Appropriateness oAppropriateness of Valproic Acid-Level Monitoring at a Childrens’ Hospital in Mexicof Valproico Acid-Level Monitoring at a Childrens’ Hospital in Mexico
DOI:
https://doi.org/10.30827/ars.v63i1.20820Keywords:
valproic; evaluation; monitoring; process.Abstract
Introduction: in Mexico, plasma drug quantitation is used to check toxicity, compliance, and dose titration in treatment with antiepileptic drugs like valproic acid (AVP), but without considering the principles of pharmacokinetics due to the absence of clinical pharmacists into the Health System.
Method: the present study is a retrospective analysis including the p
Introduction: in Mexico, plasma drug quantitation is used to check toxicity, compliance, and dose titration in treatment with antiepileptic drugs like valproic acid (AVP), but without considering the principles of pharmacokinetics due to the absence of clinical pharmacists into the Health System.
Method: the present study is a retrospective analysis including the plasmatic concentration data of AVP in pediatric patients of 1 to 15 years old, who had received a reliable diagnosis of epilepsy.
Results: files of 260 patients were reviewed. It was found that only 56,5% of the patients had serum levels at steady state. The plasma AVP levels were found in sub-therapeutic level in 22% of patients and 15% had toxic levels. The analysis shows that children under five years of age appear as a heterogeneous group for the variables studied.
Conclusions: due to the lack of recognition of clinical pharmacists in Mexico, we recommend that best clinical outcome can be evaluated only by monitoring pharmacokinetic parameters for variations appearing in individual patients, and not just through trial and error dosing.
lasmatic concentration data of AVP in pediatric patients of 1 to 15 years old, who had received a reliable diagnosis of epilepsy.
Results: files of 260 patients were reviewed. It was found that only 56,5% of the patients had serum levels at steady state. The plasma AVP levels were found in sub-therapeutic level in 22% of patients and 15% had toxic levels. The analysis shows that children under five years of age appear as a heterogeneous group for the variables studied.
Conclusions: due to the lack of recognition of clinical pharmacists in Mexico, we recommend that best clinical outcome can be evaluated only by monitoring pharmacokinetic parameters for variations appearing in individual patients, and not just through trial and error dosing.
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References
Patsalos PN, Berry DJ, Bourgeois BF, et al. Antiepileptic drugs-best practice guidelines for therapeutic drug monitoring: a position paper by the subcommission on therapeutic drug monitoring, ILAE Commission on Therapeutic Strategies. Epilepsia. 2008; 49(7):1239-76. DOI: 10.1111/j.1528-1167.2008.01561.x.
Eadie MJ. Plasma antiepileptic drug monitoring in a neurological practice: A 25-year experience. Ther Drug Monit. 1994; 16(5):458-468. DOI: 10.1097/00007691-199410000-00004.
Cloyd JC, Fischer JH, Kriel RL, Kraus DM. Valproic acid pharmacokinetics in children. IV. Effects of age and antiepileptic drugs on protein binding and intrinsic clearance. Clin Pharmacol Ther. 1993; 53(1):22-29. DOI: 10.1038/clpt.1993.5.
Peterson GM, Naunton M. Valproate: a simple chemical with so much to offer. J Clin Pharm Ther. 2005; 30:417-421. DOI: 10.1111/j.1365-2710.2005.00671.x.
Löscher W. Basic pharmacology of valproate: a review after 35 years of clinical use for the treatment of epilepsy. CNS Drugs. 2002; 16(10):669-94. DOI: 10.2165/00023210-200216100-00003.
Davis R, Peters DH, Mctavish D. Valproic acid. A reappraisal of its pharmacological properties and clinical efficacy in epilepsy. Drugs. 1994; 47(2):332-72.
Perucca E. Pharmacological and therapeutic properties of valproate: a summary after 35 years of clinical experience. CNS Drugs. 2002; 16(10):695-714. DOI: 10.2165/00023210-200216100-00004.
Pauwels S, Allegaert K. Therapeutic drug monitoring in neonates. Arch Dis Child. 2016; 101(4):377-81. DOI: 10.1136/archdischild-2013-305309.
van den Anker JN. The impact of therapeutic drug monitoring in neonatal clinical pharmacology. Clin Biochem. 2014; 47(9):704-5. DOI: 10.1016/j.clinbiochem.2014.05.018.
Johannessen SI, Landmark CJ. Value of therapeutic drug monitoring in epilepsy. Expert Rev Neurother. 2008; 8(6):929-39. DOI: 10.1586/14737175.8.6.929.
Guerrini R. Valproate as a mainstay of therapy for pediatric epilepsy. Paediatr Drugs. 2006;8(2):113-29. DOI: 10.2165/00148581-200608020-00004.
Patsalos PN, Perucca E. Clinically important drug interactions in epilepsy: interactions between antiepileptic drugs and other drugs. Lancet Neurol. 2003; 2(8):473-81. DOI: 10.1016/s1474-4422(03)00483-6.
Johannessen SI, Landmark CJ. Antiepileptic drug interactions - principles and clinical implications. Curr Neuropharmacol. 2010; 8(3):254-67. DOI: 10.2174/157015910792246254.
Sánchez-Alcaraz A, Quintana MB, López E, Rodríguez I. Valproic acid clearance in children with epilepsy. J Clin Pharm Ther.1998; 23(1):31-4.
Fattore C, Messina S, Battino D, Croci D, Mamoli D, Perucca E. The influence of old age and enzyme inducing comedication on the pharmacokinetics of valproic acid at steady-state: A case-matched evaluation based on therapeutic drug monitoring data. Epilepsy Res. 2006; 70(2-3):153-60. DOI: 10.1016/j.eplepsyres.2006.04.002.
EL Desoky ES, Fuseau E, EL Din Amry S, Cosson V. Pharmacokinetic modelling of valproic acid from routine clinical data in Egyptian epileptic patients. Eur J Clin Pharmacol. 2004; 59(11):783-90. DOI: 10.1007/s00228-003-0699-7.
Perucca E. Clinically relevant drug interactions with antiepileptic drugs. Br J Clin Pharmacol. 2006; 61(3):246-55. DOI: 10.1111/j.1365-2125.2005.02529.x.
Márquez-Cruz M, Chehue-Romero A, Ruiz-Anaya ME, Robles-Piedras AL. Appropriateness of antiepileptic drug-level monitoring at a Childrens’ Hospital in Mexico. Biomed Pharmacol J. 2017; 10(1):329-335. DOI: 10.13005/bpj/1113.
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