Heart Failure Pharmacotherapy: Differences Between Adult and Paediatric Patients
M. Bajcetic, T. Vidonja Uzelac and I. Jovanovic
Affiliation: Department of Pharmacology, Clinical Pharmacology and Toxicology, School of Medicine, University of Belgrade, P.O. Box 38, 11129 Belgrade 102, Serbia.
Keywords: Clinical studies, formulations, heart failure, off- label drug, paediatric, pharmacotherapy.
During the last decades, the introduction of new, more efficient drugs, has significantly improved the heart failure
(HF) therapy of adults. Therapeutic focus has shifted from simple hemodynamic manipulation to include neurohumoral
modulation as a consequence of the better understanding of mechanisms of HF formation, in particular at the cellular
level. The aetiologies of HF in children are remarkably different and more varied than in the adult population. Cardiac
failure is usually caused by congenital heart disease and cardiomyopathy in children, whereas in adults, coronary artery
disease, hypertension and myocardial infarction are the most common causes. Despite this fact, pharmacotherapy of children
is based on the same drugs, usually extrapolated from adult HF regimens. A recently published study in children
treated with the drugs known to be efficient in adult HF therapy, provides encouragement that the outcomes might be
similarly beneficial. On the other hand, some reports outline that children with HF, especially patients with systemic right
ventricles or single ventricle physiology, require specific drug guidelines. A general characteristic of HF pharmacotherapy
in children is the lack of paediatrically designed drugs. Drugs currently used in the treatment of HF in paediatric patients
are designed for adults, and their efficacy, safety and quality have generally not been confirmed by clinical studies of
children. Aside from this, availability of commercial paediatric drug formulations labelled for treatment of HF in children
significantly influences the quality and efficacy of therapy.
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