Evaluation of therapeutic drug level follow-up of epileptic patients using carbamazepine, phenytoin and valproic acid: izmir sample

2016 ◽  
Author(s):  
Ismail Yilmaz
Keyword(s):  
Valproic Acid ◽  
Drug Level ◽  
Therapeutic Drug ◽  
Epileptic Patients

Evaluation of intraperitoneal vancomycin in peritoneal dialysis-associated peritonitis

2021 ◽  
pp. 089686082110515
Author(s):  
Wui Ming Chang ◽  
Elaine Cheng ◽  
Karen Shalansky ◽  
Suneet R Singh
Keyword(s):  
Peritoneal Dialysis ◽  
Treatment Options ◽  
Retrospective Chart Review ◽  
Drug Level ◽  
Optimal Dose ◽  
Therapeutic Drug ◽  
Loading Dose ◽  
Eligibility Criteria ◽  
Serum Vancomycin

Background: Intraperitoneal (IP) vancomycin is recommended as one of the treatment options for gram-positive coverage in the management of peritoneal dialysis (PD)-associated peritonitis. There is a lack of literature supporting the optimal dose and approach to vancomycin therapeutic drug-level monitoring. Methods: A retrospective chart review was conducted using the BC Renal Agency PROMIS Database and our hospital records from 1 June 2011 to 1 July 2019. Adult patients with PD-associated peritonitis who received IP vancomycin and had at least one serum vancomycin level drawn were included. All patients received a loading dose of 30 mg/kg, which was repeated every 3–5 days depending on PD modality. Serum vancomycin levels were drawn prior to the second vancomycin dose, then at the discretion of the prescriber. The primary end point was the rate of therapeutic serum vancomycin levels ≥15 mg/L. Results: Twenty-three episodes of PD-associated peritonitis in 20 patients met the eligibility criteria. Only 15/23 serum vancomycin levels were drawn appropriately after the first dose. Sixty per cent of these levels were subtherapeutic at <15 mg/L. All subsequent serum vancomycin levels were above the therapeutic target. Most peritonitis episodes (78%) achieved resolution of infection. Residual kidney function was not significantly correlated with serum vancomycin levels ( p = 0.19). Conclusions: An IP vancomycin regimen of 30 mg/kg every 3–5 days resulted in subtherapeutic serum vancomycin levels in most patients following the loading dose but therapeutic levels thereafter. A large percentage of vancomycin levels were drawn inappropriately due to misalignment of outpatient follow-up visits and timing of blood work.

scholarly journals P511 Association of ustekinumab serum concentrations and clinical outcomes: results from the mUST-DECIDE trial

2020 ◽  
Vol 14 (Supplement_1) ◽  
pp. S443-S444
Author(s):  
B Bressler ◽  
B Sattin ◽  
M A Williamson ◽  
R Khanna ◽  
C H Seow ◽  
...  
Keyword(s):  
Disease Control ◽  
Clinical Outcomes ◽  
Retrospective Chart Review ◽  
Drug Level ◽  
Clinic Visit ◽  
Therapeutic Drug ◽  
Loss Of Response ◽  
Clinical Scenarios ◽  
Log Linear

Abstract Background Therapeutic drug monitoring is an important adjunct in optimising IBD management in patients treated with anti-TNF therapies. However, it remains unclear whether these principles apply to non-anti-TNF biologic therapies, such as the anti-IL12/23 agent, ustekinumab (UST). A follow-up analysis of the ‘mUST-DECIDE’ study explores the correlation between UST drug level and clinical outcomes. Methods 111 consecutive UST-treated adult CD patients across 11 sites in Canada from April 2017 to January 2018 were evaluated. Clinical decisions were recorded for all subjects at the single study visit and blood was drawn for TDM (Sanquin, radioimmunoassay). A retrospective chart review was completed in patients who had a follow-up visit ≥ 30 days after the baseline visit. Improved disease control (primary outcome) was defined as a composite assessment outcome meeting ≥ 1 disease control criterion (symptomatic, endoscopic/imaging, biochemical) without any of the non-response criteria (inadequate or loss of response, worsening of any disease control criteria, initiation of any CD-related medications and adverse events). Serum [UST] were categorised as therapeutic, subtherapeutic or uninterpretable based on their position in a 2 compartment PK model [subjects on Q8W dosing were assessed as per the log-linear model which projected a therapeutic level of ≥4.5 µg/ml at 4 weeks and ≥1.0 µg/ml at 8 weeks]. Results 53 patients had a clinical follow-up visit and an interpretable serum [UST]. Patients had refractory disease (89% anti-TNF-exposed, median 16.4 years since diagnosis), but clinically well (66% had baseline HBI &lt;5) on treatment with UST for a median [IQR] of 16.5 [10.4–26.8] months. At baseline, the majority had serum [UST] in the therapeutic range (n = 44/53, 83%). After a median [IQR] of 148 [104–193] days, improved disease control was achieved by 51% of patients at next clinic visit. The outcome appeared independent of achieving therapeutic [UST] at baseline (OR[95% CI] = 0.80[0.19–3.38]). Dose-adjustment occurred in eight (15%) patients and improvements were observed in 75% of these patients. Subgroup analyses failed to detect clinical outcomes that were dependent on therapeutic serum [UST] (Table 1). No new safety signal was observed, no patient samples were positive for antibodies to UST. Conclusion The sub-study did not detect any association between routine serum [UST] and short-term clinical outcomes at the next patient visit. These data broadly suggests that the routine measurement of serum UST in CD patients does not aid in disease management, though further studies across different clinical scenarios (e.g. loss of response) are warranted.

scholarly journals Association of SCN1A, SCN2A, and UGT2B7 Polymorphisms with Responsiveness to Valproic Acid in the Treatment of Epilepsy

2020 ◽  
Vol 2020 ◽  
pp. 1-8
Author(s):  
Yuan Lu ◽  
Quanping Su ◽  
Ming Li ◽  
Alimu Dayimu ◽  
Xiaoyu Dai ◽  
...  
Keyword(s):  
Valproic Acid ◽  
Genetic Factors ◽  
Nucleotide Polymorphisms ◽  
Chinese Han ◽  
Metabolizing Enzymes ◽  
Single Nucleotide ◽  
Potential Association ◽  
Epileptic Patients ◽  
Snp Interaction

Purpose. The efficacy of valproic acid (VPA) varies widely in clinical treatment of epileptic patients. Our study is aimed at exploring a potential association between polymorphisms of SCN1A, SCN2A, and UGT2B7 genetic factors and VPA responses. Methods. In this observational study, a total of 114 epileptic patients only treated with VPA for at least 1 year were included to explore the genetic polymorphisms of drug responses (mean follow-up time: 3.68±1.78 years). Thirty-one single-nucleotide polymorphisms (SNPs) in three candidate genes that related with drug-metabolizing enzymes and receptors were genotyped. Results. Of the 31 SNPs, eight were significantly associated with VPA responses, including rs1381105, rs2162600, rs10197716, rs2119068, rs2119067, rs353116, rs353112 and rs6740895. The interaction between rs10197716 and rs2119068 was the most significantly correlated with VPA responses compared with other combinations (the highest VPA-responsive rate 0.92 versus the lowest VPA-responsive rate 0.33, p=0.007). Conclusion. The study indicated that eight SNPs and SNP-SNP interaction may be associated with VPA responses in Chinese Han epileptic patients. The SNPs were rs1381105 (SCN1A), rs2162600 (SCN1A), rs10197716 (SCN2A), rs2119068 (SCN2A), rs2119067 (SCN2A), rs353116 (SCN2A), rs353112 (SCN2A) and rs6740895 (SCN2A), respectively. The interaction between the three pairs of rs10197716-rs2119068, rs10197716-rs11889342 and rs7598931-rs12233719 was the most significant for VPA. This implied that these SNPs may play an important role in the pharmacogenomics mechanism of valproic acid.

scholarly journals Therapeutic Drug Monitoring of Antiepileptic Drugs

2008 ◽  
Vol 47 (171) ◽  
Author(s):  
Geeta Shakya ◽  
S Malla ◽  
R Shrestha ◽  
K N Shakya
Keyword(s):  
Valproic Acid ◽  
Therapeutic Drug Monitoring ◽  
Plasma Level ◽  
Antiepileptic Drugs ◽  
Drug Monitoring ◽  
Drug Level ◽  
Therapeutic Drug ◽  
Therapeutic Level ◽  
Toxic Level ◽  
Blood Samples

Commonly used conventional antiepileptic drugs for pharmacotherapy in epilepsy are phenytoin, carbamazepine and valproic acid. These drugs have complex pharmacokinetic properties leading to fluctuation in their plasma level at given same therapeutic dose. The present study was done to monitor their plasma levels. A prospective observational study was conducted at Natoinal Public Health Laboratory. After taking detail history, blood samples were taken from epileptic patients of all age groups and both gender who were on usual therapeutic dose of one or two combined antiepileptic drugs. Plasma level of these drugs were analyzed by using Fluorescence Polarization Immuno Assay (FPIA) technique. Out of total 417 testing, 81were tested for phenytoin , 241 for carbamazepine and 95 for valproic acid. Their levels were further analyzed to find therapeutic, subtherapeutic and toxic levels. Out of total 81 blood samples tested for phenytoin, 38.8% had plasma drug at therapeutic level, 38.8% at subtherapeutic level and 28.4% had toxic level. Carbamazepine was tested in 241 samples and 79.3% cases had at therapeutic drug level, 15.8% had subtherapeutic drug level and 4.9% had toxic level. Out of 95 samples tested for valproic acid, 62% had therapeutic level and 20% had subtherapeutic and 18% had toxic level of drug. Therapeutic drug monitoring of phenytoin showed wide fluctuation in its plasma level. Its toxic and subtherapeutic levels were quite high. It is suggested that the dose of phenytoin should be adjusted after regular plasma level monitoring only. Monitoring of carbamazepine and valproic acid were also helpful when their toxicity and efficacy are doubtful.JNMA J Nepal Med Assoc. 2008 Jul-Sep;47(171):94-97.

Topical Bimatoprost Insert for Primary Open-Angle Glaucoma and Ocular Hypertension Treatment - A Phase II Controlled Study

2021 ◽  
Vol 18 ◽  
Author(s):  
Francine Rubião ◽  
Alan Cezar Faria Araújo ◽  
João Bernardo Sancio ◽  
Bárbara Silva Nogueira ◽  
Juçara Ribeiro Franca ◽  
...  
Keyword(s):  
Ocular Hypertension ◽  
Primary Open Angle Glaucoma ◽  
Open Angle Glaucoma ◽  
T Test ◽  
Controlled Study ◽  
Therapeutic Drug ◽  
Eye Drops ◽  
Open Angle ◽  
Drug Concentrations

Background: The most common treatment for primary open-angle glaucoma (POAG) is the daily use of eye drops. Sustained-release drug delivery systems have been developed to improve patient adherence by achieving prolonged therapeutic drug concentrations in ocular target tissues while limiting systemic exposure. The purpose of this study is to compare the efficacy and safety of bimatoprost inserts with bimatoprost eye drops in patients with POAG and ocular hypertension (OH). Methods: We include OH and POAG patients aged between 40 and 75 years-old. Both OH and POAG patients had intraocular pressure (IOP) greater than 21 and ≤30 mmHg at 9:00 am without glaucoma medication and normal biomicroscopy. Five normal patients with IOP≤14 mmHg constitute the control group. A chitosan-based insert of bimatoprost was placed at the upper conjunctival fornix of the right eye. In the left eye, patients used one drop of LumiganTM daily at 10:00 pm. For statistical analysis, we used a two-way analysis of variance (ANOVA), Student t-test, and paired t-test. Results: Sixteen POAG and 13 OH patients with a mean age of 61 years were assessed. In both eyes, IOP reduction was similar during three weeks of follow-up (19.5±2.2 mmHg and 16.9±3.1 mmHg), insert, and eye drop, respectively; P=0.165). The percentage of IOP reduction in the third week was 30% for insert and 35% for eye drops (P=0.165). No intolerance or discomfort with the insert was reported. Among the research participants, 58% preferred the use of the insert while 25% preferred eye drops, and 17% reported no preference. Conclusions: Bimatoprost-loaded inserts showed similar efficacy to daily bimatoprost eye drops during three weeks of follow up, without major side effects. This might suggest a possible change in the daily therapeutic regimen for the treatment of POAG and OH.

Steady-state kinetics of valproic acid in epileptic patients

1978 ◽  
Vol 24 (3) ◽  
pp. 324-332 ◽  
Author(s):  
J. Bruni ◽  
B. J. Wilder ◽  
L. J. Willmore ◽  
R. J. Perchalski ◽  
H. J. Villarreal
Keyword(s):  
Valproic Acid ◽  
Steady State ◽  
Steady State Kinetics ◽  
Epileptic Patients ◽  
Kinetics Of

scholarly journals Urinary Metabolites of Valproic Acid in Epileptic Patients.

1998 ◽  
Vol 21 (3) ◽  
pp. 304-307 ◽  
Author(s):  
Hirokazu KATAYAMA ◽  
Miki WATANABE ◽  
Hironori YOSHITOMI ◽  
Hisahiro YOSHIDA ◽  
Hiroo KIMOTO ◽  
...  
Keyword(s):  
Valproic Acid ◽  
Urinary Metabolites ◽  
Epileptic Patients

P.1.c.023 Assessment of benzodiazepines-valproic acid pharmacokinetic interaction in adult epileptic patients: population approach

2010 ◽  
Vol 20 ◽  
pp. S247-S248
Author(s):  
K. Vucicevic ◽  
B. Miljkovic ◽  
M. Pokrajac ◽  
M. Prostran ◽  
Z. Martinovic ◽  
...  
Keyword(s):  
Valproic Acid ◽  
Pharmacokinetic Interaction ◽  
Population Approach ◽  
Epileptic Patients

scholarly journals A retrospective study of a pre-travel consultation in the Lisbon Metropolitan Area, Portugal

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
D Galhano Lopes ◽  
M Bragança Pereira ◽  
M Machado Gil ◽  
S Duarte ◽  
A Moreira ◽  
...  
Keyword(s):  
Individual Characteristics ◽  
Yellow Fever Vaccine ◽  
Medical Community ◽  
Therapeutic Drug ◽  
Protective Measures ◽  
The Public ◽  
Related Risk ◽  
Medical Referral ◽  
The Impact

Abstract Background Travel from Portugal to other countries has increased in the past 5 years. A pre-travel health consultation is advised to all travellers to raise awareness and reduce travel-related risk. We describe the experience of a pre-travel consultation centre in the public health service. Methods A retrospective observational study about consultations in an international vaccination centre between 2014-2018. Variables included were: sex, age, destination, purpose, referral, and prescriptions. Descriptive analyses were performed for all variables. Results Between 2014 and 2018, there were 1,546 consultations. Regarding individual characteristics, 54% were female, and 80% had between 15 and 64 years of age. There was no referral in 66% of the consultations, followed by 16% from general practitioners in the Primary Care Centres Group. The leading destination was Africa (54%), in a downward trend (74% in 2015 and 32% in 2018) followed by Asia (18%) with an upward trend (12% to 28% in the same period). The primary purpose was tourism (83%), followed by work (9%). In total, 3,287 vaccines were prescribed with typhoid fever vaccine accounting for 26%, hepatitis A vaccine 22%, and yellow fever vaccine 15%. Mefloquine was the primary therapeutic drug prescribed for destinations with risk for malaria (41%). Regarding destinations with low risk for malaria, in 42% of the consultations, personal protective measures were the only recommendation. Conclusions Our data show that pre-travel consultations seem to be valued and actively asked for by travellers, but medical referral is still insufficient. Regarding health promotion and prevention of diseases, tracking trends in the most common destinations allows to optimize the information provided in the consultation, effectively capacitating the traveller to recognize and act on the most common travel-related health risks. In further studies, a post-travel follow-up should be carried out to determine the impact of the consultation. Key messages Pre-travel consultation is an actively sought-after service by the community, but awareness should be promoted in the medical community. Pre-travel consultation can have an important role in the health literacy of travellers.

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