Pharmacokinetics of Hydrochlorothiazide in Children: A Potential Surrogate for Renal Secretion Maturation.

Journal Article (Journal Article;Multicenter Study)

Hydrochlorothiazide (HCTZ) is a thiazide diuretic used in adults and children for the treatment of hypertension and edema. The pharmacokinetic (PK) properties of HCTZ in children are not well characterized, particularly among children with obesity who frequently suffer from hypertension and may, therefore, benefit from HCTZ therapy. HCTZ is excreted in the kidney via organic anion transporters 1 and 3 (OAT1 and OAT3). The ontogeny of OAT1 and OAT3 remain unknown, but HCTZ clearance may serve as a surrogate marker of OAT1 and OAT3 maturation. Population PK modeling was performed in NONMEM, and the model was leveraged to conduct dose-exposure simulations. This study examined 83 plasma samples from 49 participants (69% male) taking enteral HCTZ. The median (range) postnatal age was 6.7 years (0.03-19.5 years), and 17 (34%) participants were obese or morbidly obese. The median (range) dose of HCTZ was 0.654 mg/kg (0.11-1.8 kg) and the median number of doses recorded per participant was 5 (1-8). HCTZ PK was well characterized by a 1-compartment PK model. Body weight and a maturation model based on postmenstrual age were significant covariates for apparent clearance, but the presence of obesity was not. Dosing simulations were performed with a standardized 1mg/kg. Simulated exposure (area under the curve and maximum HCTZ concentrations) decreased with age and was likely due to older children receiving the maximum absolute doses of HCTZ. Further studies with more patients in each age group are required to confirm these PK findings of HCTZ in the children.

Full Text

Duke Authors

Cited Authors

  • Commander, SJ; Wu, H; Boakye-Agyeman, F; Melloni, C; Hornik, CD; Zimmerman, K; Al-Uzri, A; Mendley, SR; Harper, B; Cohen-Wolkowiez, M; Hornik, CP; Best Pharmaceuticals for Children Act-Pediatric Trials Network Steering Committee,

Published Date

  • March 2021

Published In

Volume / Issue

  • 61 / 3

Start / End Page

  • 368 - 377

PubMed ID

  • 33029806

Pubmed Central ID

  • PMC8232568

Electronic International Standard Serial Number (EISSN)

  • 1552-4604

Digital Object Identifier (DOI)

  • 10.1002/jcph.1739


  • eng

Conference Location

  • England