Drug interactions in children

Dupuis LL, Koren G, Shore A, Silverman ED, Laxter RM. Methotrexate-nonsteroidal antiinflammatory drug interaction in children with arthritis. J Rheumatol 1990 17 1469-73. 

Side effects and drug interactions in children and infants ... 

W. M. Sallas, S. Milosavljev, J. D souza, and M. Hossain, Pharmacokinetic drug interactions in children taking oxcarbazepine. Clin Pharmacol Ther 74 138-149 (2003). 

Cambonie G, Sabatier E, Guillaumont S, Masson F, Charbit J, Pidoux O, Hillaire-Buys D, Picaud JC. Digoxin-Josamycin a dangerous drug interaction in children. Arch Pediatr( 006) 13,1118-20. 

Liu, H. Delgado, N.R. Improved therapeutic monitoring of drug interactions in epileptic children using carbamazepine polytherapy. Ther.Drug Monit., 1994, 16, 132-138 [column temp 40 simultaneous metabolites]... 

Erythromycin- sulfisoxazole 50 mg/kg per day of erythromycin component in 3 4 doses Nausea, vomiting, abdominal pain, diarrhea, rash SS Many drug interactions (like clarithromycin), contraindicated in children under 2 months increasing pneumococcal resistance... 

Doxycycline 100 mg twice daily Avoid in children under 8 years Can cause photosensitivity, gastrointestinal problems, tooth staining in young children many drug-drug interactions (antacids, iron, calcium)... 

Rifapentine Adults 10 mg/kg (continuation phase) (600 mg) Dosed weekly. Children The drug is not approved for use in children Similar to those associated with RIF Drug interactions are being investigated and are likely similar to RIF... 

Adverse effects and drug interactions with codeine are similar to those reported for morphine, although they are less intense. Overdose in children results in the same effects as overdose of morphine, such as respiratory depression, miosis, and coma these symptoms are treated with naloxone administration. 

It is recommended that echinacea not be taken by anyone for more than 8 continuous weeks, and most clinical use is under 2 weeks duration. Echinacea has not yet been shown to be safe in pregnant or breastfeeding women and small children. No specific herb-drug interactions are reported, but for theoretical reasons those taking immunosuppressant drugs should avoid echinacea. 

Milk thistle appears to be remarkably safe, with loose stools due to increased bile solubility and occasional allergic reactions being the common side effects. It has not been evaluated in children or in pregnant women. There are no known serious drug or herb interactions. 

The prevalence of concurrent prescriptions raises concern regarding drug interactions with stimulants. Stimulants, especially MPH, have been used to augment the effects of tricyclic antidepressants in the treatment of refractory depression. Although one early report claimed that circulating levels of imipramine can rise seven fold when taken concurrently with MPH (Wharton et al., 1971), a more recent study found that combining stimulants with desipramine (DMI) did not increase the plasma level of DMI relative to children treated with DMI alone (Cohen et al., 1999). 

Given the use of venlafaxine for treatment-refractory depression in adults, it is likely that it will be used for similar purposes in children. In addition, it is likely that venlafaxine will be used for childhood anxiety disorders. It is unclear whether venlafaxine is serotonergi-cally powerful enough to be useful in OCD. The lack of significant drug-drug interactions may facilitate its use in patients for whom antidepressant medication combinations are anticipated. 

Clinicians should be aware that many of their patients may be taking alternative treatments either via self-care or prescribed by CAM practitioners. Inquiring about this should be routine because of potential side effects and drug interactions. A working knowledge of CAM treatments will allow child psychiatrists to give parents and patients advice about safety and effectiveness. Use of St. John s wort in children with unipolar depression may at times be appropriate, particularly in cases where more standard treatments are contraindicated or have failed. However, it should be used cautiously and with an appropriate explanation of its risks and benefits, as a competent clinician would do for any treatment. Use of St. John s wort for other conditions is not currently recommended given the lack of evidence for efficacy. Kava extracts may be used for anxiety, with similar provisos. There are much fewer data about the efficacy and safety of other dietary supplements and their use cannot be supported at this point. 

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