of drugs with half-lives similar to, or even shorter than, the average half-lives in adults. Oxazepam is conjugated with glucuronic acid in adults. The neonatal plasma half-life of this drug is considerably prolonged. This is true also for its conjugate as would be expected from the immature renal function in newborns. Adequate pharmacokinetic information is a prerequisite for rational and safe drug treatment in the neonatal period.
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References
Ackermann E, Rane A, Ericsson JLE (1972) The liver microsomal monooxygenase system in the human fetus: Distribution in different centrifugal fractions. Clin Pharmacol Ther 13: 652–662
Aranda JV, Sitar DS, Parsons WD, Loughnan PM, Neims AH (1976) Pharmacokinetic aspects of theophylline in premature newborns. N Engl J Med295: 413–416
Beckett AH, Taylor JF (1967) Blood concentration of pethidine and pentazocine in mother and infant at birth. J Pharm Pharmacol 19: (Suppl), 50S-52S
Boréus LO, Belfrage P, Wallin A, Raabe N, Hartwig P (1978) Placental transfer of pethidine and norpethidine in the newborn infant. Abstract 2563, 7th International Congress of Pharmacology, Paris
Brackbill Y, Kane J, Manniello RL, Abramson D (1974) Obstetric premedication and infant outcome. Am J Obstet Gynecol 118: 377–384
Caldwell J, Mofatt JR, Smith RL, Liebermann BA, Cawston MO, Beard RW (1976) Pharmacokinetics of bupivacaine administered epidurally during childbirth. Br J Clin Pharmacol 3: 956P-957P
Caldwell J, Wakile LA, Notarianni LJ, Smith RL, Correy GJ, Lieberman BA, Beard RW, Finnie MDA Snedden W (1978) Maternal and neonatal disposition of pethidine in childbirth — a study using quantitative gas chromatography mass spectrometry. Life Sci 22: 589–596
Drayer DE (1976) Pharmacologically active drug metabolites: therapeutic and toxic activities, plasma and urine data in man, accumulation in renal failure. Clin Pharmacokinet 1: 426–443
Dvorchik BH Hepatic drug metabolism in the fetal stumptailed monkey (Macaca arctoides) In: Neubert D, Merker HJ, Nau H, Langman J (eds) Role of pharmacokinetics in prenatal and perinatal toxicology. Georg Thieme, Stuttgart, pp 275–287
Dvorchik BH, Stenger VG, Quattropani SL (1974) Fetal hepatic drug metabolism in the nonhuman primate,Macaca arctoides. Drug Metab Dispos 2: 539–544
Fouts JR, Adamson RH (1959) Drug metabolism in the newborn rabbit, Science 129: 897–898
Garrettson LK, Procknal JA Levy G (1975) Fetal acquisition and neonatal elimination of a large amount of salicylate. Clin Pharmacol Ther 17: 98–103
Gladtke E (1968) Pharmacokinetics studies on phenylbutazone in children, Farmaco [Sci] 23: 897–906
Gram LF, Fredricson-Overø K (1976) First-pass metabolism of nortriptyline in man. Clin Pharmacol Ther 18: 305–314
Hirvonen T (1966) Fetal and postnatal development of glucuronide formation in mammalian tissue slices. Sarja-Series A II, Biologica-Geographica, Turku
Howie D, Adriaenssens PI, Prescott LF (1977) Paracetamol metabolism following overdosage: application of high performance liquid chromatography. J Pharm Pharmacol 29: 235–237
Jondorf WR, Maickel RT, Brodie BB (1958) Inability of newborn mice and guinea pigs to metabolize drugs. Biochem Pharmacol 1: 352–354
Krauer B, Draffan GH, Williams FM, Clare RA, Dollery CT, Hawkins DF (1973) Elimination kinetics of amobarbital in mothers and their newborn infants. Clin Pharmacol Ther 14: 442–447
Kuhnert BR, Kuhnert PM, Tu A-SL, Lin DCK, Foltz RL (1979a) Meperidine and normeperidine levels following meperidine administration during labor. I. Mother. Am J Obstet Gynecol 133: 904–908
Kuhnert BR, Kuhnert PM, Tu A-SL, Lin DCK (1979b) Meperidine and normeperidine levels following meperidine administration during labor. II. Fetus and neonate. Am J Obstet Gynecol 133: 909–914
Levy G, Khanna NN, Soda DM, Tsuzuki O, Stern L (1975) Pharmacokinetics of acetaminophen in the human neonate: Formation of acetaminophen glucuronide and sulfate in relation to plasma bilirubin concentration and D-glucaric acid excretion. Pediatrics 55: 818–825
Mitchell JR, Jollow DJ, Potter WZ, Davis DC, Gillette JR, Brodie BB (1973) Acetaminophen-induced hepatic necrosis. I. Role of drug metabolism. J Pharmacol Exp Ther 187: 185–194
Miller RP, Roberts RJ, Fischer LJ (1976) Acetaminophen elimination kinetics in neonates, children, and adults. Clin Pharmacol Ther 19: 284–294
Morgan D, Moore G, Thomas J, Triggs E (1978) Disposition of meperidine in pregnancy. Clin Pharmacol Ther 23: 288–295
Morrison JC, Wiser WL, Rosser SI, Gayden JO, Bucovaz ET, Whybrew WD, Fish SA (1973) Metabolites of meperidine related to fetal depression. Am J Obstet Gynecol 115: 1132–1137
Moore J, McNabb TG Glinn JB (1973) The placental transfer of pentazocine and pethidine. Br J Anaesth 45: (Suppl) 798–801
Moore RG, Thomas J, Triggs EJ, Thomas DB, Burnard ED Shanks CA (1978) The pharmacokinetics and metabolism of the anilide local anaesthetics in neonates. III. Mepivacaine. Eur J Clin Pharmacol 14: 203–212
Morselli PL, Principi N, Tognoni G, Reali E, Belvedere G, Standen SM, Sereni F (1973) Diazepam elimination in premature and full-term infants and children. J Perinat Med 1: 133–141
Nitowsky HM, Matz L, Berzofsky JA (1966) Studies on oxidative drug metabolism in the full-term newborn infant. J Pediatr 69: 1139–1149
Pacifici GM, Säwe J, Kager L, Rane A (1980) Morphine glucuronidation in human fetal and adult liver (in preparation)
Pelkonen O, Kärki NT (1973) Drug metabolism in human fetal tissues. Life Sci 13: 1163–1180
Prescott LF, Wright N, Roscoe P, Brown SS (1971) Plasma-paracetamol half-life and hepatic necrosis in patients with paracetamol overdosage. Lancet 1: 519–522
Rane A (1973) Drug metabolism in the human fetus and newborn infant. Acad. Thesis. Karolinska Institutet, Stockholm
Rane A, Ackermann E (1972) Metabolism of ethylmorphine and aniline in human fetal liver. Clin Pharmacol Ther 13: 663–670
Rane A, Sjöqvist F, Orrenius S (1973) Drugs and fetal metabolism. Clin Pharmacol Ther 14: 662–672
Rane A, Garle M, Borgå O, Sjöqvist F (1974) Plasma disappearance of transplacentally transferred diphenylhydantoin in the newborn studied by mass fragmentography. Clin Pharmacol Ther 15: 39–45
Rane A, Bertilsson L, Palmér L (1975) Disposition of placentally transferred carbamazepine (Tegretol®) in the newborn. Eur J Clin Pharmacol 8: 283–284
Rane A, Sundwall A, Tomson G (1978) Oxidative and synthetic drug-metabolic pathways in the newborn infant. Studies on the neonatal kinetics of oxazepam. In: Neubert D, Merker HJ, Nau H, Langman J (eds): Role of Pharmacokinetics in Prenatal and Perinatal Toxicology. George Thieme, Stuttgart, pp 183–191
Reinicke C, Rogner G, Frenzel J, Maak B, Klinger W (1970) Die Wirkung von Phenylbutazon und Phenobarbital auf die Amidopyrin-Elimination, die Bilirubin-Gesamtkonzentration im Serum und einige Blutgerinnungsfaktoren bei neugeborenen Kindern. Pharmacol Clin 2: 167–172
Rollins DE, von Bahr C, Glaumann H, Moldéus P, Rane A (1979) Acetaminophen: Potentially toxic metabolite formed by human fetal and adult liver microsomes and isolated fetal liver cells. Science 205: 1414–1416
Shnider SM, Moya F (1964) Effects of meperidine on the newborn infant. Am J Obstet Gynecol 89: 1009–1015
Short CR, Davis LE (1970) Perinatal development of drug-metabolizing enzyme activity in swine. J Pharmacol Exp Ther 174: 185–196
Sjöqvist F, Bergfors PG, Borgå O, Lind M, Ygge H (1972) Plasma disappearance of nortriptyline in a newborn infant following placental transfer from an intoxicated mother: Evidence for drug metabolism. J Pediatr 80: 496–500
Steiner E, von Bahr C, Rane A (1980) Sulfate and glucuronic acid conjugation of harmol in human fetal and adult liver tissue. (in preparation)
Szeto HH, Zervoudakis IA, Cederqvist LL, Inturrisi CE (1978) Amniotic fluid transfer of meperidine from maternal plasma in early pregnancy. Obstet Gynecol 52: 59–62
Tomson G, Garle M, Nisell H, Nylund L, Rane A, Thalme B (1980) Maternal kinetics and transplancental passage of pethidine during labour (in preparation)
Tomson G, Lunell N-O, Sundwall A, Rane A (1979) Placental passage of oxazepam and its metabolism in mother and newborn. Clin Pharmacol Ther 25: 74–81
Traeger A, Nöschel H, Zaumseil J (1973) Zur Pharmakokinetik von Indomethazin bei Schwangeren, Kreissenden und deren Neugeborenen. Zentralbl Gynaekol 95: 635–641
Vest MF, Streiff RR (1959) Studies on glucuronide formation in newborn infants and older children. AMA J Dis Child 98: 688–693
Weiss CF, Glazko AJ, Weston JK (1960) Chloramphenicol in the newborn infant. A physiologic explanation of its toxicity when given in excessive dose. N Engl J Med 262: 787–794
Wengle B (1964) Studies on ester sulphates. On sulphate conjugation in foetal human tissue extracts. Acta Soc Med Upsal 69: 105–124
Wilkinson GR, Shand DG (1975) A physiological approach to hepatic drug clearance. Clin Pharmacol Ther 18: 377–390
Wishart GJ, Dutton GJ (1978) Induction by natural and xenobiotic compounds of UDP-Glucuronyl-transferase activities during the perinatal period. In: Neubert D, Merker HJ, Nau H, Langman J (eds) Role of pharmacokinetics in prenatal and perinatal toxicology. George Thieme, Stuttgart, pp 215–224
Yaffe SJ, Rane A, Sjöqvist F, Boréus L-O, Orrenius S (1970) The presence of a monooxygenase system in human fetal liver microsomes. Life Sci 9: 1189–1200
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Rane, A., Tomson, G. Prenatal and neonatal drug metabolism in man. Eur J Clin Pharmacol 18, 9–15 (1980). https://doi.org/10.1007/BF00561473
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DOI: https://doi.org/10.1007/BF00561473