Overview

Dr Roxane Carr’s research focus is to study the safety and effectiveness of drugs used to treat a variety of illnesses in children. She is also interested in studying the impact of various treatment modalities (extracorporeal life support (heart-lung machine), dialysis, and therapeutic plasma exchange (plasmapharesis) on drug dosing in children as well as optimal methods to monitor the drug therapy of children and for pharmacists to communicate about drug therapy issues with children and their care givers.

Publications

Pediatric Obesity: Pharmacokinetics and Implications for Drug Dosing
Clinical Therapeutics
Jennifer G. Kendrick, Roxane R. Carr, Mary H.H. Ensom
DOI: 10.1016/j.clinthera.2015.05.495
09/2015

A naloxone admixture to prevent opioid-induced pruritus in children: a randomized controlled trial
Canadian Journal of Anesthesia/Journal canadien d'anesthésie
Nicholas West, J. Mark Ansermino, Roxane R. Carr, Karen Leung, Guohai Zhou, Gillian R. Lauder
DOI: 10.1007/s12630-015-0380-5
04/2015

Pediatric Assessment of Vancomycin Empiric Dosing (PAVED): a Retrospective Review
Pediatric Drugs
Daniel Rainkie, Mary H. H. Ensom, Roxane Carr
DOI: 10.1007/s40272-015-0122-8
03/2015

The Invisible White Coat: Awareness of Pharmacists in a Neonatal Intensive Care Unit
The Canadian Journal of Hospital Pharmacy
Rehana Bajwa, Jennifer G Kendrick, Roxane Carr
DOI: 10.4212/cjhp.v67i4.1374
08/2014

Stability of Epinephrine at Standard Concentrations
The Canadian Journal of Hospital Pharmacy
Roxane R Carr, Diane Decarie, Mary H H Ensom
DOI: 10.4212/cjhp.v67i3.1356
06/2014

Standard-Dose Versus High-Dose Acyclovir in Children Treated Empirically for Encephalitis: A Retrospective Cohort Study of Its Use and Safety
Pediatric Drugs
Jennifer G. Kendrick, Mary H. H. Ensom, Andrew Steer, Colin T. White, Eddie Kwan, Roxane R. Carr
DOI: 10.1007/s40272-014-0066-4
02/2014

Evaluating preferences for long term wheeze following RSV infection using TTO and best-worst scaling
Allergy, Asthma & Clinical Immunology
Lilla MC Roy, Nick Bansback, Carlo Marra, Roxane Carr, Mark Chilvers, Larry D Lynd
DOI: 10.1186/1710-1492-10-s1-a64
2014

A Pharmacokinetics Module Taught Within a Pediatrics Pharmacotherapy Course
American Journal of Pharmaceutical Education
Patricia Gerber, Roxane Carr
DOI: 10.5688/ajpe776126
08/2013

Compatibility and Stability of Morphine Sulphate and Naloxone Hydrochloride in 0.9% Sodium Chloride for Injection
The Canadian Journal of Hospital Pharmacy
Charlotte Kistner, Mary H H Ensom, Diane Decarie, Gillian Lauder, Roxane R Carr
DOI: 10.4212/cjhp.v66i3.1253
06/2013

Safety and Effectiveness of Dexmedetomidine in the Pediatric Intensive Care Unit (SAD–PICU)
The Canadian Journal of Hospital Pharmacy
Laura Carney, Jennifer Kendrick, Roxane Carr
DOI: 10.4212/cjhp.v66i1.1208
03/2013

Overview of antiarrhythmic drug therapy for supraventricular tachycardia in children
Progress in Pediatric Cardiology
Carolina Escudero, Roxane Carr, Shubhayan Sanatani
DOI: 10.1016/j.ppedcard.2012.11.008
01/2013

Canadian Survey of Critical Care Pharmacists' Views and Involvement in Clinical Research
Annals of Pharmacotherapy
Marc M Perreault, Zoé Thiboutot, Lisa D Burry, Louise Rose, Salmaan Kanji, Jaclyn M LeBlanc, Roxane R Carr, David R Williamson
DOI: 10.1345/aph.1r180
09/2012

The Medical Management of Pediatric Arrhythmias
Current Treatment Options in Cardiovascular Medicine
Carolina Escudero, Roxane Carr, Shubhayan Sanatani
DOI: 10.1007/s11936-012-0194-5
08/2012

Use of Methadone for Prevention of Opioid Withdrawal in Critically Ill Children
The Canadian Journal of Hospital Pharmacy
Sonia A Jeffries, Rumi McGloin, Alexander F Pitfield, Roxane R Carr
DOI: 10.4212/cjhp.v65i1.1098
02/2012

A systematic review of the pharmacokinetics of antiepileptic drugs in neonates with refractory seizures
Journal of Pediatric Pharmacology and Therapeutics
DOI: 10.5863/1551-6776-17.1.31
02/2012

Identification by families of pediatric adverse events and near misses overlooked by health care providers
Canadian Medical Association Journal
J. P. Daniels, K. Hunc, D. D. Cochrane, R. Carr, N. T. Shaw, A. Taylor, S. Heathcote, R. Brant, J. Lim, J. M. Ansermino
DOI: 10.1503/cmaj.110393
11/2011

Describing Intravenous Extravasation in Children (DIVE Study)
The Canadian Journal of Hospital Pharmacy
Vanessa Paquette, Rumi McGloin, Tracie Northway, Pia DeZorzi, Avash Singh, Roxane Carr
DOI: 10.4212/cjhp.v64i5.1069
10/2011

Safety and Pharmacokinetics of Ribavirin for the Treatment of La Crosse Encephalitis
The Pediatric Infectious Disease Journal
James E. McJunkin, Milap C. Nahata, Emily C. De Los Reyes, W. Garrett Hunt, Manuel Caceres, Raheel R. Khan, Mouna G. Chebib, Sasidharan Taravath, Linda L. Minnich, Roxane Carr, Christine A. Welch, Richard J. Whitley
DOI: 10.1097/inf.0b013e31821c922c
10/2011

The need for better data about counterfeit drugs in developing countries: a proposed standard research methodology tested in Chennai, IndiaCounterfeit drugs in developing countries
Journal of Clinical Pharmacy and Therapeutics
M. Seear, D. Gandhi, R. Carr, A. Dayal, D. Raghavan, N. Sharma
DOI: 10.1111/j.1365-2710.2010.01198.x
10/2010

Comparison of Continuous and Intermittent IV Infusion of Vancomycin: Systematic Review
The Canadian Journal of Hospital Pharmacy
Mary H H Ensom, Sally S K Man, Roxane R Carr
DOI: 10.4212/cjhp.v63i5.949
10/2010

Pharmacokinetics and drug dosing in obese children
Journal of Pediatric Pharmacology and Therapeutics
05/2010

A human factors and survey methodology-based design of a web-based adverse event reporting system for families
International Journal of Medical Informatics
Jeremy P. Daniels, Ashlee D. King, D. Douglas Cochrane, Roxane Carr, Nicola T. Shaw, Joanne Lim, J. Mark Ansermino
DOI: 10.1016/j.ijmedinf.2010.01.016
05/2010

Prevalence of Vitamin D Deficiency and Insufficiency in Children With Osteopenia or Osteoporosis Referred to a Pediatric Metabolic Bone Clinic
PEDIATRICS
S. A. Bowden, R. F. Robinson, R. Carr, J. D. Mahan
DOI: 10.1542/peds.2007-2111
06/2008

Long-term effectiveness outcome of melatonin therapy in children with treatment-resistant circadian rhythm sleep disorders
Journal of Pineal Research
Roxanne Carr, Michael B. Wasdell, Donald Hamilton, Margaret D. Weiss, Roger D. Freeman, Joseph Tai, Wop J. Rietveld, James E. Jan
DOI: 10.1111/j.1600-079x.2007.00485.x
11/2007

Azithromycin for Improving Pulmonary Function in Cystic Fibrosis
Annals of Pharmacotherapy
Roxane R Carr, Milap C Nahata
DOI: 10.1345/aph.1d589
09/2004

Drug Disposition and Therapy in Adolescence: The Effects of Puberty
The Journal of Pediatric Pharmacology and Therapeutics
Roxane R. Carr, Mary H.H. Ensom
DOI: 10.5863/1551-6776-8.2.86
04/2003

Octreotide for Sulfonylurea-Induced Hypoglycemia Following Overdose
The Annals of Pharmacotherapy
Roxane Carr, Peter J Zed
DOI: 10.1345/1542-6270(2002)0362.0.co;2
11/2002

Fluoxetine in the Treatment of Premenstrual Dysphoric Disorder
Annals of Pharmacotherapy
Roxane R Carr, Mary HH Ensom
DOI: 10.1345/aph.1a265
04/2002

Paralysis in the critically ill: Intermittent bolus pancuronium compared with continuous infusion
Critical Care Medicine
Jane M. de Lemos, Roxane R. Carr, Karen F. Shalansky, David R. Bevan, Juan J. Ronco
DOI: 10.1097/00003246-199912000-00007
1999

Primary Induction with Mycophenolate Mofetil and Corticosteroids in a Liver Transplant Recipient with Hepatorenal Syndrome
Annals of Pharmacotherapy
Roxane R Carr, Eric M Yoshida, Stephen W Chung, Nilufar Partovi
DOI: 10.1345/aph.17059
01/1998

Research

Review of Pharmacokinetics of Medications in Children Undergoing Therapeutic Plasma Exchange
Therapeutic Plasma Exchange (TPE), also known as plasmapharesis or “plex”, is a process that separates plasma for the cellular components of blood, discarding the plasma and exchanging it with replacement physiologic fluids such as albumin or fresh frozen plasma. TPE is used in the management of many types of conditions, including (but not limited to) systemic lupus erythema, thrombotic thrombocytopenic purpura (TTP), myasthenia gravis, severe septic shock, antiphospholipid antibody syndrome (APS), and Guillain Barre syndrome. By virtue of its nature, TPE extracts medications from plasma and potentially affects drug disposition and clearance. However, the degree and impact on the impact of TPE on pharmacokinetics is not well described and currently available literature is limited to case reports with highly variable parameters reported. This makes optimal dosing of key medications (especially antibiotics, sedative and anti-seizure medications) during and around TPE difficult to predict. Objectives: To describe the impact of TPE on serum drug concentrations of phenytoin, phenobarbital, vancomycin, gentamicin, and valproic acid. To describe optimal dosing around TPE to maintain target drug serum concentrations.

Correlation of limited sampling strategy for mycophenolate in pediatric solid organ transplant patients
Mycophenolate is commonly used as an immunosuppressant in children who have received solid organ transplants to prevent rejection of the graft. Currently therapeutic drug monitoring is recommended as dosage and serum concentration do not correlate well however it is unclear from the literature what the upper limit of the therapeutic range should be and if limited sampling strategies to estimate area under the curve correlates to effectiveness and adverse drug reactions. Objective: To describe the correlation between limited sampling strategy for mycophenolate and clinical effectiveness (adverse drug reactions and signs or organ graft rejection)

The Feasibility of Patient and Caregiver Self-Referral to Clinical Pharmacists in the Inpatient Pediatric Setting
Pharmacists play a significant role in patient care, part of which involves direct interaction with patients and caregivers. During hospitalization, many patients and caregivers may be unaware that a pharmacist is part of their team. In a previous study at our site, we found that only 10% of caregivers recalled speaking with a pharmacist; however 86% of caregivers indicated that they would like to speak with a pharmacist.1 Patients and caregivers may be unaware of how to contact their pharmacist during hospitalization, since they do not have the same direct access to their pharmacist as they would in other settings. Objective: To assess the feasibility of a patient/caregiver self-referral service to pharmacists

Honours & Awards

2012/2013 Pharmacotherapy Best Practices Award, Canadian Society of Hospital Pharmacists. Carney L, Kendrick J, Carr RR. Safety and Effectiveness of Dexmedetomidine in the Pediatric Intensive Care Unit (SAD–PICU)

2015/2016 Pharmacotherapy Best Practices Award, Canadian Society of Hospital Pharmacists. Collins K, Ensom MHH, Rainkie D, Carr RR. Pediatric assessment of vancomycin empiric dosing 2 (PAVED2).

Research Group Members

Lynne Taylor