Diuretics in pediatrics : current knowledge and future prospects
Affiliations
Affiliations
- Department of Paediatrics, Faculty of Medicine, University of Kuwait, Kuwait City, Kuwait. Maria@hsc.edu.kw
Abstract
This review summarizes current knowledge on the pharmacology, pharmacokinetics, pharmacodynamics, and clinical application of the most commonly used diuretics in children. Diuretics are frequently prescribed drugs in children. Their main indication is to reduce fluid overload in acute and chronic disease states such as congestive heart failure and renal failure. As with most drugs used in children, optimal dosing schedules are largely unknown and empirical. This is undesirable as it can potentially result in either under- or over-treatment with the possibility of unwanted effects. The pharmacokinetics of diuretics vary in the different pediatric age groups as well as in different disease states. To exert their action, all diuretics, except spironolactone, have to reach the tubular lumen by glomerular filtration and/or proximal tubular secretion. Therefore, renal maturation and function influence drug delivery and consequently pharmacodynamics. Currently advised doses for diuretics are largely based on adult pharmacokinetic and pharmacodynamic studies. Therefore, additional pharmacokinetic and pharmacodynamic studies for the different pediatric age groups are necessary to develop dosing regimens based on pharmacokinetic and pharmacodynamic models for all routes of administration.
Similar articles
[The use of diuretics in kidney disease].
Heramb L, Hallan S, Aasarød K.Tidsskr Nor Laegeforen. 2014 Apr 29;134(8):840-4. doi: 10.4045/tidsskr.13.0721. eCollection 2014 Apr 29.PMID: 24780983 Review. Norwegian.
The pharmacology and therapeutics of diuretics in the pediatric patient.
Wells TG.Pediatr Clin North Am. 1990 Apr;37(2):463-504. doi: 10.1016/s0031-3955(16)36880-8.PMID: 2184406 Review.
Diuretic drugs. Progress in clinical pharmacology.
Lant A.Drugs. 1986;31 Suppl 4:40-55. doi: 10.2165/00003495-198600314-00006.PMID: 3525089 Review.
Pharmacology of diuretics in the newborn.
Chemtob S, Kaplan BS, Sherbotie JR, Aranda JV.Pediatr Clin North Am. 1989 Oct;36(5):1231-50. doi: 10.1016/s0031-3955(16)36766-9.PMID: 2677940 Review.
Diuretic therapeutics in the pediatric patient.
Witte MK, Stork JE, Blumer JL.Am J Cardiol. 1986 Jan 24;57(2):44A-53A. doi: 10.1016/0002-9149(86)91006-4.PMID: 3511657 Review.
Cited by
Lava SAG, Zollinger C, Chehade H, Schaffner D, Sekarski N, Di Bernardo S.Eur J Pediatr. 2023 May;182(5):2077-2088. doi: 10.1007/s00431-022-04768-2. Epub 2023 Jan 3.PMID: 36595088 Review.
The Use of Diuretic in Mechanically Ventilated Children with Viral Bronchiolitis: a Cohort Study.
Agasthya N, Chromey K, Hertzog JH, Chauhan JC.J Crit Care Med (Targu Mures). 2021 May 12;7(2):97-103. doi: 10.2478/jccm-2021-0008. eCollection 2021 Apr.PMID: 34722910 Free PMC article.
Accuracy of Dose Administered to Children Using Off-Labelled or Unlicensed Oral Dosage Forms.
Binson G, Sanchez C, Waton K, Chanat A, Di Maio M, Beuzit K, Dupuis A.Pharmaceutics. 2021 Jul 2;13(7):1014. doi: 10.3390/pharmaceutics13071014.PMID: 34371705 Free PMC article.
Medical management of pediatric heart failure.
Ahmed H, VanderPluym C.Cardiovasc Diagn Ther. 2021 Feb;11(1):323-335. doi: 10.21037/cdt-20-358.PMID: 33708503 Free PMC article. Review.
Dai X, Chen J, Li W, Bai Z, Li X, Wang J, Li Y.Front Pediatr. 2021 Jan 25;8:589124. doi: 10.3389/fped.2020.589124. eCollection 2020.PMID: 33585362 Free PMC article.
KMEL References
References
-
- J Clin Pharmacol. 1981 Nov-Dec;21(11-12 Pt 2):587-980 - PubMed
-
- Drug Metab Dispos. 1999 Oct;27(10):1165-70 - PubMed
-
- Am J Ophthalmol. 1985 Jul 15;100(1):79-81 - PubMed
-
- Pediatr Nephrol. 2003 Nov;18(11):1102-8 - PubMed
-
- Clin Pharmacol Ther. 1996 Oct;60(4):414-23 - PubMed
-
- Am J Perinatol. 2001 Sep;18(6):353-6 - PubMed
-
- Acta Paediatr. 1997 Jun;86(6):656-60 - PubMed
-
- Lancet. 2000 Dec 23-30;356(9248):2139-43 - PubMed
-
- J Pediatr. 1985 Jul;107(1):31-7 - PubMed
-
- Clin Pharmacol Ther. 1978 Jun;23(6):644-50 - PubMed
-
- Kidney Int. 1987 Oct;32(4):572-8 - PubMed
-
- Clin Pharmacol Ther. 1982 Jun;31(6):719-25 - PubMed
-
- Pediatr Nephrol. 2001 Mar;16(3):283-93 - PubMed
-
- J Cardiovasc Pharmacol. 1993;22 Suppl 3:S1-10 - PubMed
-
- Blood Press Monit. 1999 Jun-Aug;4(3-4):189-92 - PubMed
-
- Clin Pharmacol Ther. 1987 May;41(5):580-6 - PubMed
-
- Pediatr Nephrol. 2001 May;16(5):463-5 - PubMed
-
- Ann Clin Biochem. 2003 Jan;40(Pt 1):60-4 - PubMed
-
- Cochrane Database Syst Rev. 2006 Jul 19;(3):CD001694 - PubMed
-
- Cardiology. 1994;84 Suppl 2:57-67 - PubMed
-
- Prostaglandins. 1974 Nov 25;8(4):297-301 - PubMed
-
- Lancet. 1986 Apr 19;1(8486):919-20 - PubMed
-
- Paediatr Drugs. 2003;5(5):335-49 - PubMed
-
- N Engl J Med. 2003 Feb 6;348(6):529-37 - PubMed
-
- Pediatrics. 1999 Sep;104(3):e38 - PubMed
-
- Clin Pharmacol Ther. 1979 Jan;25(1):33-42 - PubMed
-
- Paediatr Drugs. 2001;3(11):783-92 - PubMed
-
- Br J Clin Pharmacol. 1998 Dec;46(6):605-9 - PubMed
-
- J Neurotrauma. 1999 Oct;16(10):937-43 - PubMed
-
- Dev Pharmacol Ther. 1988;11(6):357-65 - PubMed
-
- J Pediatr. 1992 Dec;121(6):974-80 - PubMed
-
- Dev Pharmacol Ther. 1986;9(2):88-101 - PubMed
-
- Cochrane Database Syst Rev. 2002;(1):CD003064 - PubMed
-
- Drugs. 1991;41 Suppl 3:14-22 - PubMed
-
- Pediatr Nephrol. 1995 Jun;9(3):375-81 - PubMed
-
- Clin Pharmacol Ther. 1986 Jul;40(1):14-20 - PubMed
-
- Ann Fr Anesth Reanim. 2002 Feb;21(2):141-7 - PubMed
-
- J Pediatr. 1982 Nov;101(5):777-81 - PubMed
-
- J Pediatr. 1978 Sep;93(3):507-11 - PubMed
-
- J Trauma. 1998 Jun;44(6):958-63; discussion 963-4 - PubMed
-
- J Pharmacokinet Biopharm. 1982 Aug;10(4):393-409 - PubMed
-
- Arch Dis Child. 1975 Sep;50(9):709-13 - PubMed
-
- J Pharmacokinet Biopharm. 1979 Feb;7(1):1-27 - PubMed
-
- Am J Ther. 2001 Jul-Aug;8(4):275-89 - PubMed
-
- Pediatrics. 2001 Sep;108(3):597-607 - PubMed
-
- J Cardiovasc Pharmacol. 1995 Sep;26(3):394-400 - PubMed
-
- J Pharm Pharmacol. 1999 Mar;51(3):239-48 - PubMed
-
- J Allergy Clin Immunol. 1994 Aug;94(2 Pt 1):201-6 - PubMed
-
- Fundam Clin Pharmacol. 2003 Jun;17(3):281-99 - PubMed
-
- N Engl J Med. 1967 Feb 16;276(7):357-68 - PubMed
-
- Clin Perinatol. 1995 Jun;22(2):429-56 - PubMed
-
- Acta Paediatr. 1994 May;83(5):522-5 - PubMed
-
- N Engl J Med. 2003 Feb 6;348(6):553-6 - PubMed
-
- Mol Pharmacol. 1988 Dec;34(6):729-35 - PubMed
-
- Acta Paediatr Scand. 1981 Jan;70(1):39-42 - PubMed
-
- Pediatr Cardiol. 2001 Jul-Aug;22(4):321-6 - PubMed
-
- Am J Perinatol. 2000;17(7):345-56 - PubMed
-
- J Pediatr. 1988 Apr;112(4):653-7 - PubMed
-
- Pharmacogenomics. 2003 Nov;4(6):701-34 - PubMed
-
- Int J Clin Pharmacol Res. 1994;14(5-6):149-56 - PubMed
-
- Clin Pharmacokinet. 1980 Nov-Dec;5(6):570-5 - PubMed
-
- J Am Soc Nephrol. 2000 Jan;11(1):97-104 - PubMed
-
- Eur J Clin Pharmacol. 1982;22(1):39-45 - PubMed
-
- Am J Physiol. 1978 Aug;235(2):F131-6 - PubMed
-
- Crit Care Med. 1994 Aug;22(8):1323-9 - PubMed
-
- Cochrane Database Syst Rev. 2000;(2):CD001454 - PubMed
-
- Cochrane Database Syst Rev. 2002;(1):CD001453 - PubMed
-
- J Pediatr. 1983 Oct;103(4):618-23 - PubMed
-
- Kidney Int. 1984 Aug;26(2):183-9 - PubMed
-
- Intensive Care Med. 1997 Jun;23(6):693-7 - PubMed
-
- Clin Pharmacokinet. 1988 Aug;15(2):94-113 - PubMed
-
- Kidney Int. 2003 Aug;64(2):555-64 - PubMed
-
- Am J Nephrol. 1985;5(1):9-13 - PubMed
-
- Arch Dis Child Fetal Neonatal Ed. 2001 Nov;85(3):F207-13 - PubMed
-
- Am J Ther. 2002 Jul-Aug;9(4):317-28 - PubMed
-
- Klin Wochenschr. 1991;69 Suppl 26:36-42 - PubMed
-
- Laryngoscope. 1985 Sep;95(9 Pt 2 Suppl 38):1-14 - PubMed
-
- Curr Opin Pediatr. 2002 Apr;14(2):175-82 - PubMed
-
- J Pediatr. 1997 Jul;131(1 Pt 1):81-6 - PubMed
-
- Eur J Clin Pharmacol. 1995;47(6):483-8 - PubMed
-
- Pediatrics. 1976 Aug;58(2):259-63 - PubMed
-
- J Pediatr. 1968 Feb;72(2):257-9 - PubMed
-
- Crit Care Med. 1996 Mar;24(3):398-402 - PubMed
-
- Clin Exp Nephrol. 2003 Mar;7(1):9-17 - PubMed
-
- J Pediatr. 1984 Oct;105(4):603-9 - PubMed
-
- Clin Pharmacol Ther. 1981 Oct;30(4):461-7 - PubMed
-
- Clin Pharmacol Ther. 1985 Oct;38(4):469-74 - PubMed
-
- Transplantation. 1987 Dec;44(6):784-8 - PubMed
-
- Int J Clin Pharmacol Ther Toxicol. 1983 Dec;21(12):598-601 - PubMed
-
- Pharmacology. 1979;19(3):121-31 - PubMed
-
- Clin Nephrol. 1995 Jan;43 Suppl 1:S38-41 - PubMed
-
- J Pediatr. 1986 Oct;109(4):698-707 - PubMed
-
- Ann Thorac Surg. 1997 Oct;64(4):1133-9 - PubMed
-
- Clin Pharmacol Ther. 1996 Oct;60(4):405-13 - PubMed
-
- J Pediatr. 1994 Dec;125(6 Pt 1):976-9 - PubMed
-
- J Clin Pharmacol. 1981 Nov-Dec;21(11-12 Pt 2):628-36 - PubMed
-
- J Perinatol. 1998 Sep-Oct;18(5):357-60 - PubMed
-
- Am J Dis Child. 1969 Jun;117(6):621-5 - PubMed
-
- Neurology. 1958 Jul;8(7):522-8 - PubMed
-
- J Pediatr. 1982 Sep;101(3):433-7 - PubMed
-
- Pediatrics. 1985 Jun;75(6):1032-7 - PubMed
-
- Pediatr Clin North Am. 1990 Apr;37(2):463-504 - PubMed
-
- Semin Pediatr Neurol. 1998 Sep;5(3):161-79 - PubMed
-
- J Pharmacol Exp Ther. 1981 Mar;216(3):479-83 - PubMed
-
- J Pediatr. 1980 Jul;97(1):139-43 - PubMed
-
- Arch Neurol. 1980 Jun;37(6):376 - PubMed
-
- Prog Pediatr Cardiol. 2000 Nov 4;12(1):45-55 - PubMed
-
- Pediatr Res. 1983 Feb;17(2):141-7 - PubMed
-
- J Allergy Clin Immunol. 1995 Dec;96(6 Pt 1):906-9 - PubMed
-
- Intensive Care Med. 2001 Apr;27(4):711-5 - PubMed
-
- J Pediatr. 1990 Sep;117(3):499-502 - PubMed
-
- Clin Pharmacol Ther. 1980 Aug;28(2):182-6 - PubMed
-
- Arch Dis Child. 1981 Dec;56(12):934-8 - PubMed
-
- J Pediatr. 1986 Oct;109(4):567-71 - PubMed
-
- Cochrane Database Syst Rev. 2001;(2):CD002270 - PubMed
-
- Clin Chim Acta. 2004 Jun;344(1-2):137-48 - PubMed
-
- Pediatr Nephrol. 2003 Oct;18(10 ):981-5 - PubMed
-
- Clin Exp Hypertens A. 1983;5(2):297-307 - PubMed
-
- Annu Rev Physiol. 2001;63:607-30 - PubMed
-
- J Clin Pharmacol. 1981 Nov-Dec;21(11-12 Pt 2):615-9 - PubMed
-
- J Clin Pharmacol. 1981 Nov-Dec;21(11-12 Pt 2):680-7 - PubMed
-
- Clin Pharmacol Ther. 2002 Oct;72(4):383-90 - PubMed
-
- Kidney Blood Press Res. 2003;26(1):55-60 - PubMed
-
- J Otolaryngol. 1982 Apr;11(2):127-33 - PubMed
-
- Am J Dis Child. 1987 Jul;141(7):769-71 - PubMed
-
- Pediatrics. 1997 Sep;100(3 Pt 1):420-1 - PubMed
-
- J Pediatr. 1977 Apr;90(4):647-50 - PubMed
-
- Semin Nephrol. 1999 Jul;19(4):344-52 - PubMed
-
- J Pediatr. 1988 Apr;112(4):605-12 - PubMed
-
- Pediatr Nephrol. 1998 Sep;12(7):603-16 - PubMed
-
- Indian J Pediatr. 2001 Mar;68(3):257-66 - PubMed
-
- Thorax. 1995 Jun;50(6):677-9 - PubMed
-
- J Pediatr. 1988 Sep;113(3):540-5 - PubMed
-
- Clin Pharmacol Ther. 1996 Oct;60(4):424-34 - PubMed
-
- Am J Med Sci. 2002 Nov;324(5):261-6 - PubMed
-
- Pharmacol Toxicol. 1994 Apr-May;74(4-5):216-22 - PubMed
-
- Int Urol Nephrol. 1991;23(4):383-92 - PubMed
-
- N Engl J Med. 1999 Sep 2;341(10):709-17 - PubMed
-
- Drug Metab Dispos. 2001 Feb;29(2):121-6 - PubMed
-
- Pediatr Allergy Immunol. 1994 May;5(2):107-10 - PubMed
-
- Kidney Int Suppl. 1998 May;66:S25-33 - PubMed
-
- Arch Dis Child. 2003 Sep;88(9):836 - PubMed
-
- Clin Pharmacol Ther. 1986 Aug;40(2):134-9 - PubMed
-
- Clin Pharmacol Ther. 1997 Aug;62(2):181-6 - PubMed
-
- Pediatr Nephrol. 2002 Apr;17 (4):264-8 - PubMed
-
- J Clin Pharmacol. 1999 Dec;39(12):1203-11 - PubMed
-
- Pediatrics. 1980 May;65(5):901-9 - PubMed
-
- J Investig Allergol Clin Immunol. 1998 Mar-Apr;8(2):115-8 - PubMed
-
- Curr Opin Pediatr. 1999 Oct;11(5):419-24 - PubMed
-
- Am J Ophthalmol. 1974 Aug;78(2):327-8 - PubMed
-
- Crit Care Med. 1992 Jan;20(1):17-21 - PubMed
-
- Br Heart J. 1994 Aug;72(2 Suppl):S40-3 - PubMed
-
- Pediatr Nephrol. 2002 Nov;17(11):903-7 - PubMed
-
- Clin Nephrol. 2003 Apr;59(4):259-66 - PubMed
-
- Acta Paediatr. 2003 Sep;92(9):1052-7 - PubMed
-
- Heart Dis. 2000 Sep-Oct;2(5):354-61 - PubMed
-
- Pediatr Nephrol. 1999 Aug;13(6):506-9 - PubMed
-
- Pediatr Nephrol. 1999 Aug;13(6):501-5 - PubMed
-
- Intensive Care Med. 2001 Jan;27(1):236-9 - PubMed
-
- Pediatr Nephrol. 2000 Nov;15(1-2):105-8 - PubMed
-
- Scand J Urol Nephrol. 1994 Dec;28(4):337-44 - PubMed
-
- Pediatrics. 1978 Nov;62(5):785-8 - PubMed
-
- Can J Anaesth. 1991 May;38(4 Pt 1):502-5 - PubMed
-
- Clin Pharmacol Ther. 1982 Oct;32(4):442-9 - PubMed
-
- Arch Dis Child. 2000 Jan;82(1):71-5 - PubMed
-
- Allergy Asthma Proc. 2002 May-Jun;23(3):181-4 - PubMed
-
- Chest. 1993 Dec;104(6):1723-6 - PubMed
-
- Drugs. 1985 Nov;30(5):427-43 - PubMed
-
- Arch Dis Child. 1999 Jun;80(6):548-52 - PubMed
-
- Eur J Nucl Med. 1994 Apr;21(4):322-7 - PubMed
-
- Clin Pharmacol Ther. 1978 Aug;24(2):199-207 - PubMed
-
- Pediatr Nephrol. 2004 Jul;19(7):780-4 - PubMed
-
- J Clin Pharmacol. 1998 Nov;38(11):994-1002 - PubMed
-
- Clin Nephrol. 1996 Jul;46(1):54-8 - PubMed
-
- J Allergy Clin Immunol. 1997 Feb;99(2):204-9 - PubMed
-
- Eur J Clin Pharmacol. 1991;40(4):333-41 - PubMed
-
- Dev Pharmacol Ther. 1993;20(3-4):220-30 - PubMed
-
- Arch Dis Child. 1992 Feb;67(2):214-7 - PubMed
-
- J Clin Anesth. 1988;1(1):66-74 - PubMed
-
- Clin Pharmacol Ther. 1975 Feb;17(2):159-65 - PubMed
-
- Nephrol Dial Transplant. 2001 Aug;16(8):1607-14 - PubMed
-
- Cochrane Database Syst Rev. 2001;(1):CD000216 - PubMed
-
- Kidney Int. 1979 Aug;16(2):187-95 - PubMed
-
- J Clin Invest. 2002 Jun;109(11):1395-9 - PubMed
-
- Clin Pharmacokinet. 2000 Jan;38(1):23-40 - PubMed
-
- Pediatrics. 1997 Jan;99(1):71-5 - PubMed
-
- Kidney Int. 1994 Aug;46(2):482-8 - PubMed
-
- Kidney Int Suppl. 1998 May;66:S174-7 - PubMed
-
- J Pediatr. 1983 Sep;103(3):481-5 - PubMed
-
- Pediatrics. 1995 Sep;96(3 Pt 1):484-9 - PubMed
-
- Pediatr Nephrol. 2000 Nov;15(1-2):119-24 - PubMed
-
- J Pediatr. 1978 Jun;92(6):982-4 - PubMed
-
- J Pediatr. 1965 Jun;66:1023-30 - PubMed
-
- Pediatr Pol. 1984 Mar;59(3):197-202 - PubMed
-
- Bol Med Hosp Infant Mex. 1986 Aug;43(8):482-8 - PubMed
-
- Drug Intell Clin Pharm. 1984 Mar;18(3):235-8 - PubMed
-
- J Pediatr. 1991 Apr;118(4 Pt 1):621-6 - PubMed
-
- Pediatrics. 1985 May;75(5):908-10 - PubMed
-
- Chest. 1994 Nov;106(5):1396-400 - PubMed
-
- J Pediatr. 1977 Apr;90(4):642-6 - PubMed
-
- Am J Physiol Renal Physiol. 2000 Jun;278(6):F853-66 - PubMed
-
- Ann Intern Med. 1977 Oct;87(4):398-403 - PubMed
-
- Nature. 1959 Mar 28;183(4665):891-2 - PubMed
-
- Arch Dis Child. 1999 Feb;80(2):184-5 - PubMed
-
- J Antimicrob Chemother. 1994 Aug;34 Suppl A:19-24 - PubMed
-
- Pediatr Pulmonol. 1987 Jul-Aug;3(4):219-25 - PubMed
-
- Intensive Care Med. 1997 Sep;23(9):992-7 - PubMed
-
- N Engl J Med. 2003 Feb 6;348(6):538-49 - PubMed
-
- Am J Dis Child. 1985 May;139(5):464-6 - PubMed
-
- Am J Physiol Renal Physiol. 2001 Aug;281(2):F197-205 - PubMed