Population pharmacokinetics of propofol in neonates and infants: Gestational and postnatal age to determine clearance maturation

Louis Sandra*, Anne Smits, Karel Allegaert, Johan Nicolaï, Pieter Annaert, Thomas Bouillon

*Corresponding author for this work

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Aims: Develop a population pharmacokinetic model describing propofol pharmacokinetics in (pre)term neonates and infants, that can be used for precision dosing (e.g. during target-controlled infusion) of propofol in this population. Methods: A nonlinear mixed effects pharmacokinetic analysis (Monolix 2018R2) was performed, based on a pooled study population in 107 (pre)term neonates and infants. Results: In total, 836 blood samples were collected from 66 (pre)term neonates and 41 infants originating from 3 studies. Body weight (BW) of the pooled study population was 3.050 (0.580–11.440) kg, postmenstrual age (PMA) was 36.56 (27.00–43.00) weeks and postnatal age (PNA) was 1.14 (0–104.00) weeks (median and min-max range). A 3-compartment structural model was identified and the effect of BW was modelled using fixed allometric exponents. Elimination clearance maturation was modelled accounting for the maturational effect on elimination clearance until birth (by gestational age [GA]) and postpartum (by PNA and GA). The extrapolated adult (70 kg) population propofol elimination clearance (1.64 L min−1, estimated relative standard error = 6.02%) is in line with estimates from previous population pharmacokinetic studies. Empirical scaling of BW on the central distribution volume in function of PNA improved the model fit. Conclusions: It is recommended to describe elimination clearance maturation by GA and PNA instead of PMA on top of size effects when analyzing propofol pharmacokinetics in populations including preterm neonates. Changes in body composition in addition to weight changes or other physio-anatomical changes may explain the changes in central distribution volume. The developed model may serve as a prior for propofol dose finding and target-controlled infusion in (preterm) neonates.

Original languageEnglish
Pages (from-to)2089-2097
Number of pages9
JournalBritish Journal of Clinical Pharmacology
Issue number4
Early online date21 Oct 2020
Publication statusPublished - Apr 2021

Bibliographical note

Funding Information:
The research activities of A. Smits are supported by the Clinical Research and Education Council of the University Hospitals Leuven.

Publisher Copyright:
© 2020 British Pharmacological Society


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