Effect of Therapeutic Hypothermia on Drug Metabolism

THERAPEUTIC HYPOTHERMIA is increasingly used for neonates older than 36-weeks gestation who meet specific criteria following an apparent, acute perinatal hypoxic or ischmeic event. In their systematic review of eight randomized controlled trial of therapeutic hypothermia, which included 638 newborn infants, Jacobs and associates concluded that therapeutic hypothermia reduces death or disability in term newborns who have suffered a hypoxic episode around the time of birth. With increased application of therapeutic hypothermia, it is important to understand the impact of this therapy on other therapies used concomitantly. In a recent review of the literature, Tortorici and colleagues found that the therapeutic hypothermia has an effect on drug metabolism, elimination, and response. However, because there maybe a different response depending on the class of the drug, generalizations about adjusting dosing cannot be made. This column will review aspects of drug metabolism and relevant studies of the metabolism specific drugs in human neonates treated with hypothermia. Because few studies have addressed the effects of hypothermia on drug metabolism in neonates, this area is ripe for research.