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Mittur A, Madanick R, Langlois M, Boyd B. Effect of Hepatic Impairment on the Pharmacokinetics of Fenfluramine and Norfenfluramine. J Clin Pharmacol 2024; 64:887-898. [PMID: 38523492 DOI: 10.1002/jcph.2431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Accepted: 02/23/2024] [Indexed: 03/26/2024]
Abstract
Fenfluramine (Fintepla®) is approved for the treatment of seizures associated with the rare epileptic encephalopathies Dravet syndrome and Lennox-Gastaut syndrome. Fenfluramine is extensively metabolized; thus, patients with hepatic impairment (HI) might experience changes in exposure to fenfluramine or its metabolites. In this phase 1 study, we investigated the pharmacokinetics (PK) and safety of a single oral dose of 0.35 mg/kg fenfluramine in subjects with mild (n = 8), moderate (n = 8), or severe (n = 7) HI (Child-Pugh A/B/C, respectively) and healthy control subjects (n = 22) matched for sex, age, and BMI. All subjects underwent serial sampling to determine total plasma concentrations of fenfluramine and its active metabolite, norfenfluramine. Hepatic impairment was associated with increases in fenfluramine exposures, mainly area-under-the-curve (AUC). Geometric least squares mean ratios (90% confidence intervals) for fenfluramine AUC0-∞ in mild, moderate, and severe HI versus healthy controls were 1.98 (1.36-2.90), 2.13 (1.43-3.17), and 2.77 (1.82-4.24), respectively. Changes in exposure to norfenfluramine in mild, moderate, and severe HI were minimal compared with normal hepatic function. Exposures to fenfluramine and norfenfluramine in all HI groups were within the ranges that have been characterized in the overall development program, including ranges examined in exposure-response relationships for efficacy and safety in patients, and determined to have an acceptable safety profile. Mild and moderate HI had a modest effect on fenfluramine exposure that was not clinically meaningful, whereas the higher fenfluramine exposure in severe HI may require dose reduction based on general caution in this population. The modest decrease in norfenfluramine exposure is not considered clinically relevant.
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Affiliation(s)
| | - Ryan Madanick
- PPD, Thermo Fisher Scientific, Morrisville, North Carolina, USA
| | | | - Brooks Boyd
- UCB Biosciences, Inc, Morrisville, North Carolina, USA
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Biswas S, Kumar R, Shalimar, Acharya SK. Viral hepatitis-induced acute liver failure. Indian J Gastroenterol 2024; 43:312-324. [PMID: 38451383 DOI: 10.1007/s12664-024-01538-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Accepted: 01/18/2024] [Indexed: 03/08/2024]
Abstract
Viral hepatitis-induced acute liver failure (ALF) is a preventable cause for liver-related mortality worldwide. Viruses are the most common cause for ALF in developing nations in contrast to the west, where acetaminophen is largely responsible. Viruses may be hepatotropic or affect the liver secondary to a systemic infection. In tropical countries, infections such as leptospirosis, scrub typhus and malaria can mimic the symptoms of ALF. Differentiating these ALF mimics is crucial because they require etiology-specific therapy. Treatment of viral hepatitis-induced ALF is two-pronged and directed towards providing supportive care to prevent organ failures and antiviral drugs for some viruses. Liver transplantation (LT) is an effective modality for patients deteriorating despite adequate supportive care. Early referral and correct identification of patients who require a transplant are important. Liver support devices and plasma exchange have evolved into "bridging modalities" for LT. Preventive strategies such as hand hygiene, use of clean and potable water and inclusion of vaccines against viral hepatitis in the national program are simple yet very effective methods focusing on the preventive aspect of this disease.
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Affiliation(s)
- Sagnik Biswas
- Department of Gastroenterology and Human Nutrition Unit, All India Institute of Medical Sciences, New Delhi, 110 029, India
| | - Ramesh Kumar
- Department of Gastroenterology, All India Institute of Medical Sciences, Patna, 801 507, India
| | - Shalimar
- Department of Gastroenterology and Human Nutrition Unit, All India Institute of Medical Sciences, New Delhi, 110 029, India.
| | - Subrat Kumar Acharya
- Department of Gastroenterology and Human Nutrition Unit, All India Institute of Medical Sciences, New Delhi, 110 029, India
- KIIT University, Bhubaneswar, 751 024, India
- Fortis Escorts Digestive and Liver Institute, Okhla, New Delhi, 110 025, India
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Costa B, Vale N. Virus-Induced Epilepsy vs. Epilepsy Patients Acquiring Viral Infection: Unravelling the Complex Relationship for Precision Treatment. Int J Mol Sci 2024; 25:3730. [PMID: 38612542 PMCID: PMC11011490 DOI: 10.3390/ijms25073730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Revised: 01/04/2024] [Accepted: 03/25/2024] [Indexed: 04/14/2024] Open
Abstract
The intricate relationship between viruses and epilepsy involves a bidirectional interaction. Certain viruses can induce epilepsy by infecting the brain, leading to inflammation, damage, or abnormal electrical activity. Conversely, epilepsy patients may be more susceptible to viral infections due to factors, such as compromised immune systems, anticonvulsant drugs, or surgical interventions. Neuroinflammation, a common factor in both scenarios, exhibits onset, duration, intensity, and consequence variations. It can modulate epileptogenesis, increase seizure susceptibility, and impact anticonvulsant drug pharmacokinetics, immune system function, and brain physiology. Viral infections significantly impact the clinical management of epilepsy patients, necessitating a multidisciplinary approach encompassing diagnosis, prevention, and treatment of both conditions. We delved into the dual dynamics of viruses inducing epilepsy and epilepsy patients acquiring viruses, examining the unique features of each case. For virus-induced epilepsy, we specify virus types, elucidate mechanisms of epilepsy induction, emphasize neuroinflammation's impact, and analyze its effects on anticonvulsant drug pharmacokinetics. Conversely, in epilepsy patients acquiring viruses, we detail the acquired virus, its interaction with existing epilepsy, neuroinflammation effects, and changes in anticonvulsant drug pharmacokinetics. Understanding this interplay advances precision therapies for epilepsy during viral infections, providing mechanistic insights, identifying biomarkers and therapeutic targets, and supporting optimized dosing regimens. However, further studies are crucial to validate tools, discover new biomarkers and therapeutic targets, and evaluate targeted therapy safety and efficacy in diverse epilepsy and viral infection scenarios.
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Affiliation(s)
- Bárbara Costa
- PerMed Research Group, Center for Health Technology and Services Research (CINTESIS), Rua Doutor Plácido da Costa, s/n, 4200-450 Porto, Portugal;
- CINTESIS@RISE, Faculty of Medicine, University of Porto, Alameda Professor Hernâni Monteiro, 4200-319 Porto, Portugal
- Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine, University of Porto, Rua Doutor Plácido da Costa, s/n, 4200-450 Porto, Portugal
| | - Nuno Vale
- PerMed Research Group, Center for Health Technology and Services Research (CINTESIS), Rua Doutor Plácido da Costa, s/n, 4200-450 Porto, Portugal;
- CINTESIS@RISE, Faculty of Medicine, University of Porto, Alameda Professor Hernâni Monteiro, 4200-319 Porto, Portugal
- Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine, University of Porto, Rua Doutor Plácido da Costa, s/n, 4200-450 Porto, Portugal
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Singh GK, Kumari B, Das N, Zaman K, Prasad P, Singh RB. Design, synthesis, molecular docking and pharmacological evaluation of some thiadiazole based nipecotic acid derivatives as a potential anticonvulsant and antidepressant agents. 3 Biotech 2024; 14:71. [PMID: 38362592 PMCID: PMC10864245 DOI: 10.1007/s13205-023-03897-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 12/18/2023] [Indexed: 02/17/2024] Open
Abstract
In our continuous effort to develop novel antiepileptic drug, a new series of nipecotic acid derivatives having1,3,4-thiadiazole nucleus were designed and synthesized. This study aims to improve the lipophilicity of nipecotic acid by attaching some lipophilic anchors like thiadiazole and substituted aryl acid derivatives. In our previous study, we noticed that the N-substituted oxadiazole derivative of nipecotic acid exhibited significant antiepileptic activity in the rodent model. The synthesized compounds were characterized by FT-IR, 1H-NMR, 13C-NMR, Mass, and elemental analysis. The anticonvulsant activity was evaluated by using the maximal electroshock-induced seizure model in rats (MES) and the subcutaneous pentylenetetrazol (scPTZ) test in mice. None of the compounds were found to be active in the MES model whereas compounds (TN2, TN9, TN12, TN13, and TN15) produced significant protection against the scPTZ-induced seizures model. The compounds showing antiepileptic activity were additionally evaluated for antidepressant activity by using the forced swim test, 5-hydroxytryptophan (5-HTP)-induced head twitch test, and learned helplessness test. All the molecules that showed anticonvulsant activity (TN2, TN9, TN12, TN13, and TN15), also exerted significant antidepressant effects in the animal models. The selected compounds were subjected to different toxicity studies. Compounds were found to have no neurotoxicity in the rota-rod test and devoid of hepatic and renal toxicity in 30 days repeated oral toxicity test. Further, a homology model was developed to perform the in-silico molecular docking and dynamics studies which revealed the similar binding of compound TN9 within the active binding pocket and were found to be the most potent anti-epileptic agent. The market expectation for newly developed antiepileptic thiadiazole-based nipecotic acid derivatives is significant, driven by their potential to offer improved therapeutic outcomes and reduced side effects, addressing a critical need in epilepsy treatment. These innovative compounds hold promise for meeting the demand for more effective and safer antiepileptic medications. Supplementary Information The online version contains supplementary material available at 10.1007/s13205-023-03897-1.
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Affiliation(s)
- Gireesh Kumar Singh
- Department of Pharmacy, School of Health Sciences, Central University of South Bihar, Gaya, Bihar 824236 India
| | - Bindu Kumari
- Department of Pharmacy, School of Health Sciences, Central University of South Bihar, Gaya, Bihar 824236 India
| | - Nirupam Das
- Department of Pharmaceutical Science, SSMPS, Assam University, Silchar, Assam 788151 India
| | - Kamaruz Zaman
- Department of Pharmaceutical Sciences, Dibrugarh University, Dibrugarh, Assam 786004 India
| | - Pratibha Prasad
- Department of Neurology, All India Institute of Medical Sciences, Deoghar, Jharkhand 814142 India
| | - Ravi Bhushan Singh
- Institute of Pharmacy, Harischandra P.G. College, Bawanbeegha, Azamgarh Road, Varanasi, 221002 India
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Kim CS, Tran LK, Goodberlet MZ, Szumita PM, Marino KK. Evaluation of Goal Phenytoin Levels After an Initial Intravenous Loading Dose at an Academic Medical Center. Ann Pharmacother 2024; 58:148-155. [PMID: 37231739 DOI: 10.1177/10600280231174570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023] Open
Abstract
BACKGROUND Phenytoin intravenous loading doses are administered in status epilepticus to rapidly achieve therapeutic levels. Accurately assessing phenytoin levels after the initial load can be challenging because of its complex pharmacokinetic profile and nonstandardized weight-based loading doses. OBJECTIVES The objectives of this analysis were to determine the incidence of patients achieving goal phenytoin levels after the initial loading dose and characterize factors that contribute to achieving the goal level. METHODS This single-center, retrospective cohort analysis was approved by our institutional review board and included adult patients who received a phenytoin load from May 2016 to March 2021. Patients were excluded if no total phenytoin level was drawn within 24 hours of the load, if the maintenance dose was given before the first level was drawn, or if the patient was on phenytoin before the load. The major endpoint was the percentage of patients achieving a corrected goal phenytoin level of ≥10 mcg/mL after the initial load. Multivariate regression was used to determine predictors of achieving the goal phenytoin level. RESULTS Of the 152 patients included, 139 patients (91.4%) achieved a corrected goal level after the first load. Patients at goal received a significantly higher median weight-based loading dose (19.1 mg/kg [15.0-20.0] vs 12.6 mg/kg [10.1-15.0], P < 0.01). The multivariate analysis identified weight-based dosing as a statistically significant predictor of achieving the corrected goal level (odds ratio, 1.30; 95% CI, 1.12-1.53; P < 0.01). CONCLUSION AND RELEVANCE Most patients achieved a corrected goal phenytoin level after the initial load. A higher median weight-based loading dose was shown to be a predictor of achieving the goal level and should be encouraged for rapid seizure termination. Future studies are warranted to confirm patient-specific factors that affect rapid achievement of the goal phenytoin level.
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Affiliation(s)
- Christine S Kim
- Department of Pharmacy, Brigham and Women's Hospital, Boston, MA, USA
| | - Lena K Tran
- Department of Pharmacy, AdventHealth Central Florida, Kissimmee, FL, USA
| | | | - Paul M Szumita
- Department of Pharmacy, Brigham and Women's Hospital, Boston, MA, USA
| | - Kaylee K Marino
- Department of Pharmacy, Brigham and Women's Hospital, Boston, MA, USA
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Ayembilla JA, Khalid AR, Abubakari SB, Adams AR, Botchway FA, Antwi S, Otu PNY, Appiah M, Osei-Adjei G, Kottoh KO, Ahiabenu-Williams P, Quasie O. Acute and Subchronic Toxicity Assessment of Conventional Soxhlet Cymbopogon citratus Leaves Extracts in Sprague-Dawley Rats. J Toxicol 2023; 2023:8575741. [PMID: 38111630 PMCID: PMC10727804 DOI: 10.1155/2023/8575741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 10/03/2023] [Accepted: 11/27/2023] [Indexed: 12/20/2023] Open
Abstract
Background In Ghana, Cymbopogon citratus leaves together with guava, pawpaw, and lime are processed into a decoction to treat fever. To encourage its usage, preclinical validation of the safety profile of the plant is required. The acute and subchronic toxicities of the conventional Soxhlet ethanolic Cymbopogon citratus leaves extract in Sprague-Dawley rats were investigated. Methods Pulverized Cymbopogon citratus leaves were extracted with 98% ethanol using the conventional Soxhlet extraction (CSE) method and dried. In the acute toxicity study, a single dose of 5000 mg/kg body weight was administered to six female Sprague-Dawley rats and 1 ml/100 g body weight normal saline to control (6) once, and signs of toxicity were observed every hour for the first 12 hr, 24 hr, and 48 hr through to 14 days. In the subchronic study, the treatment groups were administered 200 mg/kg, 600 mg/kg, and 1200 mg/kg, respectively, of the CSE C. citratus leaves extract for six weeks. Analyses were conducted on the blood, urine, and serum samples of the rats. Histopathological examination of the liver, heart, kidney, spleen, and lungs was carried out at termination. Analysis of variance (ANOVA) was performed to determine statistically significant differences between the test and control rats at P < 0.05. Results The results revealed that there were no statistically significant differences (p > 0.05) in the urinalysis and haematological analysis between control and test rats over the treatment period. Similarly, CSE C. citratus leaves extract did not induce any significant biochemical changes in the treatment group; however, there was a weight loss effect on the treated rats. There were no noticeable morphological changes in the heart, liver, spleen, lung, and kidney of the test rats compared to the control. Conclusion CSE ethanolic C. citratus leaves extract has a weight loss effect, and long-term administration of the extract may not cause any organ-specific toxicity to the consumers.
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Affiliation(s)
- Jacob Apibilla Ayembilla
- Department of Science Laboratory Technology, Faculty of Applied Sciences, Accra Technical University, Accra, Ghana
| | - Abdul Raouf Khalid
- Department of Medical Laboratory Technology, Faculty of Applied Sciences, Accra Technical University, Accra, Ghana
| | - Sharif Buari Abubakari
- Department of Pharmacology & Toxicology, Centre for Plant Medicine Research, Mampong-Akuapem, Ghana
| | - Abdul Rashid Adams
- Department of Medical Laboratory Science, School of Biomedical and Allied Health Sciences, University of Ghana, Legon, Accra, Ghana
| | - Felix Abekah Botchway
- Department of Medical Laboratory Technology, Faculty of Applied Sciences, Accra Technical University, Accra, Ghana
| | - Stephen Antwi
- Department of Pharmacology & Toxicology, Centre for Plant Medicine Research, Mampong-Akuapem, Ghana
| | - Phyllis Naa Yarley Otu
- Department of Science Laboratory Technology, Faculty of Applied Sciences, Accra Technical University, Accra, Ghana
| | - Michael Appiah
- Department of Medical Laboratory Technology, Faculty of Applied Sciences, Accra Technical University, Accra, Ghana
| | - George Osei-Adjei
- Department of Medical Laboratory Technology, Faculty of Applied Sciences, Accra Technical University, Accra, Ghana
| | - Kwame Owen Kottoh
- Department of Medical Laboratory Technology, Faculty of Applied Sciences, Accra Technical University, Accra, Ghana
| | - Peace Ahiabenu-Williams
- Department of Medical Laboratory Technology, Faculty of Applied Sciences, Accra Technical University, Accra, Ghana
| | - Olga Quasie
- Department of Pharmacology & Toxicology, Centre for Plant Medicine Research, Mampong-Akuapem, Ghana
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Rosell-Hidalgo A, Eakins J, Walker P, Moore AL, Ghafourian T. Risk Assessment of Psychotropic Drugs on Mitochondrial Function Using In Vitro Assays. Biomedicines 2023; 11:3272. [PMID: 38137493 PMCID: PMC10741027 DOI: 10.3390/biomedicines11123272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Revised: 11/30/2023] [Accepted: 12/04/2023] [Indexed: 12/24/2023] Open
Abstract
Mitochondria are potential targets responsible for some drug- and xenobiotic-induced organ toxicities. However, molecular mechanisms of drug-induced mitochondrial toxicities are mostly unknown. Here, multiple in vitro assays were used to investigate the effects of 22 psychotropic drugs on mitochondrial function. The acute extracellular flux assay identified inhibitors of the electron transport chain (ETC), i.e., aripiprazole, phenytoin, and fluoxetine, an uncoupler (reserpine), substrate inhibitors (quetiapine, carbamazepine, buspirone, and tianeptine), and cytotoxic compounds (chlorpromazine and valproic acid) in HepG2 cells. Using permeabilized HepG2 cells revealed minimum effective concentrations of 66.3, 6730, 44.5, and 72.1 µM for the inhibition of complex-I-linked respiration for quetiapine, valproic acid, buspirone, and fluoxetine, respectively. Assessing complex-II-linked respiration in isolated rat liver mitochondria revealed haloperidol is an ETC inhibitor, chlorpromazine is an uncoupler in basal respiration and an ETC inhibitor under uncoupled respiration (IC50 = 135 µM), while olanzapine causes a mild dissipation of the membrane potential at 50 µM. This research elucidates some mechanisms of drug toxicity and provides some insight into their safety profile for clinical drug decisions.
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Affiliation(s)
- Alicia Rosell-Hidalgo
- Cyprotex Discovery Ltd., No. 24 Mereside, Alderley Park, Macclesfield, Cheshire SK10 4TG, UK; (A.R.-H.); (J.E.)
| | - Julie Eakins
- Cyprotex Discovery Ltd., No. 24 Mereside, Alderley Park, Macclesfield, Cheshire SK10 4TG, UK; (A.R.-H.); (J.E.)
| | - Paul Walker
- Cyprotex Discovery Ltd., No. 24 Mereside, Alderley Park, Macclesfield, Cheshire SK10 4TG, UK; (A.R.-H.); (J.E.)
| | - Anthony L. Moore
- Department of Biochemistry and Biomedicine, School of Life Sciences, University of Sussex, Falmer, Brighton BN1 9QG, UK;
| | - Taravat Ghafourian
- Department of Pharmaceutical Sciences, Barry & Judy Silverman College of Pharmacy, Nova Southeastern University, 3200 South University Drive, Ft. Lauderdale, FL 33328-2018, USA
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de Freitas RN, da Silva LGL, Fiais GA, Ferreira DSDB, Veras ASC, Teixeira GR, Oliveira SHP, Dornelles RCM, Nakamune ACDMS, Fakhouri WD, Chaves-Neto AH. Alterations in salivary biochemical composition and redox state disruption induced by the anticonvulsant valproic acid in male rat salivary glands. Arch Oral Biol 2023; 155:105805. [PMID: 37741048 DOI: 10.1016/j.archoralbio.2023.105805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 09/11/2023] [Accepted: 09/12/2023] [Indexed: 09/25/2023]
Abstract
OBJECTIVE To investigate the effects of the anticonvulsant valproic acid (VPA) on salivary glands in male rat using biochemical, functional, histomorphometric, and redox state parameters. MATERIALS AND METHODS Twenty-four male Wistar rats were randomly distributed into three groups (n = 8 per group): Control (0.9% saline solution), VPA100 (100 mg/kg), and VPA400 (400 mg/kg). After 21 consecutive days of treatment with by intragastric gavage. Pilocarpine-induced saliva was collected to determine salivary flow rate, pH, buffering capacity, and biochemical composition. Analyses of histomorphometric parameters and redox balance markers were performed on the parotid and submandibular glands. RESULTS Salivary flow rate, pH, buffering capacity, total protein, potassium, sodium, and chloride were similar between groups. However, phosphate and calcium were reduced in VPA400, while amylase was increased in both VPA100 and VPA400. We did not detect significant differences in the areas of acini, ducts, and connective tissue in the salivary glands between the groups. There were no significant changes in the redox status of the submandibular glands. In turn, in the parotid glands we detected reduced total oxidizing capacity and lipid peroxidation, measured as thiobarbituric acid reactive substances (TBARs) and higher uric acid concentration in both the VPA100 and VPA400 groups, and increased superoxide dismutase (SOD) in the VPA400 group. CONCLUSION Chronic treatment with VPA modified the salivary biochemical composition and caused disruption in the redox state of the parotid gland in rats.
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Affiliation(s)
- Rayara Nogueira de Freitas
- Department of Basic Sciences, São Paulo State University (Unesp), School of Dentistry, Araçatuba, São Paulo, Brazil; Programa de Pós-Graduação em Ciências - Saúde Bucal da Criança, São Paulo State University (Unesp), School of Dentistry, Araçatuba, São Paulo, Brazil
| | | | - Gabriela Alice Fiais
- Department of Basic Sciences, São Paulo State University (Unesp), School of Dentistry, Araçatuba, São Paulo, Brazil; Programa de Pós-Graduação Multicêntrico em Ciências Fisiológicas - SBFis, São Paulo State University (Unesp), School of Dentistry, Araçatuba, São Paulo, Brazil
| | | | - Allice Santos Cruz Veras
- Department of Physical Education, São Paulo State University (Unesp), School of Technology and Sciences, Presidente Prudente, São Paulo, Brazil; Programa de Pós-Graduação Multicêntrico em Ciências Fisiológicas - SBFis, São Paulo State University (Unesp), School of Dentistry, Araçatuba, São Paulo, Brazil
| | - Giovana Rampazzo Teixeira
- Department of Physical Education, São Paulo State University (Unesp), School of Technology and Sciences, Presidente Prudente, São Paulo, Brazil; Programa de Pós-Graduação Multicêntrico em Ciências Fisiológicas - SBFis, São Paulo State University (Unesp), School of Dentistry, Araçatuba, São Paulo, Brazil
| | - Sandra Helena Penha Oliveira
- Department of Basic Sciences, São Paulo State University (Unesp), School of Dentistry, Araçatuba, São Paulo, Brazil; Programa de Pós-Graduação Multicêntrico em Ciências Fisiológicas - SBFis, São Paulo State University (Unesp), School of Dentistry, Araçatuba, São Paulo, Brazil
| | - Rita Cássia Menegati Dornelles
- Department of Basic Sciences, São Paulo State University (Unesp), School of Dentistry, Araçatuba, São Paulo, Brazil; Programa de Pós-Graduação Multicêntrico em Ciências Fisiológicas - SBFis, São Paulo State University (Unesp), School of Dentistry, Araçatuba, São Paulo, Brazil
| | | | - Walid D Fakhouri
- Center for Craniofacial Research, Department of Diagnostic and Biomedical Sciences, School of Dentistry, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Antonio Hernandes Chaves-Neto
- Department of Basic Sciences, São Paulo State University (Unesp), School of Dentistry, Araçatuba, São Paulo, Brazil; Programa de Pós-Graduação em Ciências - Saúde Bucal da Criança, São Paulo State University (Unesp), School of Dentistry, Araçatuba, São Paulo, Brazil; Programa de Pós-Graduação Multicêntrico em Ciências Fisiológicas - SBFis, São Paulo State University (Unesp), School of Dentistry, Araçatuba, São Paulo, Brazil.
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Azzam SM, Abdel Khalek MR, Abdel Rahman AAS, Osman AA, Selim HMRM, Sharif AF, El-Khattib YA, Rabea S, Ali SK, Darwish A. Revealing how phenytoin triggers liver damage and the potential protective effects of Balanites Aegyptiaca fruit extracts: Exploring Nrf2/MAPK/ Beclin-1 signaling pathways. Biomed Pharmacother 2023; 165:115265. [PMID: 37541174 DOI: 10.1016/j.biopha.2023.115265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 07/24/2023] [Accepted: 07/31/2023] [Indexed: 08/06/2023] Open
Abstract
Phenytoin-induced liver injury (PHT ILII) is a serious condition that may necessitate discontinuation of the drug. This study investigates the mechanisms of PHT ILII and evaluates the protective effects of Balanites Aegyptiaca (BA) fruit extracts on the liver. We focus on the Nrf2/MAPK/NF-κB/Beclin-1 signaling pathways involved in oxidative stress and inflammation from drug-induced liver injury. Phytochemical analyses of BA fruit extracts (Bu-F and EA-F) are conducted. Molecular docking techniques explore the interaction between phenytoin (PHT) and the Nrf2/MAPK/NF-κB/Beclin-1 pathways. Thirty-six male rats are divided into Control, Bu-F, EA-F, PHT, Bu-F/PHT, and EA-F/PHT groups, and they are observed for 45 days. EA-F extract is rich in phenolics/flavonoids, while Bu-F extract mainly contains saponins.PHT ILII causes histological damage in liver tissues and affects Nrf-2, MAPK, TNF-α, IL-1β, Mcp-1, Beclin-1, iNOS expression, and liver function markers (ALT, AST, ALP). However, EA-F/Bu-F extracts effectively improve the histological structure and significantly reduce biochemical/immunohistochemical parameters, restoring them to near-normal levels. EA-F extract is particularly effective.In conclusion, the Nrf2/MAPK /Beclin-1 pathways play a critical role in the development of PHT ILII. BA fruit extracts show promise as hepato-protective agents, with the EA-F extract demonstrating superior efficacy. These results lay the groundwork for new treatments for PHT ILII and drug-induced liver injuries.
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Affiliation(s)
- Shaimaa M Azzam
- Department of Biochemistry, Egyptian Drug Authority (EDA), Formerly National Organization for Drug Control and Research (NODCAR), Giza, Egypt.
| | - Marwa Refaat Abdel Khalek
- Phytochemistry department, Egyptian Drug Authority (EDA), Formerly National Organization for Drug Control and Research (NODCAR), Giza 11221, Egypt.
| | - Amina A S Abdel Rahman
- Department of Zoology, Faculty of Women for Arts, Science, and Education, Ain Shams University, Asmaa Fahmy Street, Heliopolis, Cairo, Egypt.
| | - Amany Abdelhameid Osman
- Department of Zoology, Faculty of Women for Arts, Science, and Education, Ain Shams University, Asmaa Fahmy Street, Heliopolis, Cairo, Egypt.
| | - Heba Mohammed Refat M Selim
- Department of Pharmaceutical Sciences, Faculty of Pharmacy, AlMaarefa University, Diriyah 3713, Riyadh, Saudi Arabia; Microbiology and Immunology Department, Faculty of Pharmacy (Girls), Al-Azhar University, Cairo, Egypt.
| | - Asmaa Fady Sharif
- Forensic Medicine and Clinical Toxicology Department, Faculty of Medicine, Tanta University, Tanta 31527, Egypt; Clinical Medical Sciences Department, College of Medicine, Dar Al Uloom University, Riyadh 13314, Saudi Arabia.
| | | | - Sameh Rabea
- Department of Pharmaceutical Sciences, Faculty of Pharmacy, AlMaarefa University, Diriyah 3713, Riyadh, Saudi Arabia.
| | - Sahar K Ali
- Department of Clinical Pharmacology, Faculty of Medicine, Zagazig University, Zagazig 44519, Egypt.
| | - Alshaymaa Darwish
- Department of Biochemistry, Faculty of Pharmacy, Sohag University, Sohag, Egypt.
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Minz P, Oroan A, Kujur A, Paswan DK, Nag AR. Effects of anticonvulsant drug on liver enzymes among children in a tribal state of India: A longitudinal study. J Family Med Prim Care 2023; 12:1394-1398. [PMID: 37649745 PMCID: PMC10465034 DOI: 10.4103/jfmpc.jfmpc_2307_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 03/30/2023] [Accepted: 04/19/2023] [Indexed: 09/01/2023] Open
Abstract
Introduction Epilepsy is a syndrome of various neurological disorders. Idiosyncratic hepatotoxicity is a rare adverse effect associated with antiepileptic drugs (AED) therapy. Antiepileptic drugs may produce hepatic injury as part of a more widespread hypersensitivity reaction. Laboratory monitoring of asymptomatic effects may allow for the early detection of hepatotoxicity. So the present prospective longitudinal study was carried out to determine the effects of Anticonvulsant drug on liver enzymes among Epileptic Children. Materials Methods A prospective observational study was conducted among children with seizure disorder attending Paediatric outdoor patient Department of Rajendra Institute of Medical Sciences, Ranchi from February 2014 to October 2015. 50 children with newly diagnosed or untreated seizure disorder were included in case and 50 children of both sexes with same age group as cases were selected as control who did not have seizure. Children with age ranging from 2-10 years were included by consecutive sampling technique. Data was analysed using Statistical Package for Social Sciences (SPSS) software version 25(IBM Corp., Armonk, NY, USA). Paired t test was used to compare the mean values of liver enzymes amongst the children."P-value" was considered to be non - significant if found ≥ 0.05 and significant if P-value was found to be <0.05. Results In the present study there was no significant alteration of hepatic profile after treatment with valproate except serum alkaline phosphatase which was increased from the initial value than control group and was statistically significantly with P value of less than 0.05. Conclusion We concluded that these Antiepileptic drugs are safe to use in children up to 1 year.
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Affiliation(s)
- Pradeep Minz
- Department of Physiology, Rajendra Institute of Medical Sciences, Ranchi, Jharkhand, India
| | - Asha Oroan
- Department of Biochemistry, Rajendra Institute of Medical Sciences, Ranchi, Jharkhand, India
| | - Anit Kujur
- Department of Preventive and Social Medicine, Rajendra Institute of Medical Sciences, Ranchi, Jharkhand, India
| | - Dilip K. Paswan
- Department of Preventive and Social Medicine, Rajendra Institute of Medical Sciences, Ranchi, Jharkhand, India
| | - Alka R. Nag
- Department of Anatomy, Rajendra Institute of Medical Sciences, Ranchi, Jharkhand, India
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11
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Willems LM, van der Goten M, von Podewils F, Knake S, Kovac S, Zöllner JP, Rosenow F, Strzelczyk A. Adverse Event Profiles of Antiseizure Medications and the Impact of Coadministration on Drug Tolerability in Adults with Epilepsy. CNS Drugs 2023; 37:531-544. [PMID: 37271775 PMCID: PMC10239658 DOI: 10.1007/s40263-023-01013-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/11/2023] [Indexed: 06/06/2023]
Abstract
BACKGROUND Antiseizure medication (ASM) as monotherapy or in combination is the treatment of choice for most patients with epilepsy. Therefore, knowledge about the typical adverse events (AEs) for ASMs and other coadministered drugs (CDs) is essential for practitioners and patients. Due to frequent polypharmacy, it is often difficult to clinically assess the AE profiles of ASMs and differentiate the influence of CDs. OBJECTIVE This retrospective analysis aimed to determine typical AE profiles for ASMs and assess the impact of CDs on AEs in clinical practice. METHODS The Liverpool AE Profile (LAEP) and its domains were used to identify the AE profiles of ASMs based on data from a large German multicenter study (Epi2020). Following established classifications, drugs were grouped according to their mode of action (ASMs) or clinical indication (CDs). Bivariate correlation, multivariate ordinal regression (MORA), and artificial neural network (ANNA) analyses were performed. Bivariate correlation with Fisher's z-transformation was used to compare the correlation strength of LAEP with the Hospital Anxiety and Depression Scale (HADS) and Neurological Disorders Depression Inventory for Epilepsy (NDDI-E) to avoid LAEP bias in the context of antidepressant therapy. RESULTS Data from 486 patients were analyzed. The AE profiles of ASM categories and single ASMs matched those reported in the literature. Synaptic vesicle glycoprotein 2A (SV2A) and voltage-gated sodium channel (VGSC) modulators had favorable AE profiles, while brivaracetam was superior to levetiracetam regarding psychobehavioral AEs. MORA revealed that, in addition to seizure frequency, α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid (AMPA) modulators and antidepressants were the only independent predictors of high LAEP values. After Fisher's z-transformation, correlations were significantly lower between LAEP and antidepressants than between LAEP and HADS or NDDI-E. Therefore, a bias in the results toward over interpreting the impact of antidepressants on LAEP was presumed. In the ANNA, perampanel, zonisamide, topiramate, and valproic acid were important nodes in the network, while VGSC and SV2A modulators had low relevance for predicting relevant AEs. Similarly, cardiovascular agents, analgesics, and antipsychotics were important CDs in the ANNA model. CONCLUSION ASMs have characteristic AE profiles that are highly reproducible and must be considered in therapeutic decision-making. Therapy using perampanel as an AMPA modulator should be considered cautiously due to its relatively high AE profile. Drugs acting via VGSCs and SV2A receptors are significantly better tolerated than other ASM categories or substances (e.g., topiramate, zonisamide, and valproate). Switching to brivaracetam is advisable in patients with psychobehavioral AEs who take levetiracetam. Because CDs frequently pharmacokinetically interact with ASMs, the cumulative AE profile must be considered. TRIAL REGISTRATION DRKS00022024, U1111-1252-5331.
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Affiliation(s)
- Laurent M Willems
- Epilepsy Center Frankfurt Rhine-Main, Goethe-University and University Hospital Frankfurt, Schleusenweg 2-16, 60528, Frankfurt am Main, Germany
- Department of Neurology, Goethe-University and University Hospital Frankfurt, Frankfurt am Main, Germany
- LOEWE Center for Personalized Translational Epilepsy Research (CEPTeR), Goethe-University Frankfurt, Frankfurt am Main, Germany
| | - Milena van der Goten
- Epilepsy Center Frankfurt Rhine-Main, Goethe-University and University Hospital Frankfurt, Schleusenweg 2-16, 60528, Frankfurt am Main, Germany
- Department of Neurology, Goethe-University and University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Felix von Podewils
- Department of Neurology, University Hospital Greifswald, Greifswald, Germany
| | - Susanne Knake
- LOEWE Center for Personalized Translational Epilepsy Research (CEPTeR), Goethe-University Frankfurt, Frankfurt am Main, Germany
- Epilepsy Center Hessen, Philipps-University Marburg, Marburg (Lahn), Germany
- Department of Neurology, Philipps-University Marburg, Marburg (Lahn), Germany
| | - Stjepana Kovac
- Epilepsy Center Münster-Osnabrück, Westfälische Wilhelms-University, Münster, Germany
- Department of Neurology, Westfälische Wilhelms-University, Münster, Germany
| | - Johann Philipp Zöllner
- Epilepsy Center Frankfurt Rhine-Main, Goethe-University and University Hospital Frankfurt, Schleusenweg 2-16, 60528, Frankfurt am Main, Germany
- Department of Neurology, Goethe-University and University Hospital Frankfurt, Frankfurt am Main, Germany
- LOEWE Center for Personalized Translational Epilepsy Research (CEPTeR), Goethe-University Frankfurt, Frankfurt am Main, Germany
| | - Felix Rosenow
- Epilepsy Center Frankfurt Rhine-Main, Goethe-University and University Hospital Frankfurt, Schleusenweg 2-16, 60528, Frankfurt am Main, Germany
- Department of Neurology, Goethe-University and University Hospital Frankfurt, Frankfurt am Main, Germany
- LOEWE Center for Personalized Translational Epilepsy Research (CEPTeR), Goethe-University Frankfurt, Frankfurt am Main, Germany
| | - Adam Strzelczyk
- Epilepsy Center Frankfurt Rhine-Main, Goethe-University and University Hospital Frankfurt, Schleusenweg 2-16, 60528, Frankfurt am Main, Germany.
- Department of Neurology, Goethe-University and University Hospital Frankfurt, Frankfurt am Main, Germany.
- LOEWE Center for Personalized Translational Epilepsy Research (CEPTeR), Goethe-University Frankfurt, Frankfurt am Main, Germany.
- Department of Neurology, Philipps-University Marburg, Marburg (Lahn), Germany.
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12
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Neul JL, Percy AK, Benke TA, Berry-Kravis EM, Glaze DG, Marsh ED, Lin T, Stankovic S, Bishop KM, Youakim JM. Trofinetide for the treatment of Rett syndrome: a randomized phase 3 study. Nat Med 2023; 29:1468-1475. [PMID: 37291210 PMCID: PMC10287558 DOI: 10.1038/s41591-023-02398-1] [Citation(s) in RCA: 37] [Impact Index Per Article: 37.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 05/12/2023] [Indexed: 06/10/2023]
Abstract
Rett syndrome is a rare, genetic neurodevelopmental disorder. Trofinetide is a synthetic analog of glycine-proline-glutamate, the N-terminal tripeptide of the insulin-like growth factor 1 protein, and has demonstrated clinical benefit in phase 2 studies in Rett syndrome. In this phase 3 study ( https://clinicaltrials.gov identifier NCT04181723 ), females with Rett syndrome received twice-daily oral trofinetide (n = 93) or placebo (n = 94) for 12 weeks. For the coprimary efficacy endpoints, least squares mean (LSM) change from baseline to week 12 in the Rett Syndrome Behaviour Questionnaire for trofinetide versus placebo was -4.9 versus -1.7 (P = 0.0175; Cohen's d effect size, 0.37), and LSM Clinical Global Impression-Improvement at week 12 was 3.5 versus 3.8 (P = 0.0030; effect size, 0.47). For the key secondary efficacy endpoint, LSM change from baseline to week 12 in the Communication and Symbolic Behavior Scales Developmental Profile Infant-Toddler Checklist Social Composite score was -0.1 versus -1.1 (P = 0.0064; effect size, 0.43). Common treatment-emergent adverse events included diarrhea (80.6% for trofinetide versus 19.1% for placebo), which was mostly mild to moderate in severity. Significant improvement for trofinetide compared with placebo was observed for the coprimary efficacy endpoints, suggesting that trofinetide provides benefit in treating the core symptoms of Rett syndrome.
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Affiliation(s)
- Jeffrey L Neul
- Vanderbilt Kennedy Center, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Alan K Percy
- University of Alabama at Birmingham, Birmingham, AL, USA
| | - Timothy A Benke
- Children's Hospital of Colorado and University of Colorado School of Medicine, Aurora, CO, USA
| | | | - Daniel G Glaze
- Texas Children's Hospital and Baylor College of Medicine, Houston, TX, USA
| | - Eric D Marsh
- Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Tim Lin
- Acadia Pharmaceuticals Inc., San Diego, CA, USA
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13
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Wahab A, Iqbal A. Black-Box Warnings of Antiseizure Medications: What is Inside the Box? Pharmaceut Med 2023; 37:233-250. [PMID: 37119452 DOI: 10.1007/s40290-023-00475-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/28/2023] [Indexed: 05/01/2023]
Abstract
Antiseizure medications can cause serious adverse reactions and have deleterious drug interactions that often complicate the clinical management of patients. When the US Food and Drug Administration (FDA) wants to alert healthcare providers and patients about the risk of potentially serious or fatal drug reactions, the FDA requires the manufacturers of these medications to format these warnings within a "black-box" border, and prominently display this box on the first section of the package insert; such warnings are called "black-box warnings (BBWs)". The BBW is a way for the FDA to urge physicians to evaluate patients more rigorously and carefully weigh the risks and benefits, before prescribing medication that has the potential to cause serious adverse reactions, and to formulate a plan for close monitoring during therapy. The FDA BBW provides the extra layer of safety but many healthcare providers fail to comply with these warnings. Currently, there are 26 FDA-approved antiseizure medications in the US market, 38% of which have received BBWs, and most of the antiseizure medications with BBWs are older-generation drugs. Some antiseizure medications have multiple BBWs; for example, valproic acid has three BBWs including hepatotoxicity, fetal risk, and pancreatitis, carbamazepine has BBWs of serious skin and hematological reactions, and felbamate also has two BBWs including hepatic failure and aplastic anemia. The purpose of this review is to provide insight into each BBW received by antiseizure medications and discuss the FDA recommendations for evaluating the drug benefit/risk, and for monitoring parameters before the initiation of and during treatment.
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Affiliation(s)
- Abdul Wahab
- Department of Pharmacy, Emory Healthcare, Emory Decatur Hospital, Decatur, GA, 30033, USA.
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14
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Stern JI, Datta S, Chiang CC, Garza I, Vieira DL, Robertson CE. Narrative review of migraine management in patients with renal or hepatic disease. Headache 2023; 63:9-24. [PMID: 36709407 DOI: 10.1111/head.14437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 10/23/2022] [Accepted: 10/28/2022] [Indexed: 01/30/2023]
Abstract
OBJECTIVES/BACKGROUND Treatment of migraine in the setting of either renal or hepatic disease can be daunting for clinicians. Not only does the method of metabolism have to be considered, but also the method of elimination/excretion of the parent drug and any active or toxic metabolites. Furthermore, it is difficult to think about liver or kidney disease in isolation, as liver disease can sometimes contribute to impaired renal function and renal disease can sometimes impair hepatic metabolism, through the cytochrome P450 system. METHODS A detailed search for terms related to liver disease, renal disease, and migraine management was performed in PubMed, Ovid Medline, Embase, and the Cochrane Library.For each medication, product labels were retrieved and reviewed using the US FDA website, with additional review of IBM Micromedex, LiverTox, and the Renal Drug Handbook. RESULTS This manuscript provides an overview of migraine drug metabolism and how it can be affected by liver and renal impairment. It reviews the standard terminology recommended by the US Food and Drug Administration for the different stages of hepatic and renal failure. The available evidence regarding the use of abortive and preventative medicines in the setting of organ failure is discussed in detail, including more recent therapies such as lasmiditan, gepants, and calcitonin gene-related peptide antibodies. CONCLUSIONS For acute therapy, the use of NSAIDS should be limited, as these carry risk for both severe hepatic and renal disease. Triptans can be selectively used, often with dose guideline adjustments. Ubrogepant may be used in severe hepatic disease with dose adjustment and lasmiditan can be used in end stage renal disease. Though non-medicine strategies may be the most reasonable initial approach, many preventative medications can be used in the setting of hepatic and renal disease, often with dose adjustment. This review provides tables of guidelines, including reduced dosing recommendations, for the use of abortive and preventative migraine medications in hepatic and renal failure.
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Affiliation(s)
| | - Shae Datta
- Department of Neurology, NYU Langone Health, New York, New York, USA
| | | | - Ivan Garza
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | - Dorice L Vieira
- New York University Health Sciences Library, New York University Grossman School of Medicine, New York, New York, USA
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15
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Tabrizi N, Sharifi-Razavi A. Potential risk of liver injury in epileptic patients during COVID-19 pandemic. World J Virol 2022; 11:467-476. [PMID: 36483103 PMCID: PMC9724200 DOI: 10.5501/wjv.v11.i6.467] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 10/08/2022] [Accepted: 10/28/2022] [Indexed: 11/23/2022] Open
Abstract
Most of the antiseizure medications (ASMs) are metabolized in liver and many of them particularly first-generation ASMs have the potential to increase liver enzymes or induce liver injury. Hence, treatment of new onset seizures or epilepsy by ASMs during the course of coronavirus disease 2019 (COVID-19), which could potentially be complicated by hepatic dysfunction, is a challenging clinical issue. Intravenous form of levetiracetam which has no significant hepatic metabolism or drug-drug interaction is often a favorable option to control seizures in acute phase of COVID-19. Administration of enzyme inducer ASMs and valproate with the well-known hepatotoxicity and common drug interactions is not generally recommended. In patients with epilepsy who are under control with potentially hepatotoxic ASMs, close observation and cautious dose reduction or drug switch should be considered if any evidence of hepatic impairment exists. However, risks of possible breakthrough seizures should be weighed against benefits of lowering the hazard of liver injury. In patients with epilepsy who receive polytherapy with ASMs, transient dose modification with the tendency to increase the dose of ASMs with more favorable safety profile and less drug interaction and decrease the dose of drugs with main hepatic metabolism, high protein binding, potential to cause liver injury and known drug-drug reaction should be considered. Finally, decision making should be individualized based on patients’ conditions and course of illness.
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Affiliation(s)
- Nasim Tabrizi
- Department of Neurology, Mazandaran University of Medical Sciences, Sari 4815838477, Iran
| | - Athena Sharifi-Razavi
- Department of Neurology, Mazandaran University of Medical Sciences, Sari 4815838477, Iran
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16
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Lin K, Cao VFS, Au C, Dahri K. Clinical Pharmacokinetic Monitoring of Free Valproic Acid Levels: A Systematic Review. Clin Pharmacokinet 2022; 61:1345-1363. [PMID: 36040614 DOI: 10.1007/s40262-022-01171-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/07/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND Current guidelines recommend therapeutic drug monitoring as a critical component of valproic acid (VPA) therapy. Due to high protein binding, the active unbound (free) portion of VPA can be misrepresented by total VPA serum levels in certain clinical scenarios. Monitoring free VPA serum levels may be warranted when assessing the clinical response to VPA therapy. OBJECTIVES The aims were to conduct a systematic review to identify a therapeutic range for free VPA serum levels; to explore the correlation of free VPA serum levels with clinical toxicity and therapeutic benefit; and to examine predictors of discordance between free and total VPA levels. METHODS Medline, EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL), PsycINFO, BIOSIS Previews, and Cumulative Index to Nursing and Allied Health Literature (CINAHL) were searched from the time of database inception to June 20, 2021. Randomized controlled trials and observational studies that evaluated any patient receiving VPA with free VPA level monitoring were included. RESULTS Of 189 citations, we identified 27 relevant studies, which included 14 observational studies, two case series, and 11 case reports. Three studies provided a therapeutic range for free VPA levels between 20 and 410 μmol/L. Two studies suggested the occurrence of hyperammonemia and thrombocytopenia at free VPA serum levels above 60 µmol/L and 103.3 µmol/L, respectively. Two studies suggested an upper limit for neurotoxicity at free VPA serum levels of 70 µmol/L and 207.9 µmol/L. Hypoalbuminemia was identified as a predictor of therapeutic discordance. CONCLUSIONS This review demonstrates a paucity of data informing the clinical utility of free VPA serum levels. Further high-quality trials are needed to validate an optimal therapeutic range for free VPA levels.
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Affiliation(s)
- Kevin Lin
- University of British Columbia, Faculty of Pharmaceutical Sciences, Vancouver, BC, Canada
| | - Vivien F S Cao
- Department of Pharmacy, Vancouver General Hospital, Vancouver, BC, Canada.
| | - Charles Au
- Lower Mainland Pharmacy Services, Vancouver, BC, Canada
| | - Karen Dahri
- University of British Columbia, Faculty of Pharmaceutical Sciences, Vancouver, BC, Canada.,Department of Pharmacy, Vancouver General Hospital, Vancouver, BC, Canada
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17
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Jin MC, Parker JJ, Prolo LM, Wu A, Halpern CH, Li G, Ratliff JK, Han SS, Skirboll SL, Grant GA. An integrated risk model stratifying seizure risk following brain tumor resection among seizure-naive patients without antiepileptic prophylaxis. Neurosurg Focus 2022; 52:E3. [DOI: 10.3171/2022.1.focus21751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 01/27/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE
The natural history of seizure risk after brain tumor resection is not well understood. Identifying seizure-naive patients at highest risk for postoperative seizure events remains a clinical need. In this study, the authors sought to develop a predictive modeling strategy for anticipating postcraniotomy seizures after brain tumor resection.
METHODS
The IBM Watson Health MarketScan Claims Database was canvassed for antiepileptic drug (AED)– and seizure-naive patients who underwent brain tumor resection (2007–2016). The primary event of interest was short-term seizure risk (within 90 days postdischarge). The secondary event of interest was long-term seizure risk during the follow-up period. To model early-onset and long-term postdischarge seizure risk, a penalized logistic regression classifier and multivariable Cox regression model, respectively, were built, which integrated patient-, tumor-, and hospitalization-specific features. To compare empirical seizure rates, equally sized cohort tertiles were created and labeled as low risk, medium risk, and high risk.
RESULTS
Of 5470 patients, 983 (18.0%) had a postdischarge-coded seizure event. The integrated binary classification approach for predicting early-onset seizures outperformed models using feature subsets (area under the curve [AUC] = 0.751, hospitalization features only AUC = 0.667, patient features only AUC = 0.603, and tumor features only AUC = 0.694). Held-out validation patient cases that were predicted by the integrated model to have elevated short-term risk more frequently developed seizures within 90 days of discharge (24.1% high risk vs 3.8% low risk, p < 0.001). Compared with those in the low-risk tertile by the long-term seizure risk model, patients in the medium-risk and high-risk tertiles had 2.13 (95% CI 1.45–3.11) and 6.24 (95% CI 4.40–8.84) times higher long-term risk for postdischarge seizures. Only patients predicted as high risk developed status epilepticus within 90 days of discharge (1.7% high risk vs 0% low risk, p = 0.003).
CONCLUSIONS
The authors have presented a risk-stratified model that accurately predicted short- and long-term seizure risk in patients who underwent brain tumor resection, which may be used to stratify future study of postoperative AED prophylaxis in highest-risk patient subpopulations.
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Affiliation(s)
- Michael C. Jin
- Department of Neurosurgery, Stanford University School of Medicine, Stanford
| | - Jonathon J. Parker
- Department of Neurosurgery, Stanford University School of Medicine, Stanford
| | - Laura M. Prolo
- Department of Neurosurgery, Stanford University School of Medicine, Stanford
- Lucile Packard Children’s Hospital, Stanford; and
| | - Adela Wu
- Department of Neurosurgery, Stanford University School of Medicine, Stanford
| | - Casey H. Halpern
- Department of Neurosurgery, Stanford University School of Medicine, Stanford
| | - Gordon Li
- Department of Neurosurgery, Stanford University School of Medicine, Stanford
| | - John K. Ratliff
- Department of Neurosurgery, Stanford University School of Medicine, Stanford
| | - Summer S. Han
- Department of Neurosurgery, Stanford University School of Medicine, Stanford
| | - Stephen L. Skirboll
- Department of Neurosurgery, Stanford University School of Medicine, Stanford
- Section of Neurosurgery, VA Palo Alto Healthcare System, Stanford, California
| | - Gerald A. Grant
- Department of Neurosurgery, Stanford University School of Medicine, Stanford
- Lucile Packard Children’s Hospital, Stanford; and
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Smith TK, Cameron S, Trepanier LA. Incidence of hepatopathies in dogs administered zonisamide orally: A retrospective study of 384 cases. J Vet Intern Med 2022; 36:576-579. [PMID: 35238072 PMCID: PMC8965215 DOI: 10.1111/jvim.16398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 02/16/2022] [Accepted: 02/16/2022] [Indexed: 11/30/2022] Open
Abstract
Background Acute hepatopathy secondary to administration of zonisamide has been reported in 2 dogs, but overall incidence of hepatopathy is unknown. Objective To characterize the incidence of hepatopathy in dogs administered zonisamide PO. Animals Three hundred eighty‐four dogs administered zonisamide PO. Methods Multicenter retrospective study. Medical records were searched for dogs prescribed zonisamide PO and which had follow‐up for at least 3 months (acute exposure) and >3 months (chronic exposure). Reported clinical signs, physical examination findings, and serum biochemical panels were reviewed for possible hepatotoxicosis. Serum alanine aminotransferase (ALT) and alkaline phosphatase (ALP) activity and albumin concentration were documented for all available cases. Results Acute clinical hepatopathy was found in 2 of 384 treated dogs (0.52%, 95% confidence interval [CI], 0.06‐1.9) after 13‐16 days of zonisamide treatment. One additional dog had elevated serum ALT activity with no clinical signs. Of these 3 dogs, 2 recovered after administration of zonisamide was stopped, and 1 was euthanized because of liver failure. Of the 117 cases chronically administered zonisamide, 10 had an increase in ALP, 6 had an increase in ALT, and 1 had hypoalbuminemia. No clinical signs of liver disease were noted in dogs chronically treated with zonisamide (median, 20 months; range, 5‐94 months). Conclusions and Clinical Importance Acute, potentially life‐threatening hepatopathy associated with oral administration of zonisamide to dogs is estimated to occur in less than 1% of dogs and was observed in the first 3 weeks of treatment. Subclinical abnormalities in ALT and ALP activity were noted in <10% of dogs during chronic administration of zonisamide, with no clinical signs of liver disease noted.
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Affiliation(s)
- Tess K Smith
- University of Wisconsin - Madison, Madison, Wisconsin, USA
| | - Starr Cameron
- University of Wisconsin - Madison, Madison, Wisconsin, USA
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Menon V, Ransing R, Praharaj SK. Management of Psychiatric Disorders in Patients with Hepatic and Gastrointestinal Diseases. Indian J Psychiatry 2022; 64:S379-S393. [PMID: 35602369 PMCID: PMC9122174 DOI: 10.4103/indianjpsychiatry.indianjpsychiatry_18_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 01/04/2022] [Accepted: 01/05/2022] [Indexed: 12/01/2022] Open
Affiliation(s)
- Vikas Menon
- Department of Psychiatry, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Ramdas Ransing
- Department of Psychiatry, BKL Walalwalkar Rural Medical College, Ratnagiri, Maharashtra, India
| | - Samir Kumar Praharaj
- Department of Psychiatry, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India E-mail:
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Kamitaki BK, Minacapelli CD, Zhang P, Wachuku C, Gupta K, Catalano C, Rustgi V. Drug-induced liver injury associated with antiseizure medications from the FDA Adverse Event Reporting System (FAERS). Epilepsy Behav 2021; 117:107832. [PMID: 33626490 DOI: 10.1016/j.yebeh.2021.107832] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 01/26/2021] [Accepted: 01/27/2021] [Indexed: 12/22/2022]
Abstract
PURPOSE Treatment with antiseizure medications (ASMs) confers a risk of drug-induced liver injury (DILI), especially for older ASMs. We sought to quantify recent reports of DILI attributed to both older and newer generation ASMs and survey newly marketed ASMs for hepatotoxicity in a large post-marketing database. METHODS We queried over 2.6 million adverse event reports made to the FDA Adverse Event Reporting System (FAERS) database between July 1, 2018 and March 31, 2020 for DILI due to ASMs commonly used in clinical practice. Patient characteristics and outcomes were assessed. We calculated the reporting odds ratio (ROR) of DILI for each individual ASM versus all non-ASM reports. RESULTS A total of 2175 DILI cases were attributed to an ASM during the study period. 97.2% of these were designated as serious reactions, which include death, hospitalization, disability, and other life-threatening outcomes. A number of older and newer generation ASMs were associated with DILI, specifically: carbamazepine (ROR 2.92), phenobarbital (ROR 2.91), oxcarbazepine (ROR 2.58), phenytoin (ROR 2.40), valproate (ROR 2.22), lamotrigine (ROR 2.06), clobazam (ROR 1.67), levetiracetam (ROR 1.56), and diazepam (ROR 1.53). However, increased odds of DILI were not seen with zonisamide, perampanel, stiripentol, lacosamide, clonazepam, pregabalin, felbamate, eslicarbazepine, cannabidiol, topiramate, gabapentin, ethosuximide, brivaracetam, or primidone. Vigabatrin, tiagabine, and rufinamide all had zero reports of DILI. CONCLUSIONS The majority of newer generation ASMs were not significantly associated with DILI. Future studies utilizing FAERS in conjunction with other data sources will be critical for the ongoing surveillance of DILI, particularly as newly marketed ASMs continue to enter into widespread clinical use.
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Affiliation(s)
- Brad K Kamitaki
- Rutgers-Robert Wood Johnson Medical School, Department of Neurology, 125 Paterson Street Suite 6200, New Brunswick, NJ 08901, United States.
| | - Carlos D Minacapelli
- Rutgers-Robert Wood Johnson Medical School, Department of Medicine, Division of Gastroenterology and Hepatology, 125 Paterson Street Suite 5100B, New Brunswick, NJ 08901, United States; Center for Liver Diseases and Liver Masses, Rutgers-Robert Wood Johnson Medical School, 125 Paterson Street Suite 5100B, New Brunswick, NJ 08901, United States
| | - Pengfei Zhang
- Rutgers-Robert Wood Johnson Medical School, Department of Neurology, 125 Paterson Street Suite 6200, New Brunswick, NJ 08901, United States
| | - Christopher Wachuku
- Rutgers-Robert Wood Johnson Medical School, 675 Hoes Lane West, Piscataway, NJ 08901, United States
| | - Kapil Gupta
- Rutgers-Robert Wood Johnson Medical School, Department of Medicine, Division of Gastroenterology and Hepatology, 125 Paterson Street Suite 5100B, New Brunswick, NJ 08901, United States; Center for Liver Diseases and Liver Masses, Rutgers-Robert Wood Johnson Medical School, 125 Paterson Street Suite 5100B, New Brunswick, NJ 08901, United States
| | - Carolyn Catalano
- Rutgers-Robert Wood Johnson Medical School, Department of Medicine, Division of Gastroenterology and Hepatology, 125 Paterson Street Suite 5100B, New Brunswick, NJ 08901, United States; Center for Liver Diseases and Liver Masses, Rutgers-Robert Wood Johnson Medical School, 125 Paterson Street Suite 5100B, New Brunswick, NJ 08901, United States
| | - Vinod Rustgi
- Rutgers-Robert Wood Johnson Medical School, Department of Medicine, Division of Gastroenterology and Hepatology, 125 Paterson Street Suite 5100B, New Brunswick, NJ 08901, United States; Center for Liver Diseases and Liver Masses, Rutgers-Robert Wood Johnson Medical School, 125 Paterson Street Suite 5100B, New Brunswick, NJ 08901, United States
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21
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Osuntokun OS, Babatunde AA, Olayiwola G, Atere TG, Oladokun OO, Adedokun KI. Assessment of the biomarkers of hepatotoxicity following carbamazepine, levetiracetam, and carbamazepine-levetiracetam adjunctive treatment in male Wistar rats. Toxicol Rep 2021; 8:592-598. [PMID: 33786324 PMCID: PMC7994541 DOI: 10.1016/j.toxrep.2021.03.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 02/27/2021] [Accepted: 03/06/2021] [Indexed: 11/15/2022] Open
Abstract
Objective This study examined some of the biomarkers of hepatotoxicity following chronic treatment with carbamazepine (CBZ), levetiracetam (LEV), and CBZ + LEV adjunctive treatment in male rats. Method Twenty-four male Wistar rats (140-150 g) were randomized into four groups (n = 6) to receive oral dose of normal saline (0.1 mL), CBZ (25 mg/kg), LEV (50 mg/kg) or sub-therapeutic dose of CBZ (12.5 mg/kg) together with LEV (25 mg/kg) for 28 days. Activities of the liver enzymes and oxidative stress markers were determined while liver histomorphology was also carried out. Data were analyzed using descriptive and inferential statistics. The results were presented as mean ± SEM in graphs or tables, while the level of significance was taken at p < 0.05. Results The activities of alkaline-phosphatase and malondialdehyde concentrations increased significantly in all the drug treatment groups, while the activities of superoxide dismutase decreased significantly following CBZ, and CBZ + LEV treatment. Alanine-aminotransferase activities increased significantly in the CBZ and CBZ + LEV treated rats compared with control. The liver section of CBZ treated rats showed mild vascular congestion. Conclusion None of these AEDs treatment is devoid of hepatotoxicity. However, the adverse effects in CBZ were greater than LEV, or CBZ + LEV adjunctive treatment.
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Affiliation(s)
- Opeyemi Samson Osuntokun
- Department of Physiology, Faculty of Basic Medical Sciences, College of Health Sciences, Osun State University Osogbo, Nigeria
| | - Ademola Adeniyi Babatunde
- Department of Physiology, Faculty of Basic Medical Sciences, College of Health Sciences, Osun State University Osogbo, Nigeria
| | - Gbola Olayiwola
- Department of Clinical Pharmacy and Pharmacy Administration, Faculty of Pharmacy, Obafemi Awolowo University, Ile-Ife, Nigeria
| | - Tope Gafar Atere
- Department of Medical Biochemistry, Faculty of Basic Medical Sciences, College of Health Sciences, Osun State University, Osogbo, Nigeria
| | - Olayemi Olutobi Oladokun
- Department of Physiology, Faculty of Basic Medical Sciences, College of Health Sciences, Osun State University Osogbo, Nigeria
| | - Kabiru Isola Adedokun
- Department of Physiology, Faculty of Basic Medical Sciences, College of Health Sciences, Osun State University Osogbo, Nigeria
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22
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Maldonado C, Vázquez M, Fagiolino P. Potential Therapeutic Role of Carnitine and Acetylcarnitine in Neurological Disorders. Curr Pharm Des 2020; 26:1277-1285. [PMID: 32048954 DOI: 10.2174/1381612826666200212114038] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Accepted: 01/30/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND Current therapy of neurological disorders has several limitations. Although a high number of drugs are clinically available, several subjects do not achieve full symptomatic remission. In recent years, there has been an increasing interest in the therapeutic potential of L-carnitine (LCAR) and acetyl-L-carnitine (ALCAR) because of the multiplicity of actions they exert in energy metabolism, as antioxidants, neuromodulators and neuroprotectors. They also show excellent safety and tolerability profile. OBJECTIVE To assess the role of LCAR and ALCAR in neurological disorders. METHODS A meticulous review of the literature was conducted in order to establish the linkage between LCAR and ALCAR and neurological diseases. RESULTS LCAR and ALCAR mechanisms and effects were studied for Alzheimer's disease, depression, neuropathic pain, bipolar disorder, Parkinson's disease and epilepsy in the elderly. Both substances exert their actions mainly on primary metabolism, enhancing energy production, through β-oxidation, and the ammonia elimination via urea cycle promotion. These systemic actions impact positively on the Central Nervous System state, as Ammonia and energy depletion seem to underlie most of the neurotoxic events, such as inflammation, oxidative stress, membrane degeneration, and neurotransmitters disbalances, present in neurological disorders, mainly in the elderly. The impact on bipolar disorder is controversial. LCAR absorption seems to be impaired in the elderly due to the decrease of active transportation; therefore, ALCAR seems to be the more effective option to administer. CONCLUSION ALCAR emerges as a simple, economical and safe adjuvant option in order to impair the progression of most neurological disorders.
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Affiliation(s)
- Cecilia Maldonado
- Biopharmaceutics and Therapeutics, Pharmaceutical Sciences Department, Faculty of Chemistry, Universidad de la Republica, Montevideo, Uruguay
| | - Marta Vázquez
- Biopharmaceutics and Therapeutics, Pharmaceutical Sciences Department, Faculty of Chemistry, Universidad de la Republica, Montevideo, Uruguay
| | - Pietro Fagiolino
- Biopharmaceutics and Therapeutics, Pharmaceutical Sciences Department, Faculty of Chemistry, Universidad de la Republica, Montevideo, Uruguay
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Adedapo ADA, Demaki WE, Lagunju I. Non-Dose-Dependent Changes in Liver Enzyme Levels of Children With Epilepsy on Treatment With Sodium Valproate. Dose Response 2020; 18:1559325820918445. [PMID: 32362796 PMCID: PMC7180311 DOI: 10.1177/1559325820918445] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Accepted: 03/15/2020] [Indexed: 12/24/2022] Open
Abstract
Background: Sodium valproate (VPA) is considered as the drug of choice for the treatment
of generalized epilepsy in children. Sodium Valproate may be
hepatotoxic. Aim: To assess the level of derangement of liver enzymes in children with epilepsy
on treatment with sodium valproate. Methods: A cohort study. One hundred fifty-three children, comprising 51 with epilepsy
on treatment with VPA (group I), 51 with epilepsy on treatment with other
antiepileptic drugs (AEDs) but not VPA (group II), and 51 with nonconvulsive
disorders (group III) had liver function tests performed for them. Data were
analyzed by SPSS version 23.0. Results: There were 85 males and 68 females, aged 6 months to 14 years (median = 7.0
years). There was no significant difference in the mean plasma levels of
alanine transaminase (ALT), alkaline phosphatase, and gamma glutamyl
transferase across the three groups of children. The mean aspartate
transaminase level was significantly higher in children in group III. There
was a statistically significant negative correlation between the duration of
AED therapy and the mean serum level of AST (r = −0.266,
P = 0.016). The serum ALT level showed a statistically
significant positive correlation with the duration of AED therapy
(r = 0.268, P = 0.015). Conclusion: Sodium valproate monotherapy does not appear to be associated with
significant hepatotoxicity in children in our cohort.
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Affiliation(s)
| | | | - IkeOluwa Lagunju
- Department of Paediatrics, University of Ibadan, Ibadan, Nigeria
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24
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Singh RB, Das N, Singh GK, Singh SK, Zaman K. Synthesis and pharmacological evaluation of 3-[5-(aryl-[1,3,4]oxadiazole-2-yl]-piperidine derivatives as anticonvulsant and antidepressant agents. ARAB J CHEM 2020. [DOI: 10.1016/j.arabjc.2020.03.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
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25
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Rawat C, Kukal S, Kushwaha S, Agarwal R, Sharma S, Srivastava AK, Kukreti R. Elevated serum alkaline phosphatase in epilepsy: effect of age and treatment. Br J Biomed Sci 2019; 77:44-47. [DOI: 10.1080/09674845.2019.1663781] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- C Rawat
- Institute of Genomics and Integrative Biology (IGIB), Council of Scientific and Industrial Research (CSIR), Delhi, India
- Academy of Scientific and Innovative Research (AcSIR), Council of Scientific and Industrial Research (CSIR), Delhi, India
| | - S Kukal
- Institute of Genomics and Integrative Biology (IGIB), Council of Scientific and Industrial Research (CSIR), Delhi, India
- Academy of Scientific and Innovative Research (AcSIR), Council of Scientific and Industrial Research (CSIR), Delhi, India
| | - S Kushwaha
- Department of Neurology, Institute of Human Behaviour & Allied Sciences (IHBAS), Delhi, India
| | - R Agarwal
- Department of Neurochemistry, All India Institute of Medical Sciences, Delhi, India
| | - S Sharma
- Department of Neuropsychopharmacology, Institute of Human Behaviour & Allied Sciences (IHBAS), Delhi, India
| | - AK Srivastava
- Department of Neurochemistry, All India Institute of Medical Sciences, Delhi, India
| | - R Kukreti
- Institute of Genomics and Integrative Biology (IGIB), Council of Scientific and Industrial Research (CSIR), Delhi, India
- Academy of Scientific and Innovative Research (AcSIR), Council of Scientific and Industrial Research (CSIR), Delhi, India
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26
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Magwebu ZE, Mazinu M, Abdul-Rasool S, Chauke CG. The effect of hyperglycinemic treatment in captive-bred Vervet monkeys (Chlorocebus aethiops). Metab Brain Dis 2019; 34:1467-1472. [PMID: 31230217 DOI: 10.1007/s11011-019-00449-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Accepted: 06/10/2019] [Indexed: 12/24/2022]
Abstract
Nonketotic hyperglycinemia (NKH) is a neuro-metabolic disorder caused by a deficiency in the glycine cleavage system (GCS) and glycine transporter 1 (GlyT1). A case of atypical late onset of NKH has been reported in a colony of captive-bred Vervet monkeys. The purpose of this study was to evaluate the effect of sodium benzoate and dextromethorphan in reducing glycine levels in hyperglycinemic monkeys. Twelve captive-bred Vervet monkeys were assigned into three groups consisting of four animals (control, valproate induced and cataract with spontaneous hyperglycinemia). Valproate was used to elevate glycine levels and the induced group was then treated with sodium benzoate and dextromethorphan together with group three to normalise glycine levels in cerebrospinal fluid (CSF) and plasma. Valproate induction elicited changes in phosphate, alkaline phosphatase and platelet count, however, no significant changes in the glycine levels were observed, and this might be due to the individual variability within the group. The treatment intervention was only obtained in the spontaneous group whereby the glycine levels were normalised in CSF and plasma. Therefore, it can be concluded that sodium benzoate and dextromethorphan treatment was effective and beneficial to the hyperglycinemic group.
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Affiliation(s)
- Zandisiwe E Magwebu
- Primate Unit and Delft Animal Centre, South African Medical Research Council, P.O Box 19070, Tygerberg, Cape Town, 7505, South Africa.
| | - Mikateko Mazinu
- Primate Unit and Delft Animal Centre, South African Medical Research Council, P.O Box 19070, Tygerberg, Cape Town, 7505, South Africa
| | - Sahar Abdul-Rasool
- Medical Bioscience Department, University of the Western Cape, Belville, South Africa
| | - Chesa G Chauke
- Primate Unit and Delft Animal Centre, South African Medical Research Council, P.O Box 19070, Tygerberg, Cape Town, 7505, South Africa
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27
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Chen TW, Rajaji U, Chen SM, Jothi Ramalingam R. A relative study on sonochemically synthesized mesoporous WS 2 nanorods & hydrothermally synthesized WS 2 nanoballs towards electrochemical sensing of psychoactive drug (Clonazepam). ULTRASONICS SONOCHEMISTRY 2019; 54:79-89. [PMID: 30833196 DOI: 10.1016/j.ultsonch.2019.02.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2018] [Revised: 01/31/2019] [Accepted: 02/15/2019] [Indexed: 06/09/2023]
Abstract
In this paper, mesoporous tungsten sulfide electrocatalyst (MP-WS2) were developed through a facile sonochemical technique (SC) and utilized as an electrocatalyst for the sensitive electrochemical detection of Psychoactive drug. The as-prepared SC-MP-WS2 NRs and HT-WS2 NPs (hydrothermally synthesized) were characterized using XRD, Raman, XPS, FESEM, HRTEM, BET, EDX, and electrochemical analysis, which exposed the formation of WS2 in the form of mesoporous nanorods in shape. Further, the use of the as-developed SC-MP-WS2 NRs and HT-WS2 NPs as an electrocatalyst for the detection of clonazepam (CNP). Interestingly, the SC-MP-WS2 NRs modified screen-printed carbon electrode (SC-MP-WS2 NRs/SPCE) exhibited an excellent electrocatalytic performance, and enhanced reduction peak current when compared to HT-WS2 NPs with unmodified electrode. Moreover, as-prepared SC-MP-WS2 NRs/SPCE displayed wide linear response range (10-551 µM), lower detection limit (2.37 nM) and high sensitivity (24.32 µAµM-1cm-2). Furthermore, SC-MP-WS2 NRs/SPCE showed an excellent selectivity even in the existence of potentially co-interfering compounds. The proposed sensor was successfully applied for the determination of CNP in biological and drug samples with acceptable recovery.
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Affiliation(s)
- Tse-Wei Chen
- Department of Chemical Engineering and Biotechnology, National Taipei University of Technology, No. 1, Section 3, Chung-Hsiao East Road, Taipei 106, Taiwan; Research and Development Center for Smart Textile Technology, National Taipei University of Technology, No. 1, Section 3, Chung-Hsiao East Road, Taipei 106, Taiwan
| | - Umamaheswari Rajaji
- Department of Chemical Engineering and Biotechnology, National Taipei University of Technology, No. 1, Section 3, Chung-Hsiao East Road, Taipei 106, Taiwan
| | - Shen-Ming Chen
- Department of Chemical Engineering and Biotechnology, National Taipei University of Technology, No. 1, Section 3, Chung-Hsiao East Road, Taipei 106, Taiwan.
| | - R Jothi Ramalingam
- Surfactant Research Chair, Chemistry Department, College of Science, King Saud University, Riyadh 11451, Saudi Arabia
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Abstract
INTRODUCTION Epilepsy is a serious chronic neurological disorder manifested by an enduring symptomatic predisposition to seizures. Newly diagnosed individuals face increased morbidity, mortality, and socioeconomic costs. Anti-epileptic drug therapy is the treatment usually prescribed, which has efficacy in seizure control and mitigating long-term mortality. AREAS COVERED Safety of anti-epileptic drug therapy in adults with a focus in newly diagnosed patients. Areas covered include the most commonly experienced adverse drug effects, as well as those with the highest impacts on drug tolerability, quality of life, morbidity and mortality. Evidence was also reviewed to identify clinical strategies to improve the safety of anti-epileptic drug therapy. EXPERT OPINION Anti-epileptic drugs (AEDs) are mostly effective and well tolerated. However, a lack of standardised reporting of adverse drug effects in trials and in clinical practice provides an obstacle for evaluation of which adverse drug effects need to be prioritised in management. Improvement in the reporting of cognitive and other effects, as well as improved precision medicine and pharmacogenomics to target the incidence of high-mortality idiosyncratic reactions, will help to reduce the harm of AEDs in people newly diagnosed with epilepsy.
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Affiliation(s)
- Sameer Sharma
- a Department of Neuroscience , Central Clinical School, Monash University , Melbourne , Australia
| | - Patrick Kwan
- a Department of Neuroscience , Central Clinical School, Monash University , Melbourne , Australia.,b Department of Medicine , Royal Melbourne Hospital, The University of Melbourne , Melbourne , Australia.,c School of Public Health and Preventive Medicine , Monash University , Melbourne , Australia
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Anticonvulsant Effects of Dingxian Pill in Pentylenetetrazol-Kindled Rats. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2019; 2019:4534167. [PMID: 31011358 PMCID: PMC6442303 DOI: 10.1155/2019/4534167] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Accepted: 02/24/2019] [Indexed: 12/24/2022]
Abstract
Dingxian pill has been used as an antiepilepsy agent in China from ancient to modern times, of which the concrete pharmacological characterization and the underlying molecular mechanism remain unclear. The present study was undertaken to investigate them by animal behavior, electroencephalogram (EEG), Morris water maze, immunohistochemistry, transcriptomics, and real-time PCR. In our results, the treatment of Dingxian pill dose-dependently inhibited PTZ-induced seizure-like behavior and reduced the seizure grades, LFP power spectral density, and brain wave of the epileptiform EEG component induced by PTZ. In Morris water maze tests, the learning and memory ability of kindled epileptic rats could be attenuated more efficiently by Dingxian pill. For the immediate early gene c-fos, the expression was reduced after Dingxian pill treatment, and the difference was significant between the treatment and the model group. Through the transcriptome analysis of the gene expression in hippocampus, Egr3, Nrg, Arc, and Ptgs2, closely related to epilepsy, had been proved to be downregulated by application of Dingxian pill. All of the results not only highlight the antiepileptic effects of Dingxian pill and its molecular mechanism, but also provide a modern validity theory for the clinical application of traditional Chinese medicine (TCM).
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30
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Akai S, Oda S, Yokoi T. Strain and interindividual differences in lamotrigine-induced liver injury in mice. J Appl Toxicol 2018; 39:451-460. [PMID: 30325050 DOI: 10.1002/jat.3736] [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] [Received: 01/09/2018] [Revised: 09/01/2018] [Accepted: 09/01/2018] [Indexed: 12/24/2022]
Abstract
Lamotrigine (LTG) has been widely prescribed as an antipsychotic drug, although it causes idiosyncratic drug-induced liver injury in humans. LTG is mainly metabolized by UDP-glucuronosyltransferase, while LTG undergoes bioactivation by cytochrome P450 to a reactive metabolite; it is subsequently conjugated with glutathione, suggesting that reactive metabolite would be one of the causes for LTG-induced liver injury. However, there is little information regarding the mechanism of LTG-induced liver injury in both humans and rodents. In this study, we established an LTG-induced liver injury mouse model through co-administration with LTG and a glutathione synthesis inhibitor, l-buthionine-(S,R)-sulfoximine. We found an increase in alanine aminotransferase (ALT) levels (>10 000 U/L) in C57BL/6J mice, with apparent interindividual differences. On the other hand, a drastic increase in ALT was not noted in BALB/c mice, suggesting that the initiation mechanism would be different between the two strains. To examine the cause of interindividual differences, C57BL/6J mice that were co-administered LTG and l-buthionine-(S,R)-sulfoximine were categorized into three groups based on ALT values: no-responder (ALT <100 U/L), low-responder (100 U/L < ALT < 1000 U/L) and high-responder (ALT >1000 U/L). In the high-responder group, induction of hepatic oxidative stress, inflammation and damage-associated molecular pattern molecules in mRNA was associated with vacuolation and karyorrhexis in hepatocytes. In conclusion, we demonstrated that LTG showed apparent strain and interindividual differences in liver injuries from the aspects of initiation and exacerbation mechanisms. These results would support interpretation of the mechanism of LTG-induced liver injury observed in humans.
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Affiliation(s)
- Sho Akai
- Department of Drug Safety Sciences, Division of Clinical Pharmacology, Nagoya University Graduate School of Medicine, Showa-ku, Nagoya, 466-8550, Japan
| | - Shingo Oda
- Department of Drug Safety Sciences, Division of Clinical Pharmacology, Nagoya University Graduate School of Medicine, Showa-ku, Nagoya, 466-8550, Japan
| | - Tsuyoshi Yokoi
- Department of Drug Safety Sciences, Division of Clinical Pharmacology, Nagoya University Graduate School of Medicine, Showa-ku, Nagoya, 466-8550, Japan
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Hammann F, Schöning V, Drewe J. Prediction of clinically relevant drug-induced liver injury from structure using machine learning. J Appl Toxicol 2018; 39:412-419. [DOI: 10.1002/jat.3741] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Revised: 09/10/2018] [Accepted: 09/21/2018] [Indexed: 12/16/2022]
Affiliation(s)
- Felix Hammann
- Division of Clinical Pharmacology and Toxicology; University Hospital Basel; Basel Switzerland
| | - Verena Schöning
- Division of Clinical Pharmacology and Toxicology; University Hospital Basel; Basel Switzerland
| | - Jürgen Drewe
- Division of Clinical Pharmacology and Toxicology; University Hospital Basel; Basel Switzerland
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Curry B, Mican L, Smith TL. Phenytoin-induced chronic liver enzyme elevation and hepatic fibrosis: A case report. Ment Health Clin 2018; 8:184-187. [PMID: 30155393 PMCID: PMC6063461 DOI: 10.9740/mhc.2018.07.184] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Background: Liver fibrosis results from chronic damage to the liver. Advanced liver fibrosis results in cirrhosis, liver failure, and portal hypertension and may even require liver transplantation. A liver biopsy is considered the “gold standard” method for the assessment of liver fibrosis; however, ultrasonography can also detect changes in the hepatic parenchyma due to fibrosis. Although reports in the literature describe phenytoin-induced hepatic injury, often this rare occurrence is usually accompanied by a hypersensitivity reaction. Case report: Our patient is a 50-year-old female with history of schizoaffective disorder, bipolar type, who had been admitted to a state psychiatric facility. She has a history of seizure disorder, which had been well controlled with phenytoin since 2011. Mild-to-moderate elevations in her liver enzymes were noted during therapy but normalized once phenytoin was discontinued. An ultrasound of the patient's liver in January 2016 showed changes of fatty infiltration and fibrosis. Conclusion: This case differs from other cases reported in the literature that describe phenytoin-induced hepatic injury. The majority of these cases are accompanied by immune-allergic features. To our knowledge, there have been no reported cases in the literature of prolonged liver enzyme elevation resulting in phenytoin-induced hepatic fibrosis.
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Affiliation(s)
- Brent Curry
- (Corresponding author) Clinical Psychiatric Pharmacist, Central State Hospital, Louisville, Kentucky,
| | - Lisa Mican
- Assistant Director of Pharmacy, Austin State Hospital, Austin, Texas
| | - Tawny L Smith
- Associate Professor of Psychiatry, Dell Medical School, The University of Texas at Austin, Austin, Texas
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Peter AI, Naidu ECS, Akang E, Ogedengbe OO, Offor U, Rambharose S, Kalhapure R, Chuturgoon A, Govender T, Azu OO. Investigating Organ Toxicity Profile of Tenofovir and Tenofovir Nanoparticle on the Liver and Kidney: Experimental Animal Study. Toxicol Res 2018; 34:221-229. [PMID: 30057696 PMCID: PMC6057299 DOI: 10.5487/tr.2018.34.3.221] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Revised: 04/03/2018] [Accepted: 05/08/2018] [Indexed: 12/23/2022] Open
Abstract
Tenofovir nanoparticles are novel therapeutic intervention in human immunodeficiency virus (HIV) infection reaching the virus in their sanctuary sites. However, there has been no systemic toxicity testing of this formulation despite global concerns on the safety of nano drugs. Therefore, this study was designed to investigate the toxicity of Tenofovir nanoparticle (NTDF) on the liver and kidney using an animal model. Fifteen adult male Sprague-Dawley (SD) rats maintained at the animal house of the biomedical resources unit of the University of KwaZulu-Natal were weighed and divided into three groups. Control animals (A) were administered with normal saline (NS). The therapeutic doses of Tenofovir (TDF) and nanoparticles of Tenofovir (NTDF) were administered to group B and C and observed for signs of stress for four weeks after which animals were weighed and sacrificed. Liver and kidney were removed and fixed in formal saline, processed and stained using H/E, PAS and MT stains for light microscopy. Serum was obtained for renal function test (RFT) and liver function test (LFT). Cellular measurements and capturing were done using ImageJ and Leica software 2.0. Data were analysed using graph pad 6, p values < 0.05 were significant. We observed no signs of behavioural toxicity and no mortality during this study, however, in the kidneys, we reported mild morphological perturbations widening of Bowman's space, and vacuolations in glomerulus and tubules of TDF and NTDF animals. Also, there was a significant elevation of glycogen deposition in NTDF and TDF animals when compared with control. In the liver, there were mild histological changes with widening of sinusoidal spaces, vacuolations in hepatocytes and elevation of glycogen deposition in TDF and NTDF administered animals. In addition to this, there were no significant differences in stereological measurements and cell count, LFT, RFT, weight changes and organo-somatic index between treatment groups and control. In conclusion, NTDF and TDF in therapeutic doses can lead to mild hepatic and renal histological damage. Further studies are needed to understand the precise genetic mechanism.
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Affiliation(s)
- Aniekan Imo Peter
- Discipline of Clinical Anatomy, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Durban,
South Africa
| | - Edwin CS Naidu
- Discipline of Clinical Anatomy, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Durban,
South Africa
| | - Edidiong Akang
- Discipline of Clinical Anatomy, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Durban,
South Africa
| | - Oluwatosin O Ogedengbe
- Discipline of Clinical Anatomy, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Durban,
South Africa
| | - Ugochukwu Offor
- Discipline of Clinical Anatomy, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Durban,
South Africa
| | - Sanjeev Rambharose
- Discipline of Pharmaceutical Sciences, School of Health Sciences, University of KwaZulu-Natal, Durban,
South Africa
| | - Rahul Kalhapure
- Discipline of Pharmaceutical Sciences, School of Health Sciences, University of KwaZulu-Natal, Durban,
South Africa
| | - Anil Chuturgoon
- Discipline of Medical Biochemistry, University of KwaZulu-Natal, Durban,
South Africa
| | - Thirumala Govender
- Discipline of Pharmaceutical Sciences, School of Health Sciences, University of KwaZulu-Natal, Durban,
South Africa
| | - Onyemaechi O Azu
- Discipline of Clinical Anatomy, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Durban,
South Africa
- Department of Anatomy, School of Medicine, Windhoek,
Namibia
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Fernandez H, Mohammed HT, Patel T. Vitamin D supplementation for bone health in adults with epilepsy: A systematic review. Epilepsia 2018; 59:885-896. [PMID: 29399794 DOI: 10.1111/epi.14015] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/09/2017] [Indexed: 12/24/2022]
Abstract
OBJECTIVE Several antiepileptic drugs (AEDs) have been associated with a detrimental effect on bone health through a reduction in serum vitamin D. Subsequently, several studies have investigated the effect of vitamin D supplementation in persons with epilepsy being treated with AEDs. The present systematic review of published literature was conducted to determine the effect of vitamin D intervention on bone health in adults with epilepsy. METHODS The following databases were searched using keywords including but not limited to epilepsy, bone, and vitamin D: PubMed, Medline, Embase, Scopus, Cochrane Clinical Trials, International Pharmaceutical Abstracts, Health Canada Clinical Trials Database, ClinicalTrials.gov, EU Clinical Trials, and Google. Studies were eligible if there was an epilepsy diagnosis, participants were adults (18+ years old), and vitamin D treatment and bone outcome were provided. Articles were screened independently by 2 reviewers. Methodological quality was assessed using the Cochrane Collaboration's tool and a modified Newcastle Ottawa Scale for nonrandomized studies. RESULTS Nine studies were found to be eligible for this review. After vitamin D treatment, there appeared to be positive changes in bone turnover markers; 3 of 8 studies found the increase in serum calcium to be significant, 6 of 8 studies found the decrease in alkaline phosphatase to be significant, and 2 of 4 studies found the decrease in parathyroid hormone to be significant. All 6 studies that investigated bone mineralization had significant findings; however, due to varying methodologies, the impact of vitamin D on bone mineralization was inconclusive. SIGNIFICANCE Vitamin D does appear to have some benefit to bone health in adults with epilepsy, and therefore supplementation could potentially be a requisite to using some AEDs. To clarify the role of vitamin D supplementation to manage the adverse effect of AEDs on bone health in adults with epilepsy, long-term trials that use higher doses (>1800 IU) and measure bone mineral density are necessary.
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Affiliation(s)
- Haya Fernandez
- School of Pharmacy, University of Waterloo, Waterloo, Ontario, Canada
| | - Heba Tallah Mohammed
- School of Pharmacy, University of Waterloo, Waterloo, Ontario, Canada
- Department of Community Medicine, Aim Shams University, Cairo, Egypt
| | - Tejal Patel
- School of Pharmacy, University of Waterloo, Waterloo, Ontario, Canada
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
- Centre for Family Medicine Family Health Team, Kitchener, Ontario, Canada
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Calitz C, Hamman JH, Fey SJ, Wrzesinski K, Gouws C. Recent advances in three-dimensional cell culturing to assess liver function and dysfunction: from a drug biotransformation and toxicity perspective. Toxicol Mech Methods 2018; 28:369-385. [PMID: 29297242 DOI: 10.1080/15376516.2017.1422580] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- Carlemi Calitz
- Pharmacen™, Centre of Excellence for Pharmaceutical Sciences, North-West University, Potchefstroom, South Africa
| | - Josias H. Hamman
- Pharmacen™, Centre of Excellence for Pharmaceutical Sciences, North-West University, Potchefstroom, South Africa
| | - Stephen J. Fey
- Department of Biochemistry and Molecular Biology, University of Southern Denmark, Odense M, Denmark
| | - Krzysztof Wrzesinski
- Department of Biochemistry and Molecular Biology, University of Southern Denmark, Odense M, Denmark
| | - Chrisna Gouws
- Pharmacen™, Centre of Excellence for Pharmaceutical Sciences, North-West University, Potchefstroom, South Africa
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Vidaurre J, Gedela S, Yarosz S. Antiepileptic Drugs and Liver Disease. Pediatr Neurol 2017; 77:23-36. [PMID: 29097018 DOI: 10.1016/j.pediatrneurol.2017.09.013] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Revised: 09/05/2017] [Accepted: 09/19/2017] [Indexed: 12/22/2022]
Abstract
Acute, symptomatic seizures or epilepsy may complicate the course of hepatic disease. Choosing the most appropriate antiepileptic drug in this setting represents a difficult challenge, as most medications are metabolized by the liver. This article focuses on the acute and chronic treatment of seizures in patients with advanced liver disease and reviews the hepatotoxic potential of specific antiepileptic drugs. Newer antiepileptic drugs without, or with minimal, hepatic metabolism, such as levetiracetam, lacosamide, topiramate, gabapentin, and pregabalin should be used as first-line therapy. Medications undergoing extensive hepatic metabolism, such as valproic acid, phenytoin, and felbamate should be used as drugs of last resort. In special circumstances, as in patients affected by acute intermittent porphyria, exposure to most antiepileptic drugs could precipitate attacks. In this clinical scenario, bromides, levetiracetam, gabapentin, and vigabatrin constitute safe choices. For the treatment of status epilepticus, levetiracetam and lacosamide, available in intravenous preparations, are good second-line therapies after benzodiazepines fail to control seizures. Hepatotoxicity is also a rare and unexpected side effect of some antiepileptic drugs. Drugs such as valproic acid, phenytoin, and felbamate, have a well-recognized association with liver toxicity. Other antiepileptic drugs, including phenobarbital, benzodiazepines, ethosuximide, and the newer generations of antiepileptic drugs, have only rarely been linked to hepatotoxicity. Thus physicians should be mindful of the pharmacokinetic profile and the hepatotoxic potential of the different antiepileptic drugs available to treat patients affected by liver disease.
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Affiliation(s)
- Jorge Vidaurre
- Division of Pediatric Neurology, Department of Pediatrics, Nationwide Children's Hospital, Columbus, Ohio.
| | - Satyanarayana Gedela
- Division of Pediatric Neurology, Department of Pediatrics, Nationwide Children's Hospital, Columbus, Ohio
| | - Shannon Yarosz
- Division of Pediatric Neurology, Department of Pediatrics, Nationwide Children's Hospital, Columbus, Ohio
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Dispensability of Annual Laboratory Follow-Up After More than 2 Years of Valproic Acid Use: A Systematic Review. CNS Drugs 2017; 31:939-957. [PMID: 29214384 DOI: 10.1007/s40263-017-0479-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND The necessity of annual laboratory follow-up in patients treated with valproic acid (VPA) is controversial. OBJECTIVE We investigated the need for annual laboratory follow-up of liver enzymes, electrolytes, and full blood count (FBC) in patients treated with VPA. PATIENTS AND METHODS A systematic search in Evidence-Based Medicine Reviews (EBMR), MEDLINE, and EMBASE was undertaken in December 2016 to identify all published articles investigating or citing valproic acid, liver function disorders, electrolyte disorders, and FBC deviations. RESULTS This review included 108 articles. As the number of participants and duration of the study was not adequate in most studies to detect rare adverse events, studies did not demonstrate a clear prevalence of hepatotoxicity. While a transient increase of transaminases is common and seldom harmful, severe hepatotoxicity is a rare phenomenon and is not prevented by routine laboratory monitoring. VPA had no relevant effect on serum calcium, sodium, potassium, and albumin. The prevalence of FBC varied from 0.6 to 27.8%, occurred mostly in the first 2 years of therapy, and was usually asymptomatic. CONCLUSIONS Long-term monitoring in VPA treatment is only necessary when there have been dose adjustments, co-medication switches, or co-morbidity. In uncomplicated cases, annual laboratory follow-up may be discontinued after 2 years of VPA treatment. Encouraging patients to be vigilant is more effective in the detection of hepatotoxicity than laboratory testing. Follow-up of FBC at 3-6 months, 1 year, and 2 years after start or after a dose increase of VPA or interacting medication is sufficient.
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Design, synthesis, characterization, and molecular modeling studies of novel oxadiazole derivatives of nipecotic acid as potential anticonvulsant and antidepressant agents. Med Chem Res 2017. [DOI: 10.1007/s00044-017-2047-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Shi Q, Yang X, Greenhaw JJ, Salminen AT, Russotti GM, Salminen WF. Drug-Induced Liver Injury in Children: Clinical Observations, Animal Models, and Regulatory Status. Int J Toxicol 2017; 36:365-379. [PMID: 28820004 DOI: 10.1177/1091581817721675] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Drug-induced liver injury in children (cDILI) accounts for about 1% of all reported adverse drug reactions throughout all age groups, less than 10% of all clinical DILI cases, and around 20% of all acute liver failure cases in children. The overall DILI susceptibility in children has been assumed to be lower than in adults. Nevertheless, controversial evidence is emerging about children's sensitivity to DILI, with children's relative susceptibility to DILI appearing to be highly drug-specific. The culprit drugs in cDILI are similar but not identical to DILI in adults (aDILI). This is demonstrated by recent findings that a drug frequently associated with aDILI (amoxicillin/clavulanate) was rarely associated with cDILI and that the drug basiliximab caused only cDILI but not aDILI. The fatality in reported cDILI studies ranged from 4% to 31%. According to the US Food and Drug Administration-approved drugs labels, valproic acid, dactinomycin, and ampicillin appear more likely to cause cDILI. In contrast, deferasirox, isoniazid, dantrolene, and levofloxacin appear more likely to cause aDILI. Animal models have been explored to mimic children's increased susceptibility to valproic acid hepatotoxicity or decreased susceptibility to acetaminophen or halothane hepatotoxicity. However, for most drugs, animal models are not readily available, and the underlying mechanisms for the differential reactions to DILI between children and adults remain highly hypothetical. Diagnosis tools for cDILI are not yet available. A critical need exists to fill the knowledge gaps in cDILI. This review article provides an overview of cDILI and specific drugs associated with cDILI.
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Affiliation(s)
- Qiang Shi
- 1 Division of Systems Biology, National Center for Toxicological Research, Food and Drug Administration, Jefferson, AR, USA
| | - Xi Yang
- 1 Division of Systems Biology, National Center for Toxicological Research, Food and Drug Administration, Jefferson, AR, USA
| | - James J Greenhaw
- 1 Division of Systems Biology, National Center for Toxicological Research, Food and Drug Administration, Jefferson, AR, USA
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Wanji S, Eyong EEJ, Tendongfor N, Ngwa CJ, Esuka EN, Kengne-Ouafo AJ, Datchoua-Poutcheu FR, Enyong P, Agnew D, Eversole RR, Hopkins A, Mackenzie CD. Ivermectin treatment of Loa loa hyper-microfilaraemic baboons (Papio anubis): Assessment of microfilarial load reduction, haematological and biochemical parameters and histopathological changes following treatment. PLoS Negl Trop Dis 2017; 11:e0005576. [PMID: 28686693 PMCID: PMC5533442 DOI: 10.1371/journal.pntd.0005576] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Revised: 07/28/2017] [Accepted: 04/17/2017] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Individuals with high intensity of Loa loa are at risk of developing serious adverse events (SAEs) post treatment with ivermectin. These SAEs have remained unclear and a programmatic impediment to the advancement of community directed treatment with ivermectin. The pathogenesis of these SAEs following ivermectin has never been investigated experimentally. The Loa/baboon (Papio anubis) model can be used to investigate the pathogenesis of Loa-associated encephalopathy following ivermectin treatment in humans. METHODS 12 baboons with microfilarial loads > 8,000mf/mL of blood were randomised into four groups: Group 1 (control group receiving no drug), Group 2 receiving ivermectin (IVM) alone, Group 3 receiving ivermectin plus aspirin (IVM + ASA), and Group 4 receiving ivermectin plus prednisone (IVM + PSE). Blood samples collected before treatment and at Day 5, 7 or 10 post treatment, were analysed for parasitological, hematological and biochemical parameters using standard techniques. Clinical monitoring of animals for side effects took place every 6 hours post treatment until autopsy. At autopsy free fluids and a large number of standard organs were collected, examined and tissues fixed in 10% buffered formalin and processed for standard haematoxylin-eosin staining and specific immunocytochemical staining. RESULTS Mf counts dropped significantly (p<0.05) in all animals following ivermectin treatment with reductions as high as (89.9%) recorded; while no significant drop was observed in the control animals. Apart from haemoglobin (Hb) levels which recorded a significant (p = 0.028) drop post treatment, all other haematological and biochemical parameters did not show any significant changes (p>0.05). All animals became withdrawn 48 hours after IVM administration. All treated animals recorded clinical manifestations including rashes, itching, diarrhoea, conjunctival haemorrhages, lymph node enlargement, pinkish ears, swollen face and restlessness; one animal died 5 hours after IVM administration. Macroscopic changes in post-mortem tissues observed comprised haemorrhages in the brain, lungs, heart, which seen in all groups given ivermectin but not in the untreated animals. Microscopically, the major cellular changes seen, which were present in all the ivermectin treated animals included microfilariae in varying degrees of degeneration in small vessels. These were frequently associated with fibrin deposition, endothelial changes including damage to the integrity of the blood vessel and the presence of extravascular erythrocytes (haemorrhages). There was an increased presence of eosinophils and other chronic inflammatory types in certain tissues and organs, often in large numbers and associated with microfilarial destruction. Highly vascularized organs like the brain, heart, lungs and kidneys were observed to have more microfilariae in tissue sections. The number of mf seen in the brain and kidneys of animals administered IVM alone tripled that of control animals. Co-administration of IVM + PSE caused a greater increase in mf in the brain and kidneys while the reverse was noticed with the co-administration of IVM + ASA. CONCLUSIONS The treatment of Loa hyper-microfilaraemic individuals with ivermectin produces a clinical spectrum that parallels that seen in Loa hyper-microfilaraemic humans treated with ivermectin. The utilization of this experimental model can contribute to the improved management of the adverse responses in humans.
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Affiliation(s)
- Samuel Wanji
- Parasites and Vectors Research Unit, Department of Microbiology and Parasitology, Faculty of Science, University of Buea, Buea, South West Region, Cameroon
- Research Foundation for Tropical Diseases and Environment (REFOTDE), Buea, South West Region, Cameroon
| | - Ebanga-Echi J. Eyong
- Research Foundation for Tropical Diseases and Environment (REFOTDE), Buea, South West Region, Cameroon
- Department of Biological Sciences, Faculty of Science, The University of Bamenda, Bambili, North West Region, Cameroon
- Department of Zoology and Animal Physiology, Faculty of Science, University of Buea, Buea, South West Region, Cameroon
| | - Nicholas Tendongfor
- Research Foundation for Tropical Diseases and Environment (REFOTDE), Buea, South West Region, Cameroon
| | - Che J. Ngwa
- Research Foundation for Tropical Diseases and Environment (REFOTDE), Buea, South West Region, Cameroon
| | - Elive N. Esuka
- Research Foundation for Tropical Diseases and Environment (REFOTDE), Buea, South West Region, Cameroon
| | - Arnaud J. Kengne-Ouafo
- Parasites and Vectors Research Unit, Department of Microbiology and Parasitology, Faculty of Science, University of Buea, Buea, South West Region, Cameroon
- Research Foundation for Tropical Diseases and Environment (REFOTDE), Buea, South West Region, Cameroon
| | - Fabrice R. Datchoua-Poutcheu
- Parasites and Vectors Research Unit, Department of Microbiology and Parasitology, Faculty of Science, University of Buea, Buea, South West Region, Cameroon
- Research Foundation for Tropical Diseases and Environment (REFOTDE), Buea, South West Region, Cameroon
| | - Peter Enyong
- Parasites and Vectors Research Unit, Department of Microbiology and Parasitology, Faculty of Science, University of Buea, Buea, South West Region, Cameroon
- Research Foundation for Tropical Diseases and Environment (REFOTDE), Buea, South West Region, Cameroon
| | - Dalen Agnew
- Department of Pathobiology & Diagnostic Investigation, Michigan State University, East Lansing, MI, United States of America
| | - Rob R. Eversole
- Department of Biological Sciences, Western Michigan University, Kalamazoo, Michigan, United States of America
| | - Adrian Hopkins
- Mectizan Donation Programme, 325 Swanton Way, Decatur, Atlanta, Georgia, United States of America
| | - Charles D. Mackenzie
- Filarial Programmes Support Unit, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
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The role of postictal laboratory blood analyses in the diagnosis and prognosis of seizures. Seizure 2017; 47:51-65. [DOI: 10.1016/j.seizure.2017.02.013] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Revised: 02/23/2017] [Accepted: 02/24/2017] [Indexed: 12/18/2022] Open
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Chbili C, Hassine A, Laouani A, Amor SB, Nouira M, Ammou SB, Saguem S. The relationship between pharmacokinetic parameters of carbamazepine and therapeutic response in epileptic patients. Arch Med Sci 2017; 13:353-360. [PMID: 28261288 PMCID: PMC5332445 DOI: 10.5114/aoms.2016.60090] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2015] [Accepted: 04/24/2015] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION The prescribed dose and carbamazepine plasma concentration to achieve the optimal therapeutic efficacy are highly variable from one patient to the other. Our study aimed to determine whether biological parameters may be used as plasma markers that can individually adjust the carbamazepine dose necessary to optimize therapeutic efficacy. MATERIAL AND METHODS Ninety-four epileptic patients under carbamazepine monotherapy and who have never used combination therapy were recruited from the consecutive admissions at the Department of Neurology "CHU Sahloul" of Sousse Central Hospital in Tunisia from February 2010 to April 2011. The patients were monitored for epilepsy for three years on average. Carbamazepine and 10,11-epoxide-carbamazepine concentrations were analyzed through high-performance liquid chromatography. Simultaneously, therapeutic efficacy was assessed through the annual number of seizures in each patient. RESULTS Our results showed the absence of any significant correlations between specific dose (mg/kg/day), carbamazepine plasma concentrations and therapeutic efficacy (r = 0.0025, p = 0.30; r = 0.1584, p = 0.38 respectively), whereas both plasma 10,11-epoxide-carbamazepine concentration and 10,11-epoxide-carbamazepine to plasma carbamazepine ratio were closely correlated with therapeutic efficacy (r = 0.34, p = 0.03; r = 0.45, p = 0.008 respectively). The optimum therapeutic response was observed among patients who simultaneously had a plasma concentration of 0.8 μg/ml of metabolite and 5.5 μg/ml of carbamazepine. CONCLUSIONS The results suggest that plasma levels of both carbamazepine and of 10,11-epoxide-carbamazepine must be set to achieve an optimum therapeutic response.
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Affiliation(s)
- Chahra Chbili
- Metabolic Biophysics, Professional and Applied Toxicology Environmental Laboratory, Department of Biophysics, Faculty of Medicine Sousse, Sousse University, Sousse, Tunisia
| | - Anis Hassine
- Neurology Department of Central Hospital University (CHU), Sousse University, Sousse, Tunisia
| | - Aicha Laouani
- Metabolic Biophysics, Professional and Applied Toxicology Environmental Laboratory, Department of Biophysics, Faculty of Medicine Sousse, Sousse University, Sousse, Tunisia
| | - Sana Ben Amor
- Neurology Department of Central Hospital University (CHU), Sousse University, Sousse, Tunisia
| | - Manel Nouira
- Metabolic Biophysics, Professional and Applied Toxicology Environmental Laboratory, Department of Biophysics, Faculty of Medicine Sousse, Sousse University, Sousse, Tunisia
| | - Sofiène Ben Ammou
- Neurology Department of Central Hospital University (CHU), Sousse University, Sousse, Tunisia
| | - Saad Saguem
- Metabolic Biophysics, Professional and Applied Toxicology Environmental Laboratory, Department of Biophysics, Faculty of Medicine Sousse, Sousse University, Sousse, Tunisia
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Telles-Correia D, Barbosa A, Cortez-Pinto H, Campos C, Rocha NBF, Machado S. Psychotropic drugs and liver disease: A critical review of pharmacokinetics and liver toxicity. World J Gastrointest Pharmacol Ther 2017; 8:26-38. [PMID: 28217372 PMCID: PMC5292604 DOI: 10.4292/wjgpt.v8.i1.26] [Citation(s) in RCA: 65] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Revised: 11/02/2016] [Accepted: 11/16/2016] [Indexed: 02/06/2023] Open
Abstract
The liver is the organ by which the majority of substances are metabolized, including psychotropic drugs. There are several pharmacokinetic changes in end-stage liver disease that can interfere with the metabolization of psychotropic drugs. This fact is particularly true in drugs with extensive first-pass metabolism, highly protein bound drugs and drugs depending on phase I hepatic metabolic reactions. Psychopharmacological agents are also associated with a risk of hepatotoxicity. The evidence is insufficient for definite conclusions regarding the prevalence and severity of psychiatric drug-induced liver injury. High-risk psychotropics are not advised when there is pre-existing liver disease, and after starting a psychotropic agent in a patient with hepatic impairment, frequent liver function/lesion monitoring is advised. The authors carefully review the pharmacokinetic disturbances induced by end-stage liver disease and the potential of psychopharmacological agents for liver toxicity.
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Sato K, Arai N, Omori A, Hida A, Kimura A, Takeuchi S. Hyperammonaemia and associated factors in unprovoked convulsive seizures: A cross-sectional study. Seizure 2016; 43:6-12. [PMID: 27768938 DOI: 10.1016/j.seizure.2016.09.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Revised: 08/20/2016] [Accepted: 09/28/2016] [Indexed: 12/13/2022] Open
Abstract
PURPOSE Hyperammonaemia is frequently observed in patients who have experienced convulsive seizures. Although excessive muscle contraction is presumed to be responsible for the elevated levels of ammonia, the underlying mechanism is poorly understood. The present study aimed to identify the independent factors associated with ammonia elevation using large-scale multivariate analysis. METHODS We conducted a cross-sectional study involving 379 adult patients who had been transported to our emergency department and treated for unprovoked convulsive seizures between August 2010 and September 2015. Elevation of venous plasma ammonia levels was set as the primary endpoint, and patients' clinical and laboratory data were obtained. Those with severe liver dysfunction, known hepatic encephalopathy, or convulsions due to cardiovascular or psychogenic causes, and those taking valproate were excluded. RESULTS Using a cut-off value of 50μg/dL, 183 patients (48.3%) were found to have elevated levels of plasma ammonia. Four factors were identified as independent variables associated with hyperammonaemia following seizures: elevated venous lactate, lowered venous pH, sex (male), and longer duration of convulsion. CONCLUSIONS The results of the present study revealed independent factors associated with hyperammonaemia following unprovoked convulsive seizures in a larger scale and with more plausible statistical analysis. The authors further suggest that the excessive skeletal muscle contraction and/or respiratory failure during/after convulsive seizure may be the primary mechanism of hyperammonaemia.
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Affiliation(s)
- Kenichiro Sato
- Department of Neurology, Center Hospital of the National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokyo 162-8655, Japan
| | - Noritoshi Arai
- Department of Neurology, Center Hospital of the National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokyo 162-8655, Japan.
| | - Aki Omori
- Department of Neurology, Center Hospital of the National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokyo 162-8655, Japan
| | - Ayumi Hida
- Department of Neurology, Center Hospital of the National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokyo 162-8655, Japan
| | - Akio Kimura
- Department of Emergency Medicine and Critical Care, Center Hospital of the National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokyo 162-8655, Japan
| | - Sousuke Takeuchi
- Department of Neurology, Center Hospital of the National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokyo 162-8655, Japan
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Chait Mermelstein A, Mermelstein J, Adam T, Brody BD, Dubin MJ. Oxcarbazepine-induced liver injury after sensitization by valproic acid: a case report. Bipolar Disord 2016; 18:307-309. [PMID: 27041538 DOI: 10.1111/bdi.12381] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Accepted: 02/26/2016] [Indexed: 12/24/2022]
Abstract
OBJECTIVE The aim of the present case report is to describe a potential interaction between valproic acid and oxcarbazepine that resulted in hepatic injury. METHODS We report the case of a 46-year-old man with schizoaffective disorder who was cross-titrated from valproic acid to oxcarbazepine because of liver injury. RESULTS Initiation of oxcarbazepine four days after stopping valproic acid produced a significant elevation in liver enzymes that normalized with oxcarbazepine discontinuation and did not reappear with its reintroduction five days later. CONCLUSIONS Our findings suggest that a longer washout period or another agent should be considered when transitioning from valproic acid to oxcarbazepine.
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Affiliation(s)
- Alanna Chait Mermelstein
- Department of Psychiatry, New York Presbyterian Hospital/Weill Cornell Medicine, New York, NY, USA
| | - Joseph Mermelstein
- Department of Medicine, Mount Sinai Beth Israel/Icahn School of Medicine, New York, NY, USA
| | - Tarek Adam
- Department of Psychiatry, New York Presbyterian Hospital/Weill Cornell Medicine, New York, NY, USA
| | - Benjamin D Brody
- Department of Psychiatry, New York Presbyterian Hospital/Weill Cornell Medicine, New York, NY, USA
| | - Marc J Dubin
- Department of Psychiatry, New York Presbyterian Hospital/Weill Cornell Medicine, New York, NY, USA
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Carnitine and/or Acetylcarnitine Deficiency as a Cause of Higher Levels of Ammonia. BIOMED RESEARCH INTERNATIONAL 2016; 2016:2920108. [PMID: 26998483 PMCID: PMC4779505 DOI: 10.1155/2016/2920108] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Accepted: 01/27/2016] [Indexed: 12/24/2022]
Abstract
Blood carnitine and/or acetylcarnitine deficiencies are postulated in the literature as possible causes of higher ammonia levels. The aim of this study was to investigate if the use of valproic acid, the age of the patients, or certain central nervous system pathologies can cause carnitine and/or acetylcarnitine deficiency leading to increased ammonia levels. Three groups of patients were studied: (A) epileptic under phenytoin monotherapy (n = 31); (B) with bipolar disorder under valproic acid treatment (n = 28); (C) elderly (n = 41). Plasma valproic acid and blood carnitine and acyl carnitine profiles were determined using a validated HPLC and LC-MS/MS method, respectively. Blood ammonia concentration was determined using an enzymatic automated assay. Higher ammonia levels were encountered in patients under valproic acid treatment and in the elderly. This may be due to the lower carnitine and/or acetylcarnitine found in these patients. Patients with controlled seizures had normal carnitine and acetylcarnitine levels. Further studies are necessary in order to conclude if the uncontrolled bipolar disorder could be the cause of higher carnitine and/or acetylcarnitine levels.
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Mauri Llerda J, Suller Marti A, de la Peña Mayor P, Martínez Ferri M, Poza Aldea J, Gomez Alonso J, Mercadé Cerdá J. The Spanish Society of Neurology's official clinical practice guidelines for epilepsy. Special considerations in epilepsy: Comorbidities, women of childbearing age, and elderly patients. NEUROLOGÍA (ENGLISH EDITION) 2015. [DOI: 10.1016/j.nrleng.2014.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Saifi MA, Alyousif MS, Ahmed M. Biochemical Investigations on the Protective Role of Curcumin in Liver Damage by Chloroquine. INT J PHARMACOL 2015. [DOI: 10.3923/ijp.2015.870.873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Lin CH, Chen CL, Lin TK, Chen NC, Tsai MH, Chuang YC. Levetiracetam in the Treatment of Epileptic Seizures After Liver Transplantation. Medicine (Baltimore) 2015; 94:e1350. [PMID: 26402799 PMCID: PMC4635739 DOI: 10.1097/md.0000000000001350] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
After liver transplantation, patients may develop seizures or epilepsy due to a variety of etiologies. The ideal antiepileptic drugs for these patients are those with fewer drug interactions and less hepatic toxicity. In this study, we present patients using levetiracetam to control seizures after liver transplantation. We retrospectively enrolled patients who received levetiracetam for seizure control after liver transplantation. We analyzed the etiology of liver failure that required liver transplantation, etiology of the seizures, outcomes of seizure control, and the condition of the patient after follow-up at the outpatient department. Hematological and biochemical data before and after the use of levetiracetam were also collected. Fifteen patients who received intravenous or oral levetiracetam monotherapy for seizure control after liver transplantation were enrolled into this study. All of the patients remained seizure-free during levetiracetam treatment. Two patients died during the follow-up, and the other 13 patients were alive at the end of the study period and all were seizure-free without neurological sequelae that interfered with their daily activities. No patients experienced liver failure or rejection of the donor liver due to ineffective immunosuppressant medications. The dosage of immunosuppressants did not change before and after levetiracetam treatment, and there were no changes in hematological and biochemical data before and after treatment. Levetiracetam may be a suitable antiepileptic drug for patients who undergo liver transplantation due to fewer drug interactions and a favorable safety profile.
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Affiliation(s)
- Chih-Hsiang Lin
- From the Department of Neurology (C-HL, T-KL, N-CC, M-HT, Y-CC); Liver Transplantation Program and Department of Surgery (C-LC); Center for Translational Research in Biomedical Sciences, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine (C-LC, Y-CC); Department of Biological Science, National Sun Yet-sen University (Y-CC); and Department of Neurology, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan (Y-CC)
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