**6. Drugs**

302 Complementary Pediatrics

reasons, likely obligations, limited sources, and the little market share of pediatric drugs can be told. Not having been approved, most of the products are kept being used on the infants and children. Formulation of these medications may not be appropriate for pediatric patients just because they are fit for adults. Liquid forms are preferred for oral use on infants. Infants have difficulty in swallowing capsules and tablets. Besides they are too sized for them, their active ingredients are equally too much. Measuring the appropriate dose becomes, therefore, difficult. Most drugs do not dissolve in the water entirely. To make use of some drugs on the infants orally, suspensions should be formed. Carboxymethylcellulose and methylcellulose are used to achieve this. Most of the intravenous drugs used in adults are very concentrated. Therefore, their use on infants and children are quite difficult. Due to difficulties in dosing, toxic reactions are reported related to digoxin and morphine use on infants. The parenteral drugs to be used on infants, but are used in adults, are diluted in injection water or in 0.9% NaCl. The stability of these drugs should be tested for their active components and sterilities. The excipient components used in drug production are often inert matters, some of which might result in undesired effects. The benzyl alcohol used as preservative show serious toxic properties on infants; sorbitol used in high volumes as excipient may result in diarrhea. In addition, the propylene glycol used in preparations such as Phenytoin, Phenobarbital, digoxin, diazepam, vitamin D, and hydralzine, leads to

Calculation according to body weight is a preferred way of measuring the infant dose,

Many clinic experiments show that the dose calculations according to the surface area (m2) are more suitable than those using body weights for their least erroneous, thus, preferred aspect. Respiration metabolism, blood volume, extracellular liquid amount, glomerular filtration speed, and renal blood circulation are among the physiological parameters showing strong correlation with the body surface. Most of these functions have a direct

Since the metabolism is faster in children, infant doses (per kg. weight) can be greater than

Among the drugs given to infants in greater amount (per kg.) are as follow: Phenytoin, Diazepam, Imipramine, Phenobarbital, Teophylin, Chlomypramin, Carbamazepine, Enprophylin, Haloperidol, Ethosuximide, Digoxin, Chlorpromazine, Clonazepam, some

With the lower renal and hepatic functions, infants require longer drug intervals comparing to children and adults. For children to get appropriate doses, thorough clinical tests and drug's blood level studies are required. Due to certain ethical reasons, carrying out clinical studies over the children is difficult. In addition to the outstanding ethical reasons, too little size of the samples resulting in inefficiency in determination, insufficient experimental

hyperosmolarity on infants (Pala & Baktr, 2011).

Infant dose = Infant weight (kg)/ 72 x adult dose

affect on drug elimination (Pala & Baktr, 2011).

anti-cancerogenic drugs (Pala & Baktr, 2011).

that of adults (Pala & Baktr, 2011).

especially using the Clark formula (Pala & Baktr, 2011).

**5.1.2 Dosing in children** 

*Clark Formula:* 
