scholarly journals WAS IT NECESSARY TO CHANGE THERAPEUTIC RANGE OF TOPIRAMATE?

2021 ◽  
Author(s):  
Blanka Koristkova ◽  
Milan Grundmann ◽  
Ivana Kacirova ◽  
Hana Brozmanova
Keyword(s):  
Clinical Pharmacology ◽  
Seizure Frequency ◽  
Therapeutic Range ◽  
Seizure Control ◽  
Therapeutic Drug ◽  
Drug Reactions ◽  
National Guidelines ◽  
Median Plasma ◽  
Data Source ◽  
Routine Therapeutic Drug Monitoring

Aim: The Norwegian Association for Clinical Pharmacology in their National Guidelines decreased therapeutic range (TR) of topiramate (TPM) from 5-20 mg/L to 2-10 mg/L. The objective of this study is to ascertain which TR produces better clinical outcomes. Methods: Data source were request forms for routine therapeutic drug monitoring of TPM. Concentration dependent adverse drug reactions (ADRs) were evaluated in 1,721 samples taken pre-dose. Seizure frequency analysis was performed in 294 samples of monotherapy. Statistics: Prism 5.0, GraphPad Instatt: Mann–Whitney U test for median plasma level (PL). χ2-test for seizure frequency and for distribution of PL according to TR 5-20 mg/L and intervals <2, 2-5, 5-10, 10-20, >20 mg/L. Results: Better seizure control was found in children both in whole cohort (without seizure 49% vs 37% adults), as well as in monotherapy (56% vs 44%), in children with PL 5-20 mg/L vs 5 mg/L (65% vs 44%) and in children with PL 5-10 mg/L vs <2 mg/L. Seizure-free children had higher PL than those with seizure yearly: median (lower, upper quartile) [mg/L]: 5.5 (3.4-6.5) vs 4.7 (4.3-7.95). No difference was found in adults. Seizure control was poorer in all patients with PL <2 mg/L compared to 5-10 mg/L; and 10-20 mg/L; further in PL within 5-10 mg/L vs 10-20 mg/L; and in the period 2003-2005. ADRs reported in 38 samples (2.8%) were without relation to PL. Conclusions: Change of TR is not recommended.

Clinical Pharmacology

2020 ◽  
Author(s):  
Molly Droege ◽  
Eric W. Mueller
Keyword(s):  
Clinical Pharmacology ◽  
Critically Ill ◽  
Adverse Drug Reactions ◽  
Therapeutic Interventions ◽  
Surgical Patients ◽  
Therapeutic Drug ◽  
Drug Reactions ◽  
Organ Function ◽  
Key Factor ◽  
Critically Ill Surgical Patients

Critically ill patients often require surgical procedures and therapeutic interventions that produce significant pathophysiologic changes. Drug pharmacology can be greatly altered in this population wherein comorbid diseases, varied organ function, and polypharmacy can produce adverse drug reactions (ADRs). This review aims to describe basic pharmacokinetic principles (absorption, distribution, metabolism, elimination) and changes in these processes due to altered organ function in critically ill surgical patients. This knowledge is a key factor in reducing ADRs. This review contains 10 figures, 2 tables, 101 references Keywords: adverse drug reactions, drug interactions, obesity, pharmacodynamics, pharmacokinetics, plasma protein binding, therapeutic drug monitoring  

Clinical Pharmacology

2020 ◽  
Author(s):  
Molly Droege ◽  
Eric W. Mueller
Keyword(s):  
Clinical Pharmacology ◽  
Critically Ill ◽  
Adverse Drug Reactions ◽  
Therapeutic Interventions ◽  
Surgical Patients ◽  
Therapeutic Drug ◽  
Drug Reactions ◽  
Organ Function ◽  
Key Factor ◽  
Critically Ill Surgical Patients

Critically ill patients often require surgical procedures and therapeutic interventions that produce significant pathophysiologic changes. Drug pharmacology can be greatly altered in this population wherein comorbid diseases, varied organ function, and polypharmacy can produce adverse drug reactions (ADRs). This review aims to describe basic pharmacokinetic principles (absorption, distribution, metabolism, elimination) and changes in these processes due to altered organ function in critically ill surgical patients. This knowledge is a key factor in reducing ADRs. This review contains 10 figures, 2 tables, 101 references Keywords: adverse drug reactions, drug interactions, obesity, pharmacodynamics, pharmacokinetics, plasma protein binding, therapeutic drug monitoring  

Clinical Pharmacology

2020 ◽  
Author(s):  
Molly Droege ◽  
Eric W. Mueller
Keyword(s):  
Clinical Pharmacology ◽  
Critically Ill ◽  
Adverse Drug Reactions ◽  
Therapeutic Interventions ◽  
Surgical Patients ◽  
Therapeutic Drug ◽  
Drug Reactions ◽  
Organ Function ◽  
Key Factor ◽  
Critically Ill Surgical Patients

Critically ill patients often require surgical procedures and therapeutic interventions that produce significant pathophysiologic changes. Drug pharmacology can be greatly altered in this population wherein comorbid diseases, varied organ function, and polypharmacy can produce adverse drug reactions (ADRs). This review aims to describe basic pharmacokinetic principles (absorption, distribution, metabolism, elimination) and changes in these processes due to altered organ function in critically ill surgical patients. This knowledge is a key factor in reducing ADRs. This review contains 10 figures, 2 tables, 101 references Keywords: adverse drug reactions, drug interactions, obesity, pharmacodynamics, pharmacokinetics, plasma protein binding, therapeutic drug monitoring  

Interaction of Dietary Pudding With Phenytoin

PEDIATRICS ◽  
1986 ◽  
Vol 78 (5) ◽  
pp. 952-953
Author(s):  
MICHAEL W. JANN ◽  
JOHNNIE BEAN ◽  
GEORGE S. FIDONE
Keyword(s):  
Therapeutic Drug Monitoring ◽  
Patient Compliance ◽  
Drug Monitoring ◽  
Seizure Control ◽  
Monitoring Program ◽  
Therapeutic Drug ◽  
Serum Concentrations ◽  
Anticonvulsant Medication ◽  
Epileptic Patients ◽  
Routine Therapeutic Drug Monitoring

To the Editor.— Patient compliance with use of anticonvulsant medication is necessary to achieve seizure control. In nonambulatory, mentally retarded epileptic patients, phenytoin tablets (Dilantin Infatabs, Parke Davis) are often crushed and mixed with various semisolid foods to mask their taste and to enhance compliance. At our facility, phenytoin tablets were customarily mixed with vanilla pudding prior to patient administration. From our routine therapeutic drug-monitoring program, several patients were observed to have low therapeutic serum concentrations despite seemingly adequate phenytoin dosages.

Benefits and Limits of Antiretroviral Drug Monitoring in Routine Practice

2019 ◽  
Vol 17 (3) ◽  
pp. 190-197
Author(s):  
Thomas Maitre ◽  
Patrice Muret ◽  
Mathieu Blot ◽  
Anne Waldner ◽  
Michel Duong ◽  
...  
Keyword(s):  
Hiv Infection ◽  
Therapeutic Range ◽  
Drug Monitoring ◽  
Antiretroviral Treatment ◽  
University Hospital ◽  
Therapeutic Drug ◽  
Routine Practice ◽  
Hiv Viral Load ◽  
Measured Concentration ◽  
The University

Background: HIV infection is a chronic disease for which therapeutic adherence and tolerance require particular attention. Objective: This study aimed to assess whether and when therapeutic drug monitoring (TDM) could be associated with a benefit in routine practice. Methods: All HIV-infected patients who underwent at least one TDM at the University Hospital of Dijon (France) between 1st January 2009 and 31st December 2012 were retrospectively included. Compliance with the recommendations, the results (antiretroviral concentrations), any subsequent therapeutic modifications, and the virological results at 4-8 months were analysed each time TDM was performed. TDM was defined as “practically relevant” when low or high antiretroviral concentrations led to a change in therapy. Results: Of the 571 patients who followed-up, 43.4% underwent TDM. TDM complying with recommendations (120 patients) was associated with a higher proportion of antiretroviral concentrations outside the therapeutic range (p=0.03). Antiretroviral treatment was modified after TDM in 22.6% of patients. Protease inhibitors, non-nucleoside reverse transcriptase inhibitors and raltegravir were more significantly modified when the measured concentration was outside the therapeutic range (p=0.008, p=0.05 and p=0.02, respectively). Overall, 11.7% of TDM was considered “practically relevant”, though there was no significant correlation between subsequent changes in antiretroviral treatment and undetectable final HIV viral load. Conclusions: TDM may be a useful tool in the management of HIV infection in specific situations, but the overall benefit seems moderate in routine practice. TDM cannot be systematic and/or a decision tool per se, but should be included in a comprehensive approach in certain clinical situations.

Generation of Pharmacokinetic Data During Routine Therapeutic Drug Monitoring

1993 ◽  
Vol 15 (4) ◽  
pp. 281-288 ◽  
Author(s):  
E. El Desoky ◽  
J. Meinshausen ◽  
K. Bühl ◽  
G. Engel ◽  
A. Harings-Kaim ◽  
...  
Keyword(s):  
Therapeutic Drug Monitoring ◽  
Drug Monitoring ◽  
Therapeutic Drug ◽  
Pharmacokinetic Data ◽  
Routine Therapeutic Drug Monitoring

Drug Allergy

2012 ◽  
Vol 5 (6) ◽  
pp. 319-324
Author(s):  
Helen E. Smith
Keyword(s):  
Adverse Drug Reactions ◽  
Drug Allergy ◽  
Therapeutic Drug ◽  
Drug Reactions ◽  
Immune Mediated ◽  
Allergy Drug ◽  
The Way

Adverse drug reactions are a major cause of morbidity, complicating over 5% of therapeutic drug courses. The majority of these events are due to common predictable mechanisms linked to the way the drug works, but about 5% of all reactions are immune-mediated and constitute true allergy. Drug allergy is one of the potential causes of anaphylaxis, angioedema and urticaria and should always be considered when a patient presents with one of these conditions.

scholarly journals First, do no harm: the risks of overtreating children with epilepsy

2007 ◽  
Vol 65 (1) ◽  
pp. 1-4 ◽  
Author(s):  
Eunice Chuang ◽  
Marilisa M. Guerreiro ◽  
Sara Y. Tsuchie ◽  
Angelica Santucci ◽  
Carlos A. M. Guerreiro ◽  
...  
Keyword(s):  
Adverse Events ◽  
Prospective Study ◽  
Antiepileptic Drug ◽  
Antiepileptic Drugs ◽  
Seizure Frequency ◽  
Seizure Control ◽  
Control Method ◽  
Refractory Epilepsy ◽  
Do No Harm ◽  
A Prospective Study

BACKGROUND: Although overtreatment with antiepileptic drugs contributes to the morbidity associated with epilepsy, many children still are overtreated. OBJECTIVE: To evaluate if the withdrawal of at least one antiepileptic drug (AED) in children with refractory epilepsy using polytherapy enable a better seizure control. METHOD: This was a prospective study. Children with refractory epilepsy using at least two AEDs were included. Once the patient, or guardian, agreed to participate in the study, one or more AED were slowly tapered off. The remaining AEDs dosages could be adjusted as needed, but a new AED could not be introduced. RESULTS: Fifteen patients were evaluated, three girls; ages ranging from 3 to 18 (mean=8.7 years). After at least one AED withdrawal, two (13.5%) patients became seizure free, seizures improved >50% in 5 (33.5%) patients, did not change in 5 (33.5%), and seizure frequency became worse in 3 (20%). Adverse events improved in 12 patients (80%). CONCLUSION: The withdrawal of at least one AED is a valuable option in the treatment of selected children with refractory epilepsy.

scholarly journals Interrelationship between radiologic findings and prognosis of epilepsy in children with neurocysticercosis

2002 ◽  
Vol 60 (1) ◽  
pp. 1-5 ◽  
Author(s):  
Lisiane Seguti Ferreira ◽  
Verônica A. Zanardi ◽  
Min Li Li ◽  
Marilisa M. Guerreiro
Keyword(s):  
Disease Activity ◽  
Seizure Frequency ◽  
Statistical Difference ◽  
Seizure Control ◽  
Clinical Information ◽  
Radiologic Findings ◽  
Comparison Results ◽  
Before And After ◽  
Evolutive Stage ◽  
The Relationship

INTRODUCTION: Epileptic manifestations of Neurocysticercosis (NC) appear to depend on number and localization of the cysts. The objective of this study was to investigate the relationship between CT findings, number of parasites and the evolutive stage of the cysts, and the prognosis of epilepsy in children with NC. METHOD: We studied 28 patients with the parenchymal form of NC, considering: epilepsy duration; seizure frequency before and after AED treatment; seizure control; number of AED and recurrence after AED withdrawal. Clinical information was crossed with the number of lesions and disease activity in univariate comparison. RESULTS: The analysis of the clinical data in relation to the number of lesions and disease activity showed no statistical difference among the variables (p>0.05). CONCLUSION: We conclude that the course of epilepsy due to NC in childhood cannot be based exclusively on the number or stage of the parasites.

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