101
|
The Effect of Metformin in Experimentally Induced Animal Models of Epileptic Seizure. Behav Neurol 2019; 2019:6234758. [PMID: 30863464 PMCID: PMC6378775 DOI: 10.1155/2019/6234758] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Revised: 12/08/2018] [Accepted: 12/17/2018] [Indexed: 12/27/2022] Open
Abstract
Background Epilepsy is one of the common neurological illnesses which affects millions of individuals globally. Although the majority of epileptic patients have a good response for the currently available antiepileptic drugs (AEDs), about 30-40% of epileptic patients are developing resistance. In addition to low safety profiles of most of existing AEDs, there is no AED available for curative or disease-modifying actions for epilepsy so far. Objectives This systematic review is intended to evaluate the effect of metformin in acute and chronic animal models of an epileptic seizure. Methods We searched PubMed, SCOPUS, Sciences Direct, and grey literature in order to explore articles published in English from January 2010 to November 2018, using key terms “epilepsy,” “seizure,” “metformin,” “oral hypoglycemic agents,” and “oral antidiabetic drugs”. The qualities of all the included articles were assessed according to the Collaborative Approach to Meta-Analysis and Review of Animal Data from Experimental Studies (CAMARADES). Results Out of six hundred fifty original articles retrieved, eleven of them fulfilled the inclusion criteria and were included for final qualitative analysis. In these studies, metformin showed to control seizure attacks by attenuating seizure generation, delaying the onset of epilepsy, reducing hippocampal neuronal loss, and averting cognitive impairments in both acute and chronic models of an epileptic seizure. The possible mechanisms for its antiseizure or antiepileptic action might be due to activation of AMPK, antiapoptotic, antineuroinflammatory, and antioxidant properties, which possibly modify disease progression through affecting epileptogenesis. Conclusion This review revealed the benefits of metformin in alleviating symptoms of epileptic seizure and modifying different cellular and molecular changes that affect the natural history of the disease in addition to its good safety profile.
Collapse
|
102
|
Burman RJ, Wilmshurst JM, Gebauer S, Weise L, Walker KG, Donald KA. Seizures in Children with HIV infection in South Africa: A retrospective case control study. Seizure 2019; 65:159-165. [PMID: 30721872 DOI: 10.1016/j.seizure.2019.01.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Revised: 01/07/2019] [Accepted: 01/19/2019] [Indexed: 11/19/2022] Open
Abstract
PURPOSE Data relating to the role that Human immunodeficiency virus (HIV) contributes towards seizures in HIV-infected children is limited. The management of seizures in this group is complex due to potential interactions between antiseizure medication and antiretroviral therapies. This study explores the seizure semiology and course of a population of affected children based on questions raised from a previous epidemiological study. METHODS A retrospective case-control study of all patients presenting to an HIV neurology clinic between 2008-2015 was conducted. A multinomial logistic regression model was used to identify risk factors for seizure occurrence in HIV-infected children, as well as factors associated with seizure control. RESULTS Of 227 HIV-infected children (median 82 months, interquartile range 41-109), 52 (23%) reported a past or present history of seizures. Prior bacterial meningitis (p = 0.03, OR 12.5, 95% CI 1.2-136.1), cerebrovascular accident (CVA, p = 0. 005, OR 8.1, 95% CI 1.9-34.9) and or tuberculous meningitis (TBM, p = 0.0004) was associated with an increased risk of seizures in HIV-infected children. Generalised tonic-clonic seizures were the predominant seizure type (64%) with the majority caused by an infectious aetiology (62%). Thirty-two (62%) of these patients had epilepsy in-line with the latest diagnostic criteria. HIV-infected children with epilepsy who were treated with efavirenz were more likely to have poor seizure control (OR 23.1 95% CI 3.4-159.6, p = 0.0001). CONCLUSIONS This study provides new data highlighting the complex clinical presentation and management challenges of HIV-infected children with seizures.
Collapse
Affiliation(s)
- R J Burman
- Division of Paediatric Neurology, Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, University of Cape Town, Klipfontein Road, Rondebosch, Cape Town, 7700 South Africa; University of Cape Town Neuroscience Institute, Faculty of Health Sciences, Anzio Road, Observatory, Cape Town 7295 South Africa
| | - J M Wilmshurst
- Division of Paediatric Neurology, Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, University of Cape Town, Klipfontein Road, Rondebosch, Cape Town, 7700 South Africa; University of Cape Town Neuroscience Institute, Faculty of Health Sciences, Anzio Road, Observatory, Cape Town 7295 South Africa
| | - S Gebauer
- Faculty of Medical Sciences, University of Groningen, University Medical Centre Groningen, MWF-complex, A. Deusinglaan 1, Groningen, the Netherlands
| | - L Weise
- Faculty of Medical Sciences, University of Groningen, University Medical Centre Groningen, MWF-complex, A. Deusinglaan 1, Groningen, the Netherlands
| | - K G Walker
- Division of Paediatric Neurology, Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, University of Cape Town, Klipfontein Road, Rondebosch, Cape Town, 7700 South Africa
| | - K A Donald
- University of Cape Town Neuroscience Institute, Faculty of Health Sciences, Anzio Road, Observatory, Cape Town 7295 South Africa; Division of Developmental Paediatrics, Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, University of Cape Town, Klipfontein Road, Rondebosch, Cape Town, 7700 South Africa.
| |
Collapse
|
103
|
Chen CY, Zhou Y, Cui YM, Yang T, Zhao X, Wu Y. Population pharmacokinetics and dose simulation of oxcarbazepine in Chinese paediatric patients with epilepsy. J Clin Pharm Ther 2019; 44:300-311. [PMID: 30636182 DOI: 10.1111/jcpt.12792] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Revised: 09/17/2018] [Accepted: 10/26/2018] [Indexed: 02/06/2023]
Affiliation(s)
- Chao-Yang Chen
- Department of Pharmacy; Peking University First Hospital; Beijing China
| | - Ying Zhou
- Department of Pharmacy; Peking University First Hospital; Beijing China
- School of Pharmaceutical Sciences; Peking University Health Science Center; Beijing China
| | - Yi-Min Cui
- Department of Pharmacy; Peking University First Hospital; Beijing China
- School of Pharmaceutical Sciences; Peking University Health Science Center; Beijing China
| | - Ting Yang
- Department of Pharmacy; Peking University First Hospital; Beijing China
| | - Xia Zhao
- Department of Pharmacy; Peking University First Hospital; Beijing China
- School of Pharmaceutical Sciences; Peking University Health Science Center; Beijing China
| | - Ye Wu
- Department of Pediatrics; Peking University First Hospital; Beijing China
| |
Collapse
|
104
|
Ferrey AE, Geulayov G, Casey D, Wells C, Fuller A, Bankhead C, Ness J, Clements C, Gunnell D, Kapur N, Hawton K. Relative toxicity of mood stabilisers and antipsychotics: case fatality and fatal toxicity associated with self-poisoning. BMC Psychiatry 2018; 18:399. [PMID: 30587176 PMCID: PMC6307121 DOI: 10.1186/s12888-018-1993-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Accepted: 12/19/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Bipolar and other psychiatric disorders are associated with considerably increased risk of suicidal behaviour, which may include self-poisoning with medication used to treat the disorder. Therefore, choice of medication for treatment should include consideration of toxicity, especially for patients at risk. The aim of this study was to estimate the relative toxicity of specific drugs within two drug categories, antipsychotics and mood stabilizers, using large-scale databases to provide evidence that could assist clinicians in making decisions about prescribing, especially for patients at risk of suicidal behaviour. METHOD Two indices were used to assess relative toxicity of mood stabilisers and antipsychotics: case fatality (the ratio between rates of fatal and non-fatal self-poisoning) and fatal toxicity (the ratio between rates of fatal self-poisoning and prescription). Mood stabilisers assessed included lithium [reference], sodium valproate, carbamazepine, and lamotrigine, while antipsychotics included chlorpromazine [reference], clozapine, olanzapine, quetiapine and risperidone. Fatal self-poisoning (suicide) data were provided by the Office for National Statistics (ONS), non-fatal self-poisoning data by the Multicentre Study of Self-harm in England, and information on prescriptions by the Clinical Practice Research Datalink. The primary analysis focussed on deaths due to a single drug. Cases where the drug of interest was listed as the likely primary toxic agent in multiple drug overdoses were also analysed. The study period was 2005-2012. RESULTS There appeared to be little difference in toxicity between the mood stabilisers, except that based on case fatality where multiple drug poisonings were considered, carbamazepine was over twice as likely to result in death relative to lithium (OR 2.37 95% CI 1.16-4.85). Of the antipsychotics, clozapine was approximately18 times more likely to result in death when taken in overdose than chlorpromazine (single drug case fatality: OR 18.53 95% CI 8.69-39.52). Otherwise, only risperidone differed from chlorpromazine, being less toxic (OR 0.06 95% CI 0.01-0.47). CONCLUSIONS There was little difference in toxicity of the individual mood stabilisers. Clozapine was far more toxic than the other antipsychotics. The findings are relevant to prescribing policy, especially for patients at particular risk of suicidal behaviour.
Collapse
Affiliation(s)
- Anne E. Ferrey
- 0000 0004 1936 8948grid.4991.5Centre for Suicide Research, Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK ,0000 0004 1936 8948grid.4991.5Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Galit Geulayov
- 0000 0004 1936 8948grid.4991.5Centre for Suicide Research, Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK
| | - Deborah Casey
- 0000 0004 1936 8948grid.4991.5Centre for Suicide Research, Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK
| | - Claudia Wells
- 0000 0001 2157 6840grid.426100.1Office for National Statistics, Newport, UK
| | - Alice Fuller
- 0000 0004 1936 8948grid.4991.5Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Clare Bankhead
- 0000 0004 1936 8948grid.4991.5Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Jennifer Ness
- 0000 0004 0396 1667grid.418388.eCentre for Self-harm and Suicide Prevention Research, Derbyshire Healthcare NHS Foundation Trust, Derby, UK
| | - Caroline Clements
- 0000000121662407grid.5379.8Centre for Suicide Prevention, University of Manchester, Manchester, UK
| | - David Gunnell
- 0000 0004 1936 7603grid.5337.2School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Navneet Kapur
- 0000000121662407grid.5379.8Centre for Suicide Prevention, University of Manchester, Manchester, UK
| | - Keith Hawton
- 0000 0004 1936 8948grid.4991.5Centre for Suicide Research, Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK
| |
Collapse
|
105
|
Sahinovic MM, Eleveld DJ, Miyabe-Nishiwaki T, Struys MMRF, Absalom AR. Pharmacokinetics and pharmacodynamics of propofol: changes in patients with frontal brain tumours. Br J Anaesth 2018; 118:901-909. [PMID: 28549082 DOI: 10.1093/bja/aex134] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/18/2017] [Indexed: 11/14/2022] Open
Abstract
Background Models of propofol pharmacokinetics and pharmacodynamics developed in patients without brain pathology are widely used for target-controlled infusion (TCI) during brain tumour excision operations. The goal of this study was to determine if the presence of a frontal brain tumour influences propofol pharmacokinetics and pharmacodynamics and existing PK-PD model performance. Methods Twenty patients with a frontal brain tumour and 20 control patients received a propofol infusion to achieve an induction-emergence-induction anaesthetic sequence. Propofol plasma concentration was measured every 4 min and at each transition of the conscious state. Bispectral index (BIS) values were continuously recorded. We used non-linear mixed-effects modelling to analyse the effects of the presence of a brain tumour on the pharmacokinetics and pharmacodynamics of propofol. Subsequently we calculated the predictive performance of Marsh, Schnider, and Eleveld models in terms of median prediction error (MdPE) and median absolute prediction error (MdAPE). Results Patients with brain tumours showed 40% higher propofol clearance than control patients. Performance of the Schnider model (MdPEpk -20.0%, MdAPEpk 23.4%) and Eleveld volunteer model (MdPEpk -8.58%, MdAPEpk 21.6%) were good. The Marsh model performed less well (MdPEpk -14.3%, MdAPEpk 41.4%), as did the Eleveld patient model (MdPEpk -30.8%, MdAPEpk 32.1%). Conclusions Brain tumours might alter the pharmacokinetics of propofol. Caution should be exerted when using propofol TCI in patients with frontal brain tumours due to higher clearance. Trial registry number NCT01060631.
Collapse
Affiliation(s)
- M M Sahinovic
- Department of Anaesthesia, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - D J Eleveld
- Department of Anaesthesia, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | | | - M M R F Struys
- Department of Anaesthesia, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.,Department of Anaesthesia, Ghent University, Belgium
| | - A R Absalom
- Department of Anaesthesia, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| |
Collapse
|
106
|
Evaluation of the effects of Citrus aurantium (bitter orange) extract on lamotrigine pharmacokinetics: Insights from in vivo studies in rats. Food Chem Toxicol 2018; 121:166-172. [DOI: 10.1016/j.fct.2018.08.069] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Revised: 08/27/2018] [Accepted: 08/29/2018] [Indexed: 12/11/2022]
|
107
|
Lesko LJ, Vozmediano V, Brown JD, Winterstein A, Zhao P, Lippert J, Höchel J, Chaturvedula A, White A, Schmidt S. Establishing a Multidisciplinary Framework to Study Drug-Drug Interactions of Hormonal Contraceptives: An Invitation to Collaborate. CPT-PHARMACOMETRICS & SYSTEMS PHARMACOLOGY 2018; 7:706-708. [PMID: 30260082 PMCID: PMC6263668 DOI: 10.1002/psp4.12357] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Accepted: 09/16/2018] [Indexed: 11/08/2022]
Abstract
Hormonal contraceptive agents (HCAs) are widely used throughout the world, and women taking HCAs are likely to take other medications. However, little is known about the clinical effect of most drug‐drug interactions (DDIs) associated with HCAs. A team of interdisciplinary outcomes and pharmacometric researchers from academia and industry jointly engage in a research project to (i) quantitatively elucidate DDI impacts on unintended pregnancies and breakthrough bleeding, and (ii) establish a DDI‐prediction framework to inform optimal use of HCAs.
Collapse
Affiliation(s)
- Lawrence J Lesko
- Center for Pharmacometrics and Systems Pharmacology, Department of Pharmaceutics, College of Pharmacy, University of Florida, Lake Nona (Orlando), Florida, USA
| | - Valvanera Vozmediano
- Center for Pharmacometrics and Systems Pharmacology, Department of Pharmaceutics, College of Pharmacy, University of Florida, Lake Nona (Orlando), Florida, USA
| | - Joshua D Brown
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, Florida, USA
| | - Almut Winterstein
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, Florida, USA
| | - Ping Zhao
- The Bill & Melinda Gates Foundation, Seattle, Washington, USA
| | - Jörg Lippert
- Clinical Pharmacometrics, Bayer AG Pharmaceuticals, Wuppertal, Germany
| | | | - Ayyappa Chaturvedula
- Department of Pharmacotherapy, University of North Texas Health Science Center, Fort Worth, Texas, USA
| | - Annesha White
- Department of Pharmacotherapy, University of North Texas Health Science Center, Fort Worth, Texas, USA
| | - Stephan Schmidt
- Center for Pharmacometrics and Systems Pharmacology, Department of Pharmaceutics, College of Pharmacy, University of Florida, Lake Nona (Orlando), Florida, USA
| |
Collapse
|
108
|
McCudden CR. Quality, origins and limitations of common therapeutic drug reference intervals. ACTA ACUST UNITED AC 2018; 5:47-61. [PMID: 29794249 DOI: 10.1515/dx-2018-0001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Accepted: 04/24/2018] [Indexed: 12/14/2022]
Abstract
Therapeutic drug monitoring (TDM) is used to manage drugs with a narrow window between effective and toxic concentrations. TDM involves measuring blood concentrations of drugs to ensure effective therapy, avoid toxicity and monitor compliance. Common drugs for which TDM is used include aminoglycosides for infections, anticonvulsants to treat seizures, immunosuppressants for transplant patients and cardiac glycosides to regulate cardiac output and heart rate. An essential element of TDM is the provision of accurate and clinically relevant reference intervals. Unlike most laboratory reference intervals, which are derived from a healthy population, TDM reference intervals need to relate to clinical outcomes in the form of efficacy and toxicity. This makes TDM inherently more difficult to develop as healthy individuals are not on therapy, so there is no "normal value". In addition, many of the aforementioned drugs are old and much of the information regarding reference intervals is based on small trials using methods that have changed. Furthermore, individuals have different pharmacokinetics and drug responses, particularly in the context of combined therapies, which exacerbates the challenge of universal TDM targets. This focused review examines the origins and limitations of existing TDM reference intervals for common drugs, providing targets where possible based on available guidelines.
Collapse
Affiliation(s)
- Christopher R McCudden
- Department of Pathology and Laboratory Medicine, Division of Biochemistry, University of Ottawa, 501 Smyth Rd., Ottawa, ON K1H 8L6, Canada
| |
Collapse
|
109
|
Zaccara G, Gualdani E, Policardo L, Palumbo P, Francesconi P. Frequency of drug combinations between enzyme-inducing first-generation antiepileptic drugs and inducible drugs in patients with epilepsy. Epilepsy Behav 2018; 87:92-95. [PMID: 30126756 DOI: 10.1016/j.yebeh.2018.08.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Revised: 08/04/2018] [Accepted: 08/04/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVE The objective of the study was to systematically assess, through the analysis of administrative data, the frequency of combinations of first-generation enzyme-inducing (EI) antiepileptic drugs (AEDs) with drugs frequently prescribed in patients with epilepsy whose metabolism is induced by EIAEDs. METHODS From the population of Tuscany (a region in Italy of about 3,750,000 habitants), patients who had been treated with at least one first-generation EIAEDs (carbamazepine, phenytoin, phenobarbital, and primidone) and had received prescriptions of an inducible non-AED (NON-AED) included in a prespecified list of 103 inducible drugs were identified. RESULTS At the index date, 9221 patients with epilepsy were treated with at least one traditional EIAED, and there were 2538 drug combinations between EIAEDs and NON-AEDs, which may result in potentially serious clinical consequences, and 3317 combinations with NON-AEDs that have their metabolism consistently increased. CONCLUSIONS Patients with epilepsy treated with traditional EIAEDs are at a very high risk of drug interactions.
Collapse
Affiliation(s)
- Gaetano Zaccara
- Agenzia Regionale di Sanità, Regione Toscana, Firenze, Italy.
| | - Elisa Gualdani
- Agenzia Regionale di Sanità, Regione Toscana, Firenze, Italy
| | - Laura Policardo
- Agenzia Regionale di Sanità, Regione Toscana, Firenze, Italy
| | - Pasquale Palumbo
- Unit of Neurology, Department of Medicine, Usl centro Toscana Health Authority, Prato, Italy
| | | |
Collapse
|
110
|
Kumkamthornkul P, Udnaen S, Tansit T, Tuchinda P, Srinoulprasert Y. Evaluation of a lymphocyte transformation test and cytokine detection assay to identify phenytoin and carbamazepine provoked DRESS or SJS/TEN in epilepsy patients. Int Immunopharmacol 2018; 63:204-210. [DOI: 10.1016/j.intimp.2018.08.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Revised: 07/24/2018] [Accepted: 08/08/2018] [Indexed: 01/12/2023]
|
111
|
The survival effect of valproic acid in glioblastoma and its current trend: a systematic review and meta-analysis. Clin Neurol Neurosurg 2018; 174:149-155. [PMID: 30243186 DOI: 10.1016/j.clineuro.2018.09.019] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Revised: 09/03/2018] [Accepted: 09/12/2018] [Indexed: 12/15/2022]
Abstract
Glioblastoma (GBM) can often present with seizure. Attempts have been made to associate the use of anti-epileptic medication valproic acid (VPA) in standard of care management with survival benefit in the past; however, results to date have been conflicting, and most likely subjected to historical bias. This study aimed to quantify the overall survival (OS) effect of VPA in patients with GBM based on the current literature, and identify potential trend-modifying covariates. Searches of 7 electronic databases from inception to April 2018 were conducted following the appropriate guidelines. Hazard ratios (HRs) derived from Cox proportional hazard models, and mean differences (MDs), were analyzed using the random effects model. Meta-regression was used to identify potential trend-modifying covariates. Seven retrospective cohort studies satisfied selection criteria describing 2181 primary GBM diagnoses, with 534 (24%) receiving VPA in their treatment. Overall, VPA was shown to confer a statistically significant OS advantage (HR, 0.71; 95% CI, 0.56-0.91; p < 0.01) compared to the control group by up to 2.4 months (95% CI, 1.51-3.21; p < 0.01). However, upon meta-regression, this survival advantage as inferred by HRs trended towards the null in newer studies (slope, 1.15; p = 0.02) or in studies with older participants (slope, 1.13; p = 0.02). A similar result was seen with MDs. Based on the literature to date, VPA was significantly associated with better OS in GBM patients by 2.4 months when managed by current standard of care. However, this effect was particularly emphasized among older studies or studies conducted in younger participants indicating the need to exercise caution in assuming generalizability of the pooled effect. Overall, there is considerable bias risks in the current interpretation of the literature, and larger, prospective studies are required for validating our findings.
Collapse
|
112
|
Jhaj R, Sharma S, Sabir M, Kokane A. A pilot study to determine the occurrence of concomitant diseases and drug intake in patients on antituberculosis therapy. J Family Med Prim Care 2018; 7:414-419. [PMID: 30090786 PMCID: PMC6060940 DOI: 10.4103/jfmpc.jfmpc_103_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Introduction: Altered pharmacokinetics of antituberculosis (anti-TB) drugs due to interaction with non-TB medications or concomitant diseases may lead to suboptimal plasma levels of the affected drugs and hence contribute to the emergence of drug resistance in mycobacteria. Yet, few studies have investigated the prevalence of concomitant drug intake or concurrent diseases in patients on anti-TB therapy (ATT). The objective of this study is to study the prevalence of concomitant diseases and intake of non-TB drugs in patients on ATT. Methods: Adult patients who were undergoing treatment for TB at a directly observed treatment short-course (DOTS) center were interviewed to find out any concomitant drug intake and ailments they were suffering from. Data were also collected from the patients’ treatment cards. Results: A total of 105 patients were interviewed for the study over a period of 1 month. Among these, 66 (62.9%) patients reported having taken a non-ATT drug in the last 3 months, 61 (58.1%) of which were drugs that may affect the ATT. A comparable number of patients (61 [58.1%]) reported suffering from one or the other concurrent illnesses or symptoms while on DOTS, including one patient with AIDS and eight with diabetes mellitus. Fluoroquinolones had been prescribed to four patients while on DOTS. Conclusion: A large proportion of the patients with TB were found to be on non-TB concomitant medications including drugs with potential for interactions that are capable of affecting ATT outcomes. It is, therefore, important that the patients and prescribing physicians be aware of any possible drug interactions.
Collapse
Affiliation(s)
- Ratinder Jhaj
- Department of Pharmacology and Toxicology, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
| | - Shweta Sharma
- Department of Pharmacology and Toxicology, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
| | - Mohammed Sabir
- Department of Medical Student, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
| | - Arun Kokane
- Department of Community and Family Medicine, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
| |
Collapse
|
113
|
Phenytoin Could Potentially Increase Hepatic Clearance of 99mTc-Sestamibi in Myocardial Perfusion Imaging. Clin Nucl Med 2018; 43:e341-e342. [PMID: 30080190 DOI: 10.1097/rlu.0000000000002199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Myocardial perfusion imaging (MPI) is one of the most commonly used nuclear medicine imaging modalities for coronary artery disease evaluation and risk stratification. The authors present incidental image findings in a patient who underwent MPI twice because of development of seizures just before the first SPECT-MPI acquisition. The projection images for first MPI done without medication (phenytoin) showed the retention of hepatic tracer activity. After a few days from restarting of phenytoin, the repeat MPI showed complete hepatic clearance of tracer. This case highlights the possible pharmacokinetic interaction between phenytoin intake and Tc-sestamibi, resulting in faster hepatic clearance of the radiotracer.
Collapse
|
114
|
Baldoni AO, Freitas-Lima P, Alexandre V, Ferreira FIDS, Martinez EZ, Queiroz RHC, Sakamoto AC, Pereira LRL. Influence of the clinical profile of patients with refractory epilepsy on lamotrigine plasma concentration. BRAZ J PHARM SCI 2018. [DOI: 10.1590/s2175-97902018000200246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
|
115
|
Syu FK, Pan HY, Chuang PC, Huang YS, Cheng CY, Cheng FJ. Incidence of Stevens-Johnson syndrome following combination drug use of allopurinol, carbamazepine and phenytoin in Taiwan: A case-control study. J Dermatol 2018; 45:1080-1087. [DOI: 10.1111/1346-8138.14528] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Accepted: 05/31/2018] [Indexed: 11/28/2022]
Affiliation(s)
- Fei-Kai Syu
- Department of Pharmacy; College of Pharmacy; China Medical School; Taichung Taiwan
| | - Hsiu-Yung Pan
- Department of Emergency Medicine; Kaohsiung Chang Gung Memorial Hospital; Chang Gung University College of Medicine; Kaohsiung Taiwan
| | - Po-Chun Chuang
- Department of Emergency Medicine; Kaohsiung Chang Gung Memorial Hospital; Chang Gung University College of Medicine; Kaohsiung Taiwan
| | - Yi-Syun Huang
- Department of Emergency Medicine; Kaohsiung Chang Gung Memorial Hospital; Chang Gung University College of Medicine; Kaohsiung Taiwan
| | - Chi-Yung Cheng
- Department of Emergency Medicine; Kaohsiung Chang Gung Memorial Hospital; Chang Gung University College of Medicine; Kaohsiung Taiwan
| | - Fu-Jen Cheng
- Department of Emergency Medicine; Kaohsiung Chang Gung Memorial Hospital; Chang Gung University College of Medicine; Kaohsiung Taiwan
| |
Collapse
|
116
|
Thomas M, DiPaula BA, Grimm B. Important drug interaction involving phenytoin and quetiapine. Ment Health Clin 2018; 8:195-197. [PMID: 30155396 PMCID: PMC6063458 DOI: 10.9740/mhc.2018.07.195] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Objective: To describe a patient case in which a drug interaction involving quetiapine and phenytoin resulted in an absence of clinical response and serum quetiapine levels below the point of detection. Case Summary: This patient was on concurrent phenytoin, valproic acid, and quetiapine therapy for 10 months. Prior to discontinuing phenytoin, a serum quetiapine level was found to be less than 10 ng/mL. It took approximately 1 month after phenytoin's discontinuation for quetiapine levels to attain measurable concentrations. The patient's clinical response to quetiapine improved significantly after this interaction resolved. Discussion: Phenytoin is an inducer of cytochrome P450 3A4, and quetiapine is a substrate of this enzyme. Patients on concurrent phenytoin and quetiapine therapy may require monitoring of quetiapine concentrations, which is often not routine practice, as this drug interaction can result in a clinically significant reduction in quetiapine levels contributing to a lack of efficacy.
Collapse
Affiliation(s)
- Michele Thomas
- (Corresponding author) Assistant Director of Pharmacy, Springfield Hospital Center, University of Maryland School of Pharmacy Baltimore, Sykesville, Maryland,
| | - Bethany A. DiPaula
- Associate Professor, University of Maryland School of Pharmacy Baltimore, Baltimore, Maryland; Director of Pharmacy, Springfield Hospital Center, Sykesville, Maryland
| | - Beverley Grimm
- Unit Director, Springfield Hospital Center, Sykesville, Maryland
| |
Collapse
|
117
|
Marques FA, Albuquerque NCPD, Campos MSDA, Freitas-Lima P, Baldoni AO, Alexandre Júnior V, Sakamoto AC, Oliveira ARMD, Pereira LRL. Drug-resistant epilepsy and topiramate: Plasma concentration and frequency of epileptic seizures. Clin Exp Pharmacol Physiol 2018; 45:652-658. [DOI: 10.1111/1440-1681.12923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Revised: 01/16/2018] [Accepted: 01/24/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Fabiana Angelo Marques
- School of Pharmaceutical Sciences of Ribeirão Preto; University of São Paulo; Ribeirão Preto SP Brazil
| | | | | | | | | | | | | | | | | |
Collapse
|
118
|
Goldstein M, Malchi T, Shenker M, Chefetz B. Pharmacokinetics in Plants: Carbamazepine and Its Interactions with Lamotrigine. ENVIRONMENTAL SCIENCE & TECHNOLOGY 2018; 52:6957-6964. [PMID: 29787250 DOI: 10.1021/acs.est.8b01682] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
Carbamazepine and lamotrigine prescribed antiepileptic drugs are highly persistent in the environment and were detected in crops irrigated with reclaimed wastewater. This study reports pharmacokinetics of the two drugs and their metabolites in cucumber plants under hydroponic culture, testing their uptake, translocation, and transformation over 96 h in single and bisolute systems at varying pH. Ruling out root adsorption and transformations in the nutrient solution, we demonstrate that carbamazepine root uptake is largely affected by the concentration gradient across the membrane. Unlike carbamazepine, lamotrigine is adsorbed to the root and undergoes ion trapping in root cells thus its translocation to the shoots is limited. On the basis of that, carbamazepine uptake was not affected by the presence of lamotrigine, while lamotrigine uptake was enhanced in the presence of carbamazepine. Transformation of carbamazepine in the roots was slightly reduced in the presence of lamotrigine. Carbamazepine metabolism was far more pronounced in the shoots than in the roots, indicating that most of the metabolism occurs in the leaves, probably due to higher concentration and longer residence time. This study indicates that the uptake of small nonionic pharmaceuticals is passive and governed by diffusion across the root membrane.
Collapse
Affiliation(s)
- Myah Goldstein
- Department of Soil and Water Sciences, The Robert H. Smith Faculty of Agriculture, Food and Environment , The Hebrew University of Jerusalem , P.O. Box 12, Rehovot 7610001 , Israel
- The Hebrew University Center of Excellence in Agriculture and Environmental Health , P.O. Box 12, Rehovot 7610001 , Israel
| | - Tomer Malchi
- Department of Soil and Water Sciences, The Robert H. Smith Faculty of Agriculture, Food and Environment , The Hebrew University of Jerusalem , P.O. Box 12, Rehovot 7610001 , Israel
- The Hebrew University Center of Excellence in Agriculture and Environmental Health , P.O. Box 12, Rehovot 7610001 , Israel
| | - Moshe Shenker
- Department of Soil and Water Sciences, The Robert H. Smith Faculty of Agriculture, Food and Environment , The Hebrew University of Jerusalem , P.O. Box 12, Rehovot 7610001 , Israel
| | - Benny Chefetz
- Department of Soil and Water Sciences, The Robert H. Smith Faculty of Agriculture, Food and Environment , The Hebrew University of Jerusalem , P.O. Box 12, Rehovot 7610001 , Israel
- The Hebrew University Center of Excellence in Agriculture and Environmental Health , P.O. Box 12, Rehovot 7610001 , Israel
| |
Collapse
|
119
|
Contin M, Bisulli F, Santucci M, Riva R, Tonon F, Mohamed S, Ferri L, Stipa C, Tinuper P. Effect of valproic acid on perampanel pharmacokinetics in patients with epilepsy. Epilepsia 2018; 59:e103-e108. [PMID: 29897632 DOI: 10.1111/epi.14446] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/15/2018] [Indexed: 01/27/2023]
Abstract
We prospectively examined the effect of antiepileptic (AED) cotherapy on steady state plasma concentrations of perampanel (PMP) in epileptic patients. We classified AEDs as strong enzyme inducers (carbamazepine, phenobarbital, phenytoin, oxcarbazepine), not strong enzyme inducers/not inhibitors (levetiracetam, lamotrigine, topiramate, rufinamide, lacosamide, zonisamide, clobazam), and enzyme inhibitors (valproic acid [VPA]). The main outcome was the comparison of PMP plasma concentration to weight-adjusted dose ratio (C/D; [μg/mL]/mg kg-1 d-1 ) among comedication subgroups. From 79 patients (42 females, 37 males) aged (mean ± standard deviation) 33 ± 13 years (range = 12-66 years), 114 plasma samples were collected. Twenty-eight patients (44 samples) were cotreated with enzyme inducers (group A), 21 (27 samples) with not strong enzyme inducers/not inhibitors (group B), 21 (31 samples) with not strong enzyme inducers/not inhibitors + VPA (group C), and 9 (12 samples) with enzyme inducers + VPA (group D). PMP C/D was reduced (-56%, P < .001) in group A (1.79 ± 0.80) versus group B (4.05 ± 2.16) and increased (P < .001) in group C (6.72 ± 4.04) compared with groups A (+275%), B (+66%), and D (2.76 ± 2.00, +143%). Our study documents the unpublished higher PMP C/D in patients cotreated with VPA. These findings have both theoretical relevance, suggesting better characterization of PMP metabolic pathways with ad hoc studies, and clinical usefulness in managing patients on AED polytherapy.
Collapse
Affiliation(s)
- Manuela Contin
- Institute of Research and Treatment (IRCCS), Institute of Neurological Sciences of Bologna, Bologna, Italy.,Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Francesca Bisulli
- Institute of Research and Treatment (IRCCS), Institute of Neurological Sciences of Bologna, Bologna, Italy.,Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Margherita Santucci
- Institute of Research and Treatment (IRCCS), Institute of Neurological Sciences of Bologna, Bologna, Italy.,Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Roberto Riva
- Institute of Research and Treatment (IRCCS), Institute of Neurological Sciences of Bologna, Bologna, Italy.,Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Francesca Tonon
- Institute of Research and Treatment (IRCCS), Institute of Neurological Sciences of Bologna, Bologna, Italy
| | - Susan Mohamed
- Institute of Research and Treatment (IRCCS), Institute of Neurological Sciences of Bologna, Bologna, Italy
| | - Lorenzo Ferri
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Carlotta Stipa
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Paolo Tinuper
- Institute of Research and Treatment (IRCCS), Institute of Neurological Sciences of Bologna, Bologna, Italy.,Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | | |
Collapse
|
120
|
Farrokh S, Tahsili-Fahadan P, Ritzl EK, Lewin JJ, Mirski MA. Antiepileptic drugs in critically ill patients. Crit Care 2018; 22:153. [PMID: 29880020 PMCID: PMC5992651 DOI: 10.1186/s13054-018-2066-1] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Accepted: 05/14/2018] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND The incidence of seizures in intensive care units ranges from 3.3% to 34%. It is therefore often necessary to initiate or continue anticonvulsant drugs in this setting. When a new anticonvulsant is initiated, drug factors, such as onset of action and side effects, and patient factors, such as age, renal, and hepatic function, should be taken into account. It is important to note that the altered physiology of critically ill patients as well as pharmacological and nonpharmacological interventions such as renal replacement therapy, extracorporeal membrane oxygenation, and target temperature management may lead to therapeutic failure or toxicity. This may be even more challenging with the availability of newer antiepileptics where the evidence for their use in critically ill patients is limited. MAIN BODY This article reviews the pharmacokinetics and pharmacodynamics of antiepileptics as well as application of these principles when dosing antiepileptics and monitoring serum levels in critically ill patients. The selection of the most appropriate anticonvulsant to treat seizure and status epileptics as well as the prophylactic use of these agents in this setting are also discussed. Drug-drug interactions and the effect of nonpharmacological interventions such as renal replacement therapy, plasma exchange, and extracorporeal membrane oxygenation on anticonvulsant removal are also included. CONCLUSION Optimal management of antiepileptic drugs in the intensive care unit is challenging given altered physiology, polypharmacy, and nonpharmacological interventions, and requires a multidisciplinary approach where appropriate and timely assessment, diagnosis, treatment, and monitoring plans are in place.
Collapse
Affiliation(s)
- Salia Farrokh
- Department of Pharmacy, The Johns Hopkins Hospital, 600 N. Wolfe Street, Carnegie 180, Baltimore, MD 21287 USA
| | - Pouya Tahsili-Fahadan
- Department of Neurology, The Johns Hopkins Hospital, Baltimore, MD USA
- Department of Medicine, Virginia Commonwealth University School of Medicine, INOVA Campus, Falls Church, VA USA
| | - Eva K. Ritzl
- Department of Neurology, The Johns Hopkins Hospital, Baltimore, MD USA
- Department of Anesthesiology and Critical Care Medicine, The Johns Hopkins Hospital, Baltimore, MD USA
| | - John J. Lewin
- Department of Pharmacy, The Johns Hopkins Hospital, 600 N. Wolfe Street, Carnegie 180, Baltimore, MD 21287 USA
| | - Marek A. Mirski
- Department of Pharmacy, The Johns Hopkins Hospital, 600 N. Wolfe Street, Carnegie 180, Baltimore, MD 21287 USA
| |
Collapse
|
121
|
Abstract
OBJECTIVES Valproic acid and clozapine are drugs commonly used in the treatment of schizophrenic and schizoaffective disorders. Pharmacokinetic interactions of valproic acid with several drugs are well known, yet results concerning the interaction with clozapine are inconsistent. METHODS Steady-state dose-corrected serum concentrations of clozapine and its main metabolite norclozapine were retrospectively analyzed in 45 patients receiving both clozapine and valproic acid. Controls were matched for sex, age, smoking, comedication, and inflammatory response. RESULTS The group receiving comedication with valproic acid showed significantly lower median dose-corrected serum concentrations of norclozapine (0.44 [0.27-0.58] (ng/mL)/(mg/d) vs 0.78 [0.60-1.07] (ng/mL)/(mg/d)) as well as metabolite to parent compound ratios (0.40 [0.36-0.47] vs 0.71 [0.58-0.84]) by approximately 44%. Dose-corrected serum concentrations of clozapine were not significantly lower. The effect of valproic acid was independent of sex and smoking. CONCLUSIONS Comedication with valproic acid accelerated metabolism of clozapine with predominant effects on the degradation of norclozapine. Therapeutic drug monitoring should be applied to guide individual patient responses upon initiation of comedication.
Collapse
|
122
|
Hao N, Graham J, Hitchcock A, O'Brien TJ, Vajda FJE. The role of ethnicity on pregnancy outcomes in women with epilepsy: The need for specific research. Epilepsia 2018; 59:1124-1131. [PMID: 29727483 DOI: 10.1111/epi.14086] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/30/2018] [Indexed: 02/05/2023]
Abstract
The role of ethnicity on pregnancy outcomes of women with epilepsy (WWE) has received little research attention but is important to guide management. The aim of this review is to identify and describe current knowledge of ethnicity for WWE giving birth. Literature searches were performed with the following terms: ethnic/race combined with epilepsy/seizure, antiepileptic drugs (AED), and/or pregnancy, and combined them with congenital malformation, birth outcome, or pregnancy complication, with English language restriction in PubMed, EMBASE, and Web of Science. Both primary studies and review articles were included. Ethnicity disparities exist in specific congenital malformations, pregnancy complications, and birth outcomes among the general population. There is also ethnicity-related diversity of AED disposition. Information on ethnicity is rarely considered in studies about pregnant WWE. The association between ethnicity and pregnancy outcomes of WWE remains to be elucidated. The lack of data relating to ethnicity in pregnancy studies among WWE needs addressing. Knowledge of potential effects of ethnicity on pregnancy outcomes in WWE will help inform better clinical care around the world.
Collapse
Affiliation(s)
- Nanya Hao
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China.,Department of Medicine and Neurology, Royal Melbourne Hospital and University of Melbourne, Parkville, Vic., Australia
| | - Janet Graham
- Department of Medicine and Neurology, Royal Melbourne Hospital and University of Melbourne, Parkville, Vic., Australia
| | - Alison Hitchcock
- Department of Medicine and Neurology, Royal Melbourne Hospital and University of Melbourne, Parkville, Vic., Australia
| | - Terence J O'Brien
- Department of Medicine and Neurology, Royal Melbourne Hospital and University of Melbourne, Parkville, Vic., Australia.,Departments of Neurosciences and Neurology, The Central Clinical School, The Alfred Hospital, Monash University, Melbourne, Vic., Australia
| | - Frank J E Vajda
- Department of Medicine and Neurology, Royal Melbourne Hospital and University of Melbourne, Parkville, Vic., Australia
| |
Collapse
|
123
|
Sasaki E, Yokoi T. Role of cytochrome P450-mediated metabolism and involvement of reactive metabolite formations on antiepileptic drug-induced liver injuries. J Toxicol Sci 2018; 43:75-87. [PMID: 29479037 DOI: 10.2131/jts.43.75] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Several drugs have been withdrawn from the market or restricted to avoid unexpected adverse outcomes. Drug-induced liver injury (DILI) is a serious issue for drug development. Among DILIs, idiosyncratic DILIs have been a serious problem in drug development and clinical uses. Idiosyncratic DILI is most often unrelated to pharmacological effects or the dosing amount of a drug. The number of drugs that cause idiosyncratic DILI continue to grow in part because no practical preclinical tests have emerged that can identify drug candidates with the potential for developing idiosyncratic DILIs. Nevertheless, the implications of drug metabolism-related factors and immune-related factors on idiosyncratic DILIs has not been fully clarified because this toxicity can not be reproduced in animals. Therefore, accumulated evidence for the mechanisms of the idiosyncratic toxicity has been limited to only in vitro studies. This review describes current knowledge of the effects of cytochrome P450 (CYP)-mediated metabolism and its detoxification abilities based on studies of idiosyncratic DILI animal models developed recently. This review also focused on antiepileptic drugs, phenytoin (diphenyl hydantoin, DPH) and carbamazepine (CBZ), which have rarely caused severe adverse reactions, such as fulminant hepatitis, and have been recognized as sources of idiosyncratic DILI. The studies of animal models of idiosyncratic DILIs have produced new knowledge of chronic administration, CYP inductions/inhibitions, glutathione contents, and immune-related factors for the initiation of idiosyncratic DILIs. Considering changes in the drug metabolic profile and detoxification abilities, idiosyncratic DILIs caused by antiepileptic drugs will lead to understanding the mechanisms of these DILIs.
Collapse
Affiliation(s)
- Eita Sasaki
- Department of Safety Research on Blood and Biological Products, National Institute of Infectious Diseases
| | - Tsuyoshi Yokoi
- Department of Drug Safety Sciences, Nagoya University Graduate School of Medicine
| |
Collapse
|
124
|
O'Dwyer M, Peklar J, Mulryan N, McCallion P, McCarron M, Henman MC. Prevalence and patterns of anti-epileptic medication prescribing in the treatment of epilepsy in older adults with intellectual disabilities. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2018; 62:245-261. [PMID: 29314463 DOI: 10.1111/jir.12461] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Revised: 09/28/2017] [Accepted: 11/29/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND The prevalence of epilepsy is higher in people with intellectual disability (ID) and increases with the degree of ID. Although life expectancy for people with ID is increasing, people with ID coexisting with epilepsy have a higher mortality rate, particularly those who had recent seizures. There have been few observational studies of the prevalence and patterns of anti-epileptic prescribing among older people with ID and epilepsy. The aim of this study was to investigate prevalence and patterns of anti-epileptic prescribing in the treatment of epilepsy in a representative population of older people with ID and epilepsy. METHODS This was an observational cross-sectional study from wave 1 (2009/2010) of Intellectual Disability Supplement to the Irish Longitudinal Study on Aging, a nationally representative sample of 753 persons with ID aged between 41 and 90 years. Participants and/or proxies recorded medicines used on a regular basis and reported doctor's diagnosis of epilepsy; medication data were available for 736 (98%). Prescribing of anti-epileptic drugs (AEDs) for epilepsy in those with a doctor's diagnosis of epilepsy (N = 205) was the primary exposure of interest for this study. Participant exposure to these AEDs was then categorised into AED monotherapy and polytherapy. Participants/carers reported seizure frequency, when epilepsy was last reviewed and which practitioner reviewed epilepsy. In addition, medications that may lower the seizure threshold that were listed in the Maudsley prescribing guidelines in psychiatry were examined. RESULTS Of the 736 participants with reported medicines use, 38.9% (n = 287) were exposed to AEDs, and 30.6% (225) had a doctor's diagnosis of epilepsy. Of those with epilepsy (n = 225), 90.9% (n = 205) reported concurrent use of AEDs and epilepsy. Of these 205 participants, 50.3% (n = 103) were exposed to AED polytherapy, and 63 different polytherapy regimes were reported. The most frequently reported AEDs were valproic acid (n = 100, 48.7%), carbamazepine (n = 89, 46.3%) and lamotrigine (n = 57, 27.8%). In total, 13.7% had a concurrent psychotropic, which should be avoided in epilepsy, and 32.6% had a psychotropic where caution is required. Antipsychotics with potential epileptogenic potential accounted for 80% of these medications. Of those with AED polytherapy (n = 103), 29.5% (28) reported being seizure free for the previous 2 years. CONCLUSIONS Prevalence of epilepsy was high among older people with ID, and half were exposed to two or more AEDs. Despite the use of AED therapy, over half had seizures in the previous 2 years. As the primary goals of optimal AED treatment are to achieve seizure freedom without unacceptable adverse effects, this was not achievable for many older patients with ID and epilepsy. Our findings indicated that people with ID and epilepsy were often exposed to psychotropic medications that may lower the seizure threshold. Regular review of epilepsy and medicines (including medicines that may interact with AEDs or lower the seizure threshold) by multidisciplinary teams working to agreed standards may improve quality of prescribing. Improved exchange of information and coordination of care between specialists and primary care practitioners in line with expert consensus recommendations could bring substantial benefit.
Collapse
Affiliation(s)
- M O'Dwyer
- School of Pharmacy and Pharmaceutical Sciences, Trinity College Dublin, Dublin, Ireland
- IDS-TILDA, School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
| | - J Peklar
- School of Pharmacy, University of Ljubljana, Ljubljana, Slovenia
| | - N Mulryan
- IDS-TILDA, School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
| | - P McCallion
- School of Social Work. College of Public Health, Temple University, Philadelphia, PA, USA
| | - M McCarron
- Dean of the Faculty of Health Sciences, Trinity College Dublin, Dublin, Ireland
| | - M C Henman
- School of Pharmacy and Pharmaceutical Sciences, Trinity College Dublin, Dublin, Ireland
| |
Collapse
|
125
|
Methaneethorn J. A systematic review of population pharmacokinetics of valproic acid. Br J Clin Pharmacol 2018; 84:816-834. [PMID: 29328514 DOI: 10.1111/bcp.13510] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Revised: 12/26/2017] [Accepted: 01/02/2018] [Indexed: 12/31/2022] Open
Abstract
AIMS Population pharmacokinetics is an essential tool that helps guide individualized dosing regimens. The aims of this systematic review are to provide knowledge concerning population pharmacokinetics of valproic acid (VPA) and to identify factors influencing VPA pharmacokinetic variability. METHODS PubMed and Embase databases were systematically searched from inception to June, 2017. Relevant articles from reference lists were also included. All population pharmacokinetic studies of VPA conducted in humans and that employed a nonlinear mixed effect modelling approach were included in this review. RESULTS Twenty-six studies were included in this review. Most studies characterized VPA pharmacokinetics as a one-compartment model. Three studies reported a two-compartment model. Body weight, dose and age were significant predictors for VPA volume of distribution (Vd ). The estimated Vd for one-compartment models ranged from 8.4 to 23.3 l. For two-compartment models, peripheral volumes of distribution ranged from 4.08 to 42.1 l. Frequently reported significant predictors for VPA clearance (CLVPA ) included body weight, VPA dose, concomitant medications, gender and age. The estimated CLVPA ranged from 0.206 to 1.154 l h-1 and the inter-individual variability ranged from 13.40 to 35.90%. Two studies reported population pharmacokinetics/pharmacodynamics of VPA in patients with epilepsy. Seventeen studies evaluated the performance of their final models. CONCLUSIONS Significant predictors influencing VPA pharmacokinetics as well as model methodologies are highlighted in this review. For clinical application, CLVPA could be predicted using body weight, VPA dose, concomitant medications, gender or age. For future research, there is a knowledge gap regarding population pharmacokinetics/pharmacodynamics of VPA in a population other than epileptic patients.
Collapse
Affiliation(s)
- Janthima Methaneethorn
- Pharmacokinetic Research Unit, Department of Pharmacy Practice, Faculty of Pharmaceutical Sciences, Naresuan University, Phitsanulok, Thailand.,Center of Excellence for Environmental Health and Toxicology, Naresuan University, Phitsanulok, Thailand
| |
Collapse
|
126
|
Lovrić M, Čajić I, Petelin Gadže Ž, Klarica Domjanović I, Božina N. Effect of antiepileptic drug comedication on lamotrigine concentrations. Croat Med J 2018; 59:13-19. [PMID: 29498493 PMCID: PMC5833099 DOI: 10.3325/cmj.2018.59.13] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Aim To estimate the effect size of concomitant antiepileptic therapy on the concentrations of lamotrigine, a drug often prescribed in combination with other antiepileptic drugs (AED), which can act as enzyme inducers or inhibitors. Methods A total of 304 patients with epilepsy, aged 18-70 years, were divided into a lamotrigine monotherapy group and groups receiving lamotrigine with AEDs that act as enzyme inducers, enzyme inhibitors, or both. We compared lamotrigine monotherapy serum concentrations with those where lamotrigine was administered with a metabolic inhibitor valproate, metabolic inducers carbamazepine, oxcarbazepine, phenobarbital, phenytoin, or topiramate, and both an inducer and an inhibitor. Results Comparison of trough lamotrigine monotherapy concentrations and lamotrigine polytherapy concentrations showed an almost similar median concentration in case of drug-inducers, and higher lamotrigine concentration in case of comedication with valproate as an inhibitor. A significant difference was confirmed after dose correction (P < 0.001). Significant positive correlations of lamotrigine trough serum concentrations with valproate were observed before and after the dose correction (r = 0.480, P < 0.001 and r = 0.561, P < 0.001, respectively). Positive correlations between the dose-corrected lamotrigine trough concentration and carbamazepine (r = 0.439; P < 0.001) or monohydroxy metabolite of oxcarbazepine (MHD) (r = 0.675; P < 0.001) were also significant. Conclusion Higher valproate levels resulted in higher inhibition potency and higher lamotrigine levels. Increased dose-corrected concentrations of inducers carbamazepine and MHD, after the process of induction was finished, did not lower lamotrigine concentrations. These findings can be of clinical significance for optimal AED dosing.
Collapse
Affiliation(s)
- Mila Lovrić
- Mila Lovrić, Department of Laboratory Diagnostics, University Hospital Centre Zagreb, Kišpatićeva 12, 10 000 Zagreb,
| | | | | | | | | |
Collapse
|
127
|
Kandil MM, Badowski ME, Schriever CA. Sustained viral suppression with co-administration of oxcarbazepine and dolutegravir. Int J STD AIDS 2018; 29:831-833. [PMID: 29350111 DOI: 10.1177/0956462417751961] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Co-administration of dolutegravir and oxcarbazepine has been reported to reduce levels of dolutegravir and therefore is contraindicated due to insufficient data to make dosing recommendations. We present eight cases in which patients with human immunodeficiency virus (HIV) inadvertently received oxcarbazepine while concurrently receiving 50 mg of dolutegravir daily as part of their antiretroviral therapy. Upon further evaluation, lab results revealed that despite the risk of decreased levels of dolutegravir due to possible oxcarbazepine enzyme induction, patients maintained at or near virologic suppression (viral load <20 copies/ml). Suppression was maintained in patients virally suppressed prior to oxcarbazepine initiation as well as in patients receiving high doses of oxcarbazepine (>1200 mg). All patients self-reported complete adherence to oxcarbazepine and dolutegravir. Furthermore, careful review of additional patient medications suggested no other identifiable drug interactions that could have affected their antiretroviral therapy. This case series suggests that despite the well-documented drug interaction, concomitant administration of oxcarbazepine and dolutegravir in the clinical setting did not adversely affect viral suppression in patients with HIV.
Collapse
Affiliation(s)
- Manar M Kandil
- Department of Pharmacy Practice, University of Illinois Chicago College of Pharmacy, Chicago, IL, USA
| | - Melissa E Badowski
- Department of Pharmacy Practice, University of Illinois Chicago College of Pharmacy, Chicago, IL, USA
| | - Christopher A Schriever
- Department of Pharmacy Practice, University of Illinois Chicago College of Pharmacy, Chicago, IL, USA
| |
Collapse
|
128
|
Cortegiani A, Pavan A, Azzeri F, Accurso G, Vitale F, Gregoretti C. Precision and Bias of Target‐Controlled Prolonged Propofol Infusion for General Anesthesia and Sedation in Neurosurgical Patients. J Clin Pharmacol 2018; 58:606-612. [DOI: 10.1002/jcph.1060] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2017] [Accepted: 11/16/2017] [Indexed: 12/15/2022]
Affiliation(s)
- Andrea Cortegiani
- Department of Biopathology and Medical Biotechnologies (DIBIMED), Section of Anesthesia Analgesia Intensive Care and Emergency, Policlinico Paolo Giaccone, University of Palermo Palermo Italy
| | - Alessandra Pavan
- Anestesia e Rianimazione Ospedale Civico di Chivasso Asl TO4 Chivasso Italy
| | | | | | - Filippo Vitale
- Department of Biopathology and Medical Biotechnologies (DIBIMED), Section of Anesthesia Analgesia Intensive Care and Emergency, Policlinico Paolo Giaccone, University of Palermo Palermo Italy
| | - Cesare Gregoretti
- Department of Biopathology and Medical Biotechnologies (DIBIMED), Section of Anesthesia Analgesia Intensive Care and Emergency, Policlinico Paolo Giaccone, University of Palermo Palermo Italy
| |
Collapse
|
129
|
Willems LM, Zöllner JP, Paule E, Schubert-Bast S, Rosenow F, Strzelczyk A. Eslicarbazepine acetate in epilepsies with focal and secondary generalised seizures: systematic review of current evidence. Expert Rev Clin Pharmacol 2017; 11:309-324. [PMID: 29285947 DOI: 10.1080/17512433.2018.1421066] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
INTRODUCTION Eslicarbazepine acetate (ESL) is a third-generation antiepileptic drug (AED) approved for adjunctive treatment in adults, children, and adolescents with focal-onset seizures. Recently ESL was approved for initial monotherapy in adults. The intention of this article is to review current evidence for ESL and to summarise its pharmacological profile in comparison to other AEDs of the dibenzazepine group. Areas covered: We performed a systematic literature search in electronic databases (MEDLINE database, Cochrane Central Register of Controlled Trials, Excerpta Medica dataBASE) using a combined search strategy including the following keywords: eslicarbazepine, epilepsy and seizure. The search was performed from 2000 until December 2017. Using a standardised assessment form, information on the study design, methodological framework, data sources and efficacy and adverse events attributed to ESL were extracted from each publication and systematically reported. Expert commentary: ESL is an effective, safe and well tolerated third-generation AED for the treatment of focal epilepsies. During therapy, especially serum sodium levels and possible interactions with other substances have to be monitored. As of yet, long-term experience is still needed to make severe late-occurring adverse events unlikely and to obtain data regarding its use in pregnancy.
Collapse
Affiliation(s)
- Laurent M Willems
- a Epilepsy Center Frankfurt Rhine-Main and Department of Neurology , Goethe-University , Frankfurt am Main , Germany
| | - Johann Philipp Zöllner
- a Epilepsy Center Frankfurt Rhine-Main and Department of Neurology , Goethe-University , Frankfurt am Main , Germany
| | - Esther Paule
- a Epilepsy Center Frankfurt Rhine-Main and Department of Neurology , Goethe-University , Frankfurt am Main , Germany
| | - Susanne Schubert-Bast
- a Epilepsy Center Frankfurt Rhine-Main and Department of Neurology , Goethe-University , Frankfurt am Main , Germany.,c Department of Neuropediatrics , Goethe-University , Frankfurt am Main , Germany
| | - Felix Rosenow
- a Epilepsy Center Frankfurt Rhine-Main and Department of Neurology , Goethe-University , Frankfurt am Main , Germany.,b Epilepsy Center Hessen and Department of Neurology , Philipps-University , Marburg , Germany
| | - Adam Strzelczyk
- a Epilepsy Center Frankfurt Rhine-Main and Department of Neurology , Goethe-University , Frankfurt am Main , Germany.,b Epilepsy Center Hessen and Department of Neurology , Philipps-University , Marburg , Germany
| |
Collapse
|
130
|
Stefanović S, Janković SM, Novaković M, Milosavljević M, Folić M. Pharmacodynamics and common drug-drug interactions of the third-generation antiepileptic drugs. Expert Opin Drug Metab Toxicol 2017; 14:153-159. [PMID: 29268032 DOI: 10.1080/17425255.2018.1421172] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
INTRODUCTION Anticonvulsants that belong to the third generation are considered as 'newer' antiepileptic drugs, including: eslicarbazepine acetate, lacosamide, perampanel, brivaracetam, rufinamide and stiripentol. Areas covered: This article reviews pharmacodynamics (i.e. mechanisms of action) and clinically relevant drug-drug interactions of the third-generation antiepileptic drugs. Expert opinion: Newer antiepileptic drugs have mechanisms of action which are not shared with the first and the second generation anticonvulsants, like inhibition of neurotransmitters release, blocking receptors for excitatory amino acids and new ways of sodium channel inactivation. New mechanisms of action increase chances of controlling forms of epilepsy resistant to older anticonvulsants. Important advantage of the third-generation anticonvulsants could be their little propensity for interactions with both antiepileptic and other drugs observed until now, making prescribing much easier and safer. However, this may change with new studies specifically designed to discover drug-drug interactions. Although the third-generation antiepileptic drugs enlarged therapeutic palette against epilepsy, 20-30% of patients with epilepsy is still treatment-resistant and need new pharmacological approach. There is great need to explore all molecular targets that may directly or indirectly be involved in generation of seizures, so a number of candidate compounds for even newer anticonvulsants could be generated.
Collapse
Affiliation(s)
- Srđan Stefanović
- a Faculty of Medical Sciences , University of Kragujevac , Kragujevac , Serbia
| | - Slobodan M Janković
- a Faculty of Medical Sciences , University of Kragujevac , Kragujevac , Serbia
| | - Milan Novaković
- a Faculty of Medical Sciences , University of Kragujevac , Kragujevac , Serbia
| | - Marko Milosavljević
- a Faculty of Medical Sciences , University of Kragujevac , Kragujevac , Serbia
| | - Marko Folić
- a Faculty of Medical Sciences , University of Kragujevac , Kragujevac , Serbia
| |
Collapse
|
131
|
Therapeutic Drug Monitoring of Clobazam and Its Metabolite-Impact of Age and Comedication on Pharmacokinetic Variability. Ther Drug Monit 2017; 38:350-7. [PMID: 26751267 DOI: 10.1097/ftd.0000000000000272] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Clobazam (CLB) has been used as an antiepileptic drug for several decades. There is still insufficient data regarding its pharmacokinetic variability in clinical practice. The purpose of this study was to investigate pharmacokinetic variability of CLB with emphasis on the impact of age and comedication in patients with epilepsy. METHODS Serum concentration measurements of CLB and its metabolite N-desmethylclobazam (NCLB), as well as demographic and clinical data were retrieved from the routine therapeutic drug monitoring service at the National Center for Epilepsy, Norway, 2009-2013. NCLB/CLB and total (CLB + NCLB), CLB and NCLB concentration/dose (C/D) ratios were calculated. RESULTS 550 patients (296 women/254 men), average age 27 years (range 1-86), were included. The interindividual pharmacokinetic variability was extensive, as illustrated by a 100-fold variability in serum concentration compared with dose (total C/D ratio 0.03-3.29 µmol·L·mg). The CLB C/D ratio was 36% lower in young children (2-9 years) than in adults (18-64 years), reflecting a higher clearance. In patients receiving phenytoin, felbamate, stiripentol, oxcarbazepine or eslicarbazepine acetate, valproate, phenobarbital, zonisamide or carbamazepine one or more of the calculated ratios were significantly different from that in patients receiving no or neutral comedications. The mean values for the different groups were in the order of 20%-230% of C/D ratios in the neutral group and 200%-950% of the NCLB/CLB ratio. CONCLUSIONS The pharmacokinetic variability of CLB and its metabolite NCLB in clinical practice is extensive, and is influenced by drug-drug interactions, age, and pharmacogenetics. Therapeutic drug monitoring of CLB and NCLB is therefore valuable in patient management.
Collapse
|
132
|
Anticonvulsant Activity of 3-imidazolylflavanones and Their Flexible Analogs: 1-[(2-benzyloxy)phenyl]-2-(azol-1-yl)ethanones as New Lead Compounds. Pharm Chem J 2017. [DOI: 10.1007/s11094-017-1694-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
133
|
Johnson-Agbakwu C, Brown L, Yuan J, Kissling R, Greenblatt DJ. Effects of Flibanserin on the Pharmacokinetics of a Combined Ethinylestradiol/Levonorgestrel Oral Contraceptive in Healthy Premenopausal Women: A Randomized Crossover Study. Clin Ther 2017; 40:64-73. [PMID: 29198449 DOI: 10.1016/j.clinthera.2017.08.021] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Revised: 08/21/2017] [Accepted: 08/31/2017] [Indexed: 10/18/2022]
Abstract
PURPOSE This study aimed to investigate the effect of steady-state exposure to flibanserin, a 5-HT1A agonist/5-HT2A antagonist approved for the treatment of hypoactive sexual desire disorder in premenopausal women, on the single-dose pharmacokinetics of the contraceptive steroids ethinylestradiol and levonorgestrel in healthy premenopausal women. METHODS Healthy female volunteers (N = 24) received 2 single doses of a combined oral contraceptive containing ethinylestradiol 30 μg and levonorgestrel 150 μg, either alone (reference) or preceded by treatment with flibanserin 100 mg once daily for 14 days (test). The 2 treatments were given in randomized order, with a 4-week washout period following the last administration of the first treatment. Plasma concentrations of ethinylestradiol and levonorgestrel were measured over 48 hours after dosing for the determination of pharmacokinetic parameters; the primary end points were Cmax and AUC0-∞ of ethinylestradiol and levonorgestrel. FINDINGS Of the 24 women enrolled (mean age, 38.0 years), 23 completed the study. Mean (SD) Cmax and AUC0-∞ values of ethinylestradiol were 66.7 (16.3) pg/mL and 693 (268) pg · h/mL, respectively, following the oral contraceptive alone, and 72.7 (25.5) pg/mL and 740 (235) pg · h/mL, respectively, when the oral contraceptive was preceded by flibanserin. In both cases, the 90% CIs of the reference/test ratios of Cmax and AUC0-∞ were within the range of 80% to 125%, indicating that flibanserin had no significant effect on the pharmacokinetic properties of ethinylestradiol. Similarly, the mean (SD) Cmax and AUC0-∞ values of levonorgestrel were 5.0 (1.6) ng/mL and 52.2 (18.7) ng · h/mL, respectively, with the oral contraceptive alone, and 5.0 (1.6) ng/mL and 53.3 (20.4) ng · h/mL, respectively, following flibanserin; again, in both cases, the 90% CIs of the reference/test ratios were within the range of 80% to 125%, indicating that flibanserin had no significant effect on the pharmacokinetic properties of levonorgestrel. All adverse events were mild to moderate in intensity (incidence: 12.5% and 70.8% with ethinylestradiol/levonorgestrel treatment alone and following administration of flibanserin, respectively). IMPLICATIONS Pretreatment with flibanserin 100 mg once daily for 2 weeks did not produce a clinically relevant change in oral contraceptive drug exposure following single-dose administration of ethinylestradiol/levonorgestrel. This finding is relevant to women with hypoactive sexual desire disorder who might prefer oral contraceptives to other forms of birth control. EudraCT No: 2006-006960-46.
Collapse
Affiliation(s)
| | - Louise Brown
- Valeant Pharmaceuticals North America LLC, Bridgewater, New Jersey
| | - James Yuan
- Valeant Pharmaceuticals North America LLC, Bridgewater, New Jersey
| | - Robert Kissling
- Valeant Pharmaceuticals North America LLC, Bridgewater, New Jersey
| | | |
Collapse
|
134
|
Mohamed S, Candela C, Riva R, Contin M. Simple and rapid validated HPLC-fluorescence determination of perampanel in the plasma of patients with epilepsy. Pract Lab Med 2017; 10:15-20. [PMID: 29234708 PMCID: PMC5722279 DOI: 10.1016/j.plabm.2017.11.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Revised: 11/21/2017] [Accepted: 11/22/2017] [Indexed: 10/26/2022] Open
Abstract
We present a simple and fast high-performance liquid chromatography method with fluorescence detection for the determination of the antiepileptic drug perampanel in human plasma. The chromatographic separation was performed on a Kinetex PFP (100 × 2.6 mm, 4.6 µm) column, using a mobile phase of sodium acetate 0.03 M pH 3.7 and acetonitrile (40/60, v/v), at a flow rate of 0.8 mL/min. Total chromatography time for each run was 5 min. Sample preparation (250 µL) involved only one simple precipitation step by acetonitrile spiked with mirtazapine as internal standard. The method was validated over a concentration range of 20-1000 ng/mL and successfully applied to measure perampanel concentrations in plasma samples obtained from patients with epilepsy. This assay combines the high specificity of fluorescence detection with a very simple and fast sample pretreatment and can offer real advantages over existing methods in terms of simplicity and transferability to a therapeutic drug monitoring setting.
Collapse
Key Words
- AED, antiepileptic drug
- AMPA, α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid
- Antiepileptic drugs
- CBZ, carbamazepine
- Clinical pharmacokinetics
- Epilepsy
- HPLC-F
- HPLC-F, high performance liquid chromatography-fluorescence detector
- IS, internal standard
- LLE, liquid-liquid extraction
- LLOD, lower limit of detection
- LLOQ, lower limit of quantification
- MIR, mirtazapine
- MS/MS, tandem mass spectrometer
- OXC, oxcarbazepine
- PER, perampanel
- PHT, phenytoin
- Perampanel
- QC, quality control
- TDM, therapeutic drug monitoring
- VPA, valproic acid
Collapse
Affiliation(s)
- Susan Mohamed
- IRCCS-ISNB Institute of Neurological Sciences of Bologna, Italy
| | - Carmina Candela
- IRCCS-ISNB Institute of Neurological Sciences of Bologna, Italy.,Department of Biomedical and Neuromotor Sciences University of Bologna, Bologna, Italy
| | - Roberto Riva
- IRCCS-ISNB Institute of Neurological Sciences of Bologna, Italy.,Department of Biomedical and Neuromotor Sciences University of Bologna, Bologna, Italy
| | - Manuela Contin
- IRCCS-ISNB Institute of Neurological Sciences of Bologna, Italy.,Department of Biomedical and Neuromotor Sciences University of Bologna, Bologna, Italy
| |
Collapse
|
135
|
Himmelstein DS, Lizee A, Hessler C, Brueggeman L, Chen SL, Hadley D, Green A, Khankhanian P, Baranzini SE. Systematic integration of biomedical knowledge prioritizes drugs for repurposing. eLife 2017; 6:26726. [PMID: 28936969 PMCID: PMC5640425 DOI: 10.7554/elife.26726] [Citation(s) in RCA: 233] [Impact Index Per Article: 33.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2017] [Accepted: 09/11/2017] [Indexed: 12/16/2022] Open
Abstract
The ability to computationally predict whether a compound treats a disease would improve the economy and success rate of drug approval. This study describes Project Rephetio to systematically model drug efficacy based on 755 existing treatments. First, we constructed Hetionet (neo4j.het.io), an integrative network encoding knowledge from millions of biomedical studies. Hetionet v1.0 consists of 47,031 nodes of 11 types and 2,250,197 relationships of 24 types. Data were integrated from 29 public resources to connect compounds, diseases, genes, anatomies, pathways, biological processes, molecular functions, cellular components, pharmacologic classes, side effects, and symptoms. Next, we identified network patterns that distinguish treatments from non-treatments. Then, we predicted the probability of treatment for 209,168 compound-disease pairs (het.io/repurpose). Our predictions validated on two external sets of treatment and provided pharmacological insights on epilepsy, suggesting they will help prioritize drug repurposing candidates. This study was entirely open and received realtime feedback from 40 community members.
Collapse
Affiliation(s)
- Daniel Scott Himmelstein
- Biological and Medical Informatics Program, University of California, San Francisco, San Francisco, United States.,Department of Systems Pharmacology and Translational Therapeutics, University of Pennsylvania, Philadelphia, United States
| | - Antoine Lizee
- Department of Neurology, University of California, San Francisco, San Francisco, United States.,ITUN-CRTI-UMR 1064 Inserm, University of Nantes, Nantes, France
| | - Christine Hessler
- Department of Neurology, University of California, San Francisco, San Francisco, United States
| | - Leo Brueggeman
- Department of Neurology, University of California, San Francisco, San Francisco, United States.,University of Iowa, Iowa City, United States
| | - Sabrina L Chen
- Department of Neurology, University of California, San Francisco, San Francisco, United States.,Johns Hopkins University, Baltimore, United States
| | - Dexter Hadley
- Department of Pediatrics, University of California, San Fransisco, San Fransisco, United States.,Institute for Computational Health Sciences, University of California, San Francisco, San Francisco, United States
| | - Ari Green
- Department of Neurology, University of California, San Francisco, San Francisco, United States
| | - Pouya Khankhanian
- Department of Neurology, University of California, San Francisco, San Francisco, United States.,Center for Neuroengineering and Therapeutics, University of Pennsylvania, Philadelphia, United States
| | - Sergio E Baranzini
- Biological and Medical Informatics Program, University of California, San Francisco, San Francisco, United States.,Department of Neurology, University of California, San Francisco, San Francisco, United States
| |
Collapse
|
136
|
Andonie D, Gáll Z, Bosa P, Dogaru MT, Vancea S. Simultaneous Determination of Carbamazepine and Carbamazepine-10,11-epoxide in Different Biological Matrices by LC-MS/MS. JOURNAL OF INTERDISCIPLINARY MEDICINE 2017. [DOI: 10.1515/jim-2017-0075] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
An uncomplicated, sensitive liquid chromatography linked to mass spectrometry (LC/MS) for evaluation of carbamazepine and carbamazepine-10,11-epoxide (its metabolite) in human plasma, human saliva, rat plasma, and rabbit plasma was developed. Analyses were conducted on a Zorbax SB-C18, 100 mm × 3 mm ID, 3.5 μm column, at a column temperature of 40 ºC. The mobile phase was comprised of 0.1% formic acid in water and methanol in a 35 : 65 (v/v) ratio, with a flow rate of 0.4 mL/min. Lacosamide was utilized as internal standard. Under these chromatographic conditions, the retention times of lacosamide, carbamazepine-10,11-epoxide, and carbamazepine were 1.4 min, 1.6 min, and 2.2 min, respectively. The quantification of the analytes was performed using multiple reaction monitoring, with the use of a triple quadrupole mass spectrometer with electrospray positive ionization. The monitored ions were m/z 194 derived from m/z 237 for carbamazepine, m/z 180 derived from m/z 253 for carbamazepine-10,11-epoxide, and m/z 108 derived from m/z 251 for lacosamide. The samples were prepared by protein precipitation from 0.2 mL of plasma/saliva using 0.6 mL of internal standard solution in methanol. Calibration curves were constructed over the ranges 1.1–17.6 µg/mL and 0.23–5.47 µg/mL for carbamazepine and carbamazepine-epoxide, respectively. The coefficients of determination obtained by using a weighted (1/x) linear regression were greater than 0.994. The reported LC-MS/MS method was applied to preclinical pharmacokinetic studies and therapeutic drug monitoring.
Collapse
Affiliation(s)
- Dan Andonie
- Faculty of Pharmacy , University of Medicine and Pharmacy , Tîrgu Mureş , Romania
| | - Zsolt Gáll
- Faculty of Pharmacy , University of Medicine and Pharmacy , Tîrgu Mureş , Romania
| | - Paul Bosa
- Faculty of Pharmacy , University of Medicine and Pharmacy , Tîrgu Mureş , Romania
| | - Maria Titica Dogaru
- Faculty of Pharmacy , University of Medicine and Pharmacy , Tîrgu Mureş , Romania
| | - Szende Vancea
- Faculty of Pharmacy , University of Medicine and Pharmacy , Tîrgu Mureş , Romania
| |
Collapse
|
137
|
Johannessen Landmark C, Burns ML, Baftiu A, Farmen AH, Lossius MI, Johannessen SI, Tomson T. Pharmacokinetic variability of valproate in women of childbearing age. Epilepsia 2017; 58:e142-e146. [DOI: 10.1111/epi.13872] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/27/2017] [Indexed: 12/13/2022]
Affiliation(s)
- Cecilie Johannessen Landmark
- Program for Pharmacy; Department of Life Sciences and Health; Faculty of Health Sciences; Oslo and Akershus University College of Applied Sciences; Oslo Norway
- National Center for Epilepsy; Oslo University Hospital; Sandvika Norway
- Department of Pharmacology; Oslo University Hospital; Oslo Norway
| | | | - Arton Baftiu
- Program for Pharmacy; Department of Life Sciences and Health; Faculty of Health Sciences; Oslo and Akershus University College of Applied Sciences; Oslo Norway
| | | | - Morten I. Lossius
- National Center for Epilepsy; Oslo University Hospital; Sandvika Norway
| | - Svein I. Johannessen
- National Center for Epilepsy; Oslo University Hospital; Sandvika Norway
- Department of Pharmacology; Oslo University Hospital; Oslo Norway
| | - Torbjörn Tomson
- Department of Clinical Neuroscience; Karolinska Institute; Stockholm Sweden
| |
Collapse
|
138
|
Gaston TE, Bebin EM, Cutter GR, Liu Y, Szaflarski JP. Interactions between cannabidiol and commonly used antiepileptic drugs. Epilepsia 2017; 58:1586-1592. [DOI: 10.1111/epi.13852] [Citation(s) in RCA: 222] [Impact Index Per Article: 31.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/22/2017] [Indexed: 02/02/2023]
Affiliation(s)
- Tyler E. Gaston
- Division of Epilepsy; Department of Neurology; University of Alabama at Birmingham; Birmingham Alabama U.S.A
| | - E. Martina Bebin
- Division of Epilepsy; Department of Neurology; University of Alabama at Birmingham; Birmingham Alabama U.S.A
- Department of Pediatric Neurology; Children's of Alabama; Birmingham Alabama U.S.A
| | - Gary R. Cutter
- Department of Biostatistics; University of Alabama at Birmingham School of Public Health; Birmingham Alabama U.S.A
| | - Yuliang Liu
- Department of Biostatistics; University of Alabama at Birmingham School of Public Health; Birmingham Alabama U.S.A
| | - Jerzy P. Szaflarski
- Division of Epilepsy; Department of Neurology; University of Alabama at Birmingham; Birmingham Alabama U.S.A
| | | |
Collapse
|
139
|
Tomankova V, Anzenbacher P, Anzenbacherova E. Effects of obesity on liver cytochromes P450 in various animal models. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2017; 161:144-151. [DOI: 10.5507/bp.2017.026] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Accepted: 05/11/2017] [Indexed: 01/24/2023] Open
|
140
|
Influence of genetic variants of CYP2D6, CYP2C9, CYP2C19 and CYP3A4 on antiepileptic drug metabolism in pediatric patients with refractory epilepsy. Pharmacol Rep 2017; 69:504-511. [DOI: 10.1016/j.pharep.2017.01.007] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Revised: 01/10/2017] [Accepted: 01/16/2017] [Indexed: 12/11/2022]
|
141
|
Serum Valproic Acid Levels During Initial Conversion of Antituberculoid Therapy in Bipolar Mania: A Case Report and Literature Review. PSYCHOSOMATICS 2017; 58:446-449. [PMID: 28413090 DOI: 10.1016/j.psym.2017.02.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Revised: 02/16/2017] [Accepted: 02/17/2017] [Indexed: 11/20/2022]
|
142
|
Esposito S, Canevini MP, Principi N. Complications associated with antibiotic administration: neurological adverse events and interference with antiepileptic drugs. Int J Antimicrob Agents 2017; 50:1-8. [PMID: 28414069 DOI: 10.1016/j.ijantimicag.2017.01.027] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2016] [Accepted: 01/28/2017] [Indexed: 11/19/2022]
Abstract
Antibiotic use is associated with toxic effects involving the peripheral and central nervous systems and it may interfere with antiepileptic drugs, causing significant variations in their serum levels and activity. Prompt identification of neurological complications during antibiotic therapy is important in order to make appropriate modifications to medication. Characteristics of the drug and the patient, including age and underlying diseases, may favour these complications. The main aim of this study was to review the neurological adverse events that may follow antibiotic administration, the mechanisms that cause them, and the possibility of prevention and treatment. Moreover, the interference of antibiotics with serum levels and the activity of antiepileptic drugs are discussed. The results demonstrate that antibiotic-associated adverse events involving the nervous system are relatively uncommon and are only rarely severe and irreversible, although neurotoxicity has been reported for several antibiotics. Moreover, for patients receiving antiepileptic drugs, monitoring of drug serum levels to avoid the risk of toxicity or inadequate therapy is mandatory during antibiotic treatment. Areas for future research include the effects of combined antibiotic therapies as well as multiple antiepileptic drugs in study populations with an adequate sample size, including neonates and infants, patients with pharmacoresistant epilepsy and elderly patients.
Collapse
Affiliation(s)
- Susanna Esposito
- Pediatric Clinic, Università degli Studi di Perugia, Perugia, Italy.
| | - Maria Paola Canevini
- Child Neurology Unit-Epilepsy Center, San Paolo Hospital, Department of Health Sciences, Università degli Studi di Milano, Milan, Italy
| | - Nicola Principi
- Pediatric Highly Intensive Care Unit, Department of Pathophysiology and Transplantation, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy
| |
Collapse
|
143
|
Black A, Guilbert E, Costescu D, Dunn S, Fisher W, Kives S, Mirosh M, Norman WV, Pymar H, Reid R, Roy G, Varto H, Waddington A, Wagner MS, Whelan AM. No 329-Consensus canadien sur la contraception (4e partie de 4) : chapitre 9 – contraception hormonale combinée. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2017; 39:269-314.e5. [DOI: 10.1016/j.jogc.2017.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
144
|
Bathena SPR, Leppik IE, Kanner AM, Birnbaum AK. Antiseizure, antidepressant, and antipsychotic medication prescribing in elderly nursing home residents. Epilepsy Behav 2017; 69:116-120. [PMID: 28242474 PMCID: PMC5464952 DOI: 10.1016/j.yebeh.2017.01.027] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Revised: 01/24/2017] [Accepted: 01/25/2017] [Indexed: 12/18/2022]
Abstract
OBJECTIVE The incidence of epilepsy is highest in the elderly and the prevalence of epilepsy is higher in nursing home residents than in other cohorts. Co-medications that act in the central nervous system (CNS) are frequently prescribed in this population. The objective was to identify the most commonly prescribed antiseizure drugs (ASDs) and determine the frequency of use of antipsychotic and antidepressant medications in elderly nursing home residents receiving ASDs. METHODS Data were obtained from a pharmacy database serving 18,752 patients in Minnesota and Wisconsin nursing homes. Prescribing information was available on ASD, antidepressant, and antipsychotic drugs on one day in October 2013. The frequency distribution by age, formulation, trademarked/generic drugs, route of administration, and multiple drug combinations were determined. RESULTS Overall, 66.8% of 18,752 residents received at least one CNS-active drug as classified by the Generic Product Identifier classification system. For those 65years and older, ASDs were prescribed for 14.3% residents. Gabapentin comprised 7.3%; valproate 3.0%; levetiracetam 1.8%; and phenytoin 0.9%. An antidepressant was used in 64.2% of persons prescribed an ASD. Antidepressant use varied for specific ASDs and ranged from 50 to 75%. An antipsychotic medication was used in 30% of persons prescribed an ASD and ranged from 16.8 to 54.2% for specific ASDs. Both antidepressant and antipsychotic use occurred in 22.2% of persons prescribed an ASD, respectively. SIGNIFICANCE The pattern of CNS-active drug use has changed from previous years in this geographic region. Use of phenytoin has declined markedly, but antidepressant use has increased substantially. The CNS side effect profile of these medications and the possible long-term consequences in this population can greatly complicate their therapy.
Collapse
Affiliation(s)
- Sai Praneeth R Bathena
- Department of Experimental and Clinical Pharmacology, University of Minnesota, Minneapolis, MN, United States
| | - Ilo E Leppik
- Department of Experimental and Clinical Pharmacology, University of Minnesota, Minneapolis, MN, United States; MINCEP Epilepsy Care, Minneapolis, MN, United States; Department of Neurology, School of Medicine, University of Minnesota, United States
| | - Andres M Kanner
- Department of Neurology, Miller School of Medicine, University of Miami, United States
| | - Angela K Birnbaum
- Department of Experimental and Clinical Pharmacology, University of Minnesota, Minneapolis, MN, United States.
| |
Collapse
|
145
|
Borghs S, Thieffry S, Noack-Rink M, Dedeken P, Hong LS, Byram L, Logan J, Chan J, Kiri V. Health care cost associated with the use of enzyme-inducing and non-enzyme-active antiepileptic drugs in the UK: a long-term retrospective matched cohort study. BMC Neurol 2017; 17:59. [PMID: 28335764 PMCID: PMC5364597 DOI: 10.1186/s12883-017-0837-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Accepted: 03/13/2017] [Indexed: 11/29/2022] Open
Abstract
Background Some antiepileptic drugs (AEDs) induce expression of hepatic enzymes. This can contribute to comorbidities via interference with metabolic pathways and concomitant drug metabolization, thereby increasing the likelihood of health care interventions. Using medical records, we compared the direct health care cost in patients initiating epilepsy therapy with enzyme-inducing AEDs (EIAEDs) vs non-enzyme-active AEDs (nEAAEDs) over up to 12 years. Methods Patients with untreated epilepsy were indexed in the UK Clinical Practice Research Datalink and Hospital Episode Statistics database when prescribed a new EIAED or nEAAED between January 2001 and December 2010. Propensity score matching reduced confounding factors between cohorts. Patients were followed until cohort treatment failure or data cut-off. The primary outcome was the median standardized monthly direct health care cost during follow-up in 2014 £GBP, calculated using published reference costs and compared using a Mann–Whitney U test. Results The unmatched EIAED cohort (n = 2752) was older (54 vs 46 years), more likely to be male, had more comorbidities, and higher health care resource use/cost during the 1-year pre-index period (median £3014 vs £2516) than the nEAAED cohort (n = 2,137). The most common index EIAED and nEAAED were carbamazepine (63.3%) and lamotrigine (58.0%), respectively. After matching, cohorts had similar features (n = 951 each). Over up to 12 years of follow-up, the median standardized monthly direct health care cost was £229 for the EIAED and £188 for the nEAAED cohorts (p = 0.0091). The median cost was higher for the EIAED cohort in every year of follow-up. In the two cohorts, 25.1% and 20.1% of total mean cost during follow-up was epilepsy-related, with approximately 4.6% and 3.0% for AED acquisition, respectively. The median time to cohort treatment failure was shorter in the matched EIAED cohort (468 vs 1194 days). Conclusions Patients in the UK who initiated epilepsy therapy with an EIAED appeared to be at higher risk of complications associated with enzyme induction. In long-term matched cohort analyses, the median total direct health care cost associated with EIAED therapy was higher than with nEAAEDs. Changing current treatment practices could potentially improve patient outcomes and reduce costs. Electronic supplementary material The online version of this article (doi:10.1186/s12883-017-0837-y) contains supplementary material, which is available to authorized users.
Collapse
|
146
|
Huang CR, Lin CH, Hsiao SC, Chen NC, Tsai WC, Chen SD, Lu YT, Chuang YC. Drug interaction between valproic acid and carbapenems in patients with epileptic seizures. Kaohsiung J Med Sci 2017; 33:130-136. [DOI: 10.1016/j.kjms.2016.12.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Revised: 11/07/2016] [Accepted: 12/13/2016] [Indexed: 11/28/2022] Open
|
147
|
Sperling MR, Klein P, Tsai J. Randomized, double‐blind, placebo‐controlled phase 2 study of ganaxolone as add‐on therapy in adults with uncontrolled partial‐onset seizures. Epilepsia 2017; 58:558-564. [DOI: 10.1111/epi.13705] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/18/2017] [Indexed: 11/27/2022]
Affiliation(s)
- Michael R. Sperling
- Jefferson Comprehensive Epilepsy Center Thomas Jefferson University Philadelphia Pennsylvania U.S.A
| | - Pavel Klein
- Mid‐Atlantic Epilepsy and Sleep Center Bethesda Maryland U.S.A
| | - Julia Tsai
- Marinus Pharmaceuticals Radnor Pennsylvania U.S.A
| |
Collapse
|
148
|
Abstract
Idiosyncratic hepatotoxicity is one of the most common reasons for an approved drug being restricted. This article focuses on hepatotoxicity of selected and recently introduced agents, such as, tyrosine kinase inhibitors, monoclonal antibodies, novel oral anticoagulants, newer antiplatelets, antibiotics, anti-diabetics, anti-epileptics, anti-depressants, anti-psychotics and anti-retrovirals. Overall, the incidence of clinically relevant hepatotoxicity from newer agents seems to be lower than that of the older agents. Nevertheless, cases of severe hepatotoxicity have been reported due to some of these newer agents, including, trastuzumab, ipilimumab, infliximab, imatinib, bosutinib, dasatinib, gefitinib, erlotinib, sunitinib, ponatinib, lapatinib, vemurafenib, dabigatran, rivaroxaban, felbamate, lamotrigine, levetiracetam, venlafaxine, duloxetine, darunavir, and maraviroc.
Collapse
Affiliation(s)
- Chalermrat Bunchorntavakul
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Pennsylvania, 2 Dulles, 3400 Spruce Street, HUP, Philadelphia, PA 19104, USA; Division of Gastroenterology and Hepatology, Department of Medicine, Rajavithi Hospital, College of Medicine, Rangsit University, Rajavithi Road, Ratchathewi, Bangkok 10400, Thailand
| | - K Rajender Reddy
- Liver Transplantation, Viral Hepatitis Center, University of Pennsylvania, 2 Dulles, 3400 Spruce Street, HUP, Liver Transplant Office, Philadelphia, PA 19104, USA.
| |
Collapse
|
149
|
Farouk F, ElKady EF, Azzazy HME. Simultaneous UPLC-MS/MS determination of antiepileptic agents for dose adjustment. Biomed Chromatogr 2017; 31. [DOI: 10.1002/bmc.3921] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2016] [Revised: 11/27/2016] [Accepted: 12/12/2016] [Indexed: 11/07/2022]
Affiliation(s)
- Faten Farouk
- Pharmaceutical Chemistry Department, Faculty of Pharmacy; Ahram Canadian University; 6th of October City Egypt
| | - Ehab F. ElKady
- Pharmaceutical Chemistry Department, Faculty of Pharmacy; Cairo University; Cairo Egypt
| | - Hassan M. E. Azzazy
- Department of Chemistry, School of Science and Engineering; American University in Cairo; New Cairo Egypt
| |
Collapse
|
150
|
|