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Biso L, Aringhieri S, Carli M, Scarselli M, Longoni B. Therapeutic Drug Monitoring in Psychiatry: Enhancing Treatment Precision and Patient Outcomes. Pharmaceuticals (Basel) 2024; 17:642. [PMID: 38794212 PMCID: PMC11124530 DOI: 10.3390/ph17050642] [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: 04/12/2024] [Revised: 05/09/2024] [Accepted: 05/14/2024] [Indexed: 05/26/2024] Open
Abstract
Psychiatric disorders often require pharmacological interventions to alleviate symptoms and improve quality of life. However, achieving an optimal therapeutic outcome is challenging due to several factors, including variability in the individual response, inter-individual differences in drug metabolism, and drug interactions in polytherapy. Therapeutic drug monitoring (TDM), by measuring drug concentrations in biological samples, represents a valuable tool to address these challenges, by tailoring medication regimens to each individual. This review analyzes the current landscape of TDM in psychiatric practice, highlighting its significance in optimizing drug dosages, minimizing adverse effects, and improving therapeutic efficacy. The metabolism of psychiatric medications (i.e., mood stabilizers, antipsychotics, antidepressants) often exhibits significant inter-patient variability. TDM can help address this variability by enhancing treatment personalization, facilitating early suboptimal- or toxic-level detection, and allowing for timely interventions to prevent treatment failure or adverse effects. Furthermore, this review briefly discusses technological advancements and analytical methods supporting the implementation of TDM in psychiatric settings. These innovations enable quick and cost-effective drug concentration measurements, fostering the widespread adoption of TDM as a routine practice in psychiatric care. In conclusion, the integration of TDM in psychiatry can improve treatment outcomes by individualizing medication regimens within the so-called precision medicine.
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Affiliation(s)
- Letizia Biso
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, 56126 Pisa, Italy; (L.B.); (M.C.); (M.S.)
| | - Stefano Aringhieri
- Mental Health and Pathological Addiction Department, AUSL Romagna Forlì-Cesena, 47121 Forlì, Italy;
| | - Marco Carli
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, 56126 Pisa, Italy; (L.B.); (M.C.); (M.S.)
| | - Marco Scarselli
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, 56126 Pisa, Italy; (L.B.); (M.C.); (M.S.)
| | - Biancamaria Longoni
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, 56126 Pisa, Italy; (L.B.); (M.C.); (M.S.)
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Zita L, Kurhan S, Krunt O, Chmelíková E, Kraus A, Čítek J, Klouček P, Stupka R. The Effect of Carbamazepine on Performance, Carcass Value, Hematological and Biochemical Blood Parameters, and Detection of Carbamazepine and Its Metabolites in Tissues, Internal Organs, and Body Fluids in Growing Rabbits. Animals (Basel) 2023; 13:2041. [PMID: 37370551 DOI: 10.3390/ani13122041] [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: 05/11/2023] [Revised: 06/15/2023] [Accepted: 06/19/2023] [Indexed: 06/29/2023] Open
Abstract
Antiepileptic drugs (e.g., carbamazepine; CBZ) are widely prescribed for various conditions beyond epilepsy, including neurologic and psychiatric disorders. These medications can have both favorable and unfavorable impacts on mood, anxiety, depression, and psychosis. CBZ has been found at low concentrations (in the unit of nanograms per liter) in rivers, surface water, and even drinking water. As a result, when reclaimed wastewater is used for irrigation in agricultural ecosystems, CBZ can be reintroduced into the environment. That is why we tested different doses of CBZ in rabbits' feed as the meat is consumed in every community, has no religious barriers, and the potential risk of consuming meat which has been exposed to CBZ treatment is not known. Also, the evidence of the effect of CBZ on rabbits is missing. Mainly, the CBZ doses affected the count of leukocytes and other blood traits, meaning the higher the dose, the higher the reduction. Moreover, there were only low amounts of CBZ in rabbits' meat or tissues when they were exposed to the treatment.
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Affiliation(s)
- Lukáš Zita
- Department of Animal Science, Faculty of Agrobiology, Food and Natural Resources, Czech University of Life Sciences Prague, 165 00 Prague, Czech Republic
| | - Sebnem Kurhan
- Department of Food Science, Faculty of Agrobiology, Food and Natural Resources, Czech University of Life Sciences Prague, 165 00 Prague, Czech Republic
| | - Ondřej Krunt
- Department of Animal Science, Faculty of Agrobiology, Food and Natural Resources, Czech University of Life Sciences Prague, 165 00 Prague, Czech Republic
| | - Eva Chmelíková
- Department of Veterinary Sciences, Faculty of Agrobiology, Food and Natural Resources, Czech University of Life Sciences Prague, 165 00 Prague, Czech Republic
| | - Adam Kraus
- Department of Animal Science, Faculty of Agrobiology, Food and Natural Resources, Czech University of Life Sciences Prague, 165 00 Prague, Czech Republic
| | - Jaroslav Čítek
- Department of Animal Science, Faculty of Agrobiology, Food and Natural Resources, Czech University of Life Sciences Prague, 165 00 Prague, Czech Republic
| | - Pavel Klouček
- Department of Food Science, Faculty of Agrobiology, Food and Natural Resources, Czech University of Life Sciences Prague, 165 00 Prague, Czech Republic
| | - Roman Stupka
- Department of Animal Science, Faculty of Agrobiology, Food and Natural Resources, Czech University of Life Sciences Prague, 165 00 Prague, Czech Republic
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Tkalec Ž, Codling G, Tratnik JS, Mazej D, Klánová J, Horvat M, Kosjek T. Suspect and non-targeted screening-based human biomonitoring identified 74 biomarkers of exposure in urine of Slovenian children. ENVIRONMENTAL POLLUTION (BARKING, ESSEX : 1987) 2022; 313:120091. [PMID: 36064054 DOI: 10.1016/j.envpol.2022.120091] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Revised: 08/06/2022] [Accepted: 08/29/2022] [Indexed: 06/15/2023]
Abstract
Human exposure to organic contaminants is widespread. Many of these contaminants show adverse health effects on human population. Human biomonitoring (HBM) follows the levels and the distribution of biomarkers of exposure (BoE), but it is usually done in a targeted manner. Suspect and non-targeted screening (SS/NTS) tend to find BoE in an agnostic way, without preselection of compounds, and include finding evidence of exposure to predicted, unpredicted known and unknown chemicals. This study describes the application of high-resolution mass spectrometry (HRMS)-based SS/NTS workflow for revealing organic contaminants in urine of a cohort of 200 children from Slovenia, aged 6-9 years. The children originated from two regions, urban and rural, and the latter were sampled in two time periods, summer and winter. We tentatively identified 74 BoE at the confidence levels of 2 and 3. These BoE belong to several classes of pharmaceuticals, personal care products, plasticizers and plastic related products, volatile organic compounds, nicotine, caffeine and pesticides. The risk of three pesticides, atrazine, amitraz and diazinon is of particular concern since their use was limited in the EU. Among BoE we tentatively identified compounds that have not yet been monitored in HBM schemes and demonstrate limited exposure data, such as bisphenol G, polyethylene glycols and their ethers. Furthermore, 7 compounds with unknown use and sources of exposure were tentatively identified, either indicating the entry of new chemicals into the market, or their metabolites and transformation products. Interestingly, several BoE showed location and time dependency. Globally, this study presents high-throughput approach to SS/NTS for HBM. The results shed a light on the exposure of Slovenian children and raise questions on potential adverse health effects of such mixtures on this vulnerable population.
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Affiliation(s)
- Žiga Tkalec
- Department of Environmental Sciences, Jožef Stefan Institute, Ljubljana, Slovenia; Jožef Stefan International Postgraduate School, Ljubljana, Slovenia
| | - Garry Codling
- Research Centre for Toxic Compounds in the Environment, Masaryk University, Brno, Czech Republic
| | - Janja Snoj Tratnik
- Department of Environmental Sciences, Jožef Stefan Institute, Ljubljana, Slovenia
| | - Darja Mazej
- Department of Environmental Sciences, Jožef Stefan Institute, Ljubljana, Slovenia
| | - Jana Klánová
- Research Centre for Toxic Compounds in the Environment, Masaryk University, Brno, Czech Republic
| | - Milena Horvat
- Department of Environmental Sciences, Jožef Stefan Institute, Ljubljana, Slovenia; Jožef Stefan International Postgraduate School, Ljubljana, Slovenia
| | - Tina Kosjek
- Department of Environmental Sciences, Jožef Stefan Institute, Ljubljana, Slovenia; Jožef Stefan International Postgraduate School, Ljubljana, Slovenia.
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Mensah JA, Johnson K, Reilly CA, Wilcox KS, Rower JE, Metcalf CS. Evaluating the efficacy of prototype antiseizure drugs using a preclinical pharmacokinetic approach. Epilepsia 2022; 63:2937-2948. [PMID: 36054499 PMCID: PMC9669179 DOI: 10.1111/epi.17402] [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: 07/11/2022] [Revised: 08/25/2022] [Accepted: 08/25/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Pharmacokinetics (PK) of a drug drive its exposure, efficacy, and tolerability. A thorough preclinical PK assessment of antiseizure medications (ASMs) is therefore essential to evaluate the clinical potential. We tested protection against evoked seizures of prototype ASMs in conjunction with analysis of plasma and brain PK as a proof-of-principle study to enhance our understanding of drug efficacy and duration of action using rodent seizure models. METHODS In vivo seizure protection assays were performed in adult male CF-1 mice and Sprague Dawley rats. Clobazam (CLB), N-desmethyl CLB (NCLB), carbamazepine (CBZ), CBZ-10,11-epoxide (CBZE), sodium valproate (VPA), and levetiracetam (LEV) concentrations were quantified in plasma and brain using liquid chromatography-tandem mass spectrometry. Mean concentrations of each analyte were calculated and used to determine PK parameters via noncompartmental analysis in Phoenix WinNonLin. RESULTS NCLB concentrations were approximately 10-fold greater than CLB in mice. The antiseizure profile of CLB was partially sustained by NCLB in mice. CLB concentrations were lower in rats than in mice. CBZE plasma exposures were approximately 70% of CBZ in both mice and rats, likely contributing to the antiseizure effect of CBZ. VPA showed a relatively short half-life in both mice and rats, which correlated with a sharp decline in efficacy. LEV had a prolonged brain and plasma half-life, associated with a prolonged duration of action in mice. SIGNIFICANCE The study demonstrates the utility of PK analyses for understanding the seizure protection time course in mice and rats. The data indicate that distinct PK profiles of ASMs between mice and rats likely drive differences in drug efficacy between rodent models.
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Affiliation(s)
- Jeffrey A. Mensah
- Department of Pharmacology & Toxicology, University of Utah, Salt Lake City, UT, USA
| | - Kristina Johnson
- Epilepsy Therapy Screening Program (ETSP) Contract Site, University of Utah, Salt Lake, UT, USA
| | - Christopher A. Reilly
- Department of Pharmacology & Toxicology, University of Utah, Salt Lake City, UT, USA
- Center for Human Toxicology, College of Pharmacy, University of Utah, Salt Lake City, UT, USA
| | - Karen S. Wilcox
- Epilepsy Therapy Screening Program (ETSP) Contract Site, University of Utah, Salt Lake, UT, USA
- Department of Pharmacology & Toxicology, University of Utah, Salt Lake City, UT, USA
| | - Joseph E. Rower
- Department of Pharmacology & Toxicology, University of Utah, Salt Lake City, UT, USA
- Center for Human Toxicology, College of Pharmacy, University of Utah, Salt Lake City, UT, USA
| | - Cameron S. Metcalf
- Epilepsy Therapy Screening Program (ETSP) Contract Site, University of Utah, Salt Lake, UT, USA
- Department of Pharmacology & Toxicology, University of Utah, Salt Lake City, UT, USA
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Pal R, Singh K, Khan SA, Chawla P, Kumar B, Akhtar MJ. Reactive metabolites of the anticonvulsant drugs and approaches to minimize the adverse drug reaction. Eur J Med Chem 2021; 226:113890. [PMID: 34628237 DOI: 10.1016/j.ejmech.2021.113890] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 09/01/2021] [Accepted: 09/29/2021] [Indexed: 12/22/2022]
Abstract
Several generations of antiepileptic drugs (AEDs) are available in the market for the treatment of seizures, but these are amalgamated with acute to chronic side effects. The most common side effects of AEDs are dose-related, but some are idiosyncratic adverse drug reactions (ADRs) that transpire due to the formation of reactive metabolite (RM) after the bioactivation process. Because of the adverse reactions patients usually discontinue the medication in between the treatment. The AEDs such as valproic acid, lamotrigine, phenytoin etc., can be categorized under such types because they form the RM which may prevail with life-threatening adverse effects or immune-mediated reactions. Hepatotoxicity, teratogenicity, cutaneous hypersensitivity, dizziness, addiction, serum sickness reaction, renal calculi, metabolic acidosis are associated with the metabolites of drugs such as arene oxide, N-desmethyldiazepam, 2-(1-hydroxyethyl)-2-methylsuccinimide, 2-(sulphamoy1acetyl)-phenol, E-2-en-VPA and 4-en-VPA and carbamazepine-10,11-epoxide, etc. The major toxicities are associated with the moieties that are either capable of forming RM or the functional groups may itself be too reactive prior to the metabolism. These functional groups or fragment structures are typically known as structural alerts or toxicophores. Therefore, minimizing the bioactivation potential of lead structures in the early phases of drug discovery by a modification to low-risk drug molecules is a priority for the pharmaceutical companies. Additionally, excellent potency and pharmacokinetic (PK) behaviour help in ensuring that appropriate (low dose) candidate drugs progress into the development phase. The current review discusses about RMs in the anticonvulsant drugs along with their mechanism vis-a-vis research efforts that have been taken to minimize the toxic effects of AEDs therapy.
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Affiliation(s)
- Rohit Pal
- Department of Pharmaceutical Chemistry, ISF College of Pharmacy, Ghal Kalan, Ferozpur, G.T. Road, Moga, 142001, Punjab, India
| | - Karanvir Singh
- Department of Pharmaceutical Chemistry, ISF College of Pharmacy, Ghal Kalan, Ferozpur, G.T. Road, Moga, 142001, Punjab, India
| | - Shah Alam Khan
- Department of Pharmaceutical Chemistry, College of Pharmacy, National University of Science and Technology, PO 620, PC 130, Azaiba, Bousher, Muscat, Oman
| | - Pooja Chawla
- Department of Pharmaceutical Chemistry, ISF College of Pharmacy, Ghal Kalan, Ferozpur, G.T. Road, Moga, 142001, Punjab, India
| | - Bhupinder Kumar
- Department of Pharmaceutical Chemistry, ISF College of Pharmacy, Ghal Kalan, Ferozpur, G.T. Road, Moga, 142001, Punjab, India.
| | - Md Jawaid Akhtar
- Department of Pharmaceutical Chemistry, ISF College of Pharmacy, Ghal Kalan, Ferozpur, G.T. Road, Moga, 142001, Punjab, India; Department of Pharmaceutical Chemistry, College of Pharmacy, National University of Science and Technology, PO 620, PC 130, Azaiba, Bousher, Muscat, Oman.
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Eryavuz Onmaz D, Abusoglu S, Ozturk B, Abusoglu G, Yerlikaya FH, Unlu A. Determination of serum carbamazepine and its metabolite by validated tandem mass spectrometric method and the effect of carbamazepine on various hematological and biochemical parameters. J Pharm Biomed Anal 2021; 205:114299. [PMID: 34388672 DOI: 10.1016/j.jpba.2021.114299] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Revised: 07/28/2021] [Accepted: 07/30/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The study aimed to develop a validated LC-MS / MS method for the measurement of carbamazepine and carbamazepine-10,11-epoxide (CBZE) levels, to compare the carbamazepine concentrations measured by AbSciex API 3200 LC-MS/MS and Beckman Coulter Emit® 2000 immunoassay and to investigate the effect of carbamazepine concentrations on various hematological and biochemical parameters. METHODS For the measurement of carbamazepine and CBZE levels, a validated LC-MS / MS method was developed. Serum carbamazepine levels of patients were measured by AbSciex API 3200 LC-MS / MS and Beckman Coulter Emit® 2000 immunoassay. Biochemical, hematological parameters, and hormone levels were measured by Beckman-Coulter AU 5800 (Beckman Coulter, Brea, USA), Beckman Coulter LH 780 (Beckman Coulter, Miami, FL, USA), and Cobas 6000 (Roche Diagnostics, Germany) analyzers, respectively. RESULTS The imprecision values for all analytes were less than 7.0 %. The correlation coefficient between the methods was 0.981 (95 % confidence interval: 0.975 to 0.985). Linear regression analysis demonstrated highly significant associations of carbamazepine concentrations with albumin (B = -0.300, p = 0.040), calcium (B = -0.262, p = 0.004), phosphorus (B = -0.241, p = 0.022), WBC (B = -0.288, p = <0.001), PLT (B = -0.236, p = 0.003), RBC (B = -0.257, p = 0.001), NEU% (B = -0.289, p = <0.001), LYM% (B = -0.268, p = 0.001), D vitamini (B = -0.344, p = 0.006) levels. CONCLUSIONS A robust, rapid, and simple method has been developed. Our study revealed that carbamazepine and its metabolite have a significant correlation and likely impact on bone metabolism, blood cell counts, serum protein, albumin levels, and electrolyte concentrations.
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Affiliation(s)
- Duygu Eryavuz Onmaz
- Department of Biochemistry, Selcuk University Faculty of Medicine, Konya, Turkey.
| | - Sedat Abusoglu
- Department of Biochemistry, Selcuk University Faculty of Medicine, Konya, Turkey
| | - Bahadir Ozturk
- Department of Biochemistry, Selcuk University Faculty of Medicine, Konya, Turkey
| | - Gulsum Abusoglu
- Department of Medical Laboratory Techniques, Selcuk University Vocational School of Health, Konya, Turkey
| | | | - Ali Unlu
- Department of Biochemistry, Selcuk University Faculty of Medicine, Konya, Turkey
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Kong R, Ma J, Beers B, Kaushik D, Lin E, Goodwin E, Colacino J, Bibbiani F. Metabolite V, an epoxide species is a minor circulating metabolite in humans following a single oral dose of deflazacort. Pharmacol Res Perspect 2020; 8:e00677. [PMID: 33090712 PMCID: PMC7580709 DOI: 10.1002/prp2.677] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 09/25/2020] [Accepted: 09/25/2020] [Indexed: 01/04/2023] Open
Abstract
Deflazacort (Emflaza) was approved in the United States in 2017 for the treatment of the Duchenne muscular dystrophy in patients aged 2 years and older. Several deflazacort metabolites were isolated and identified from rats, dogs, monkeys, and humans. Among them, 1ß,2ß-epoxy-3ß-hydroxy-21-desacetyl deflazacort, referred to as Metabolite V, was reported to be one of the major circulating metabolites in humans. However, its quantitative distribution in plasma was not fully characterized. The objective of this study was to determine deflazacort plasma pharmacokinetics, metabolite profiles and their quantitative exposures in humans following a single oral dose. Six healthy male subjects were each administered a single oral dose of 60 mg [14 C]-deflazacort. Plasma and urine were collected and deflazacort metabolites in plasma were quantified by high performance liquid chromatography radio-profiling followed by liquid chromatography-mass spectrometry characterization. Metabolite V was isolated from urine and its structure was further confirmed by nuclear magnetic resonance analysis. These analyses demonstrated that deflazacort was not detectable in plasma; of the eight circulating deflazacort metabolites identified or characterized, the pharmacologically active metabolite 21-desacetyl deflazacort and inactive metabolite 6ß-hydroxy-21-desacetyl deflazacort accounted for 25.0% and 32.9% of the 0-24 hours plasma total radioactivity, respectively, while Metabolite V, an epoxide species, was a minor circulating metabolite, representing only about 4.7% of the total plasma radioactivity.
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Affiliation(s)
| | - Jiyuan Ma
- PTC Therapeutics, Inc.South PlainfieldNJUSA
| | | | | | - E Lin
- PTC Therapeutics, Inc.South PlainfieldNJUSA
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Pharmacokinetic interaction of brivaracetam on other antiepileptic drugs in adults with focal seizures: Pooled analysis of data from randomized clinical trials. Epilepsy Res 2019; 158:106218. [DOI: 10.1016/j.eplepsyres.2019.106218] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Revised: 10/09/2019] [Accepted: 10/13/2019] [Indexed: 11/15/2022]
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9
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Vivisenco CI, Ulmeanu CE. Rare Conduction Abnormality in a Four-year-old Child with Carbamazepine Acute Poisoning. MÆDICA 2019; 14:165-168. [PMID: 31523299 DOI: 10.26574/maedica.2019.14.2.165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background:Cardiac conduction abnormalities are reported after ingestion of a toxic dose of carbamazepine. Case presentation:We describe the case of a four-year-old child with carbamazepine acute poisoning who developed reversible synoatrial block along with neurological toxic signs, despite a serum level of carbamazepine close to the upper limit of the therapeutic range. Discussion:Although carbamazepine-induced sinoatrial block has been reported in the literature even at therapeutic doses in adult patients, our personal research has not identified any record of this cardiac conduction abnormality in acute carbamazepine poisoning at pediatric age. Conclusion:The electrocardiogram is indispensable in the assessment and monitoring of pediatric cases with acute poisoning with carbamazepine.
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Miller TH, Ng KT, Bury ST, Bury SE, Bury NR, Barron LP. Biomonitoring of pesticides, pharmaceuticals and illicit drugs in a freshwater invertebrate to estimate toxic or effect pressure. ENVIRONMENT INTERNATIONAL 2019; 129:595-606. [PMID: 31053240 PMCID: PMC6554641 DOI: 10.1016/j.envint.2019.04.038] [Citation(s) in RCA: 56] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Revised: 04/15/2019] [Accepted: 04/17/2019] [Indexed: 05/05/2023]
Abstract
Multiple classes of environmental contaminants have been found in aquatic environments, globally. Understanding internalised concentrations in the organism could further improve the risk assessment process. The present study is concerned with the determination of several contaminant classes (107 compounds) in Gammarus pulex collected from 15 sites covering 5 river catchments across Suffolk, UK. Quantitative method performance was acceptable for 67 compounds including pharmaceuticals, pesticides, illicit drugs and drugs of abuse. A total of 56 compounds were detectable and ranged from
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Affiliation(s)
- Thomas H Miller
- Department of Analytical, Environmental & Forensic Sciences, School of Population Health & Environmental Sciences, Faculty of Life Sciences and Medicine, King's College London, 150 Stamford Street, London SE1 9NH, UK.
| | - Keng Tiong Ng
- Department of Analytical, Environmental & Forensic Sciences, School of Population Health & Environmental Sciences, Faculty of Life Sciences and Medicine, King's College London, 150 Stamford Street, London SE1 9NH, UK
| | - Samuel T Bury
- St Olaves Grammer School, Goddington Lane, Orpington, BR6 9SH, UK
| | - Sophie E Bury
- Department of Pyschology, Royal Holloway, University of London, Egham, Surrey TW20 0EX, UK
| | - Nicolas R Bury
- School of Science, Technology and Engineering, University of Suffolk, James Hehir Building, University Avenue, Ipswich, Suffolk IP3 0FS, UK; Suffolk Sustainability Institute, University of Suffolk, Waterfront Building, Neptune Quay, Ipswich IP4 1QJ, UK
| | - Leon P Barron
- Department of Analytical, Environmental & Forensic Sciences, School of Population Health & Environmental Sciences, Faculty of Life Sciences and Medicine, King's College London, 150 Stamford Street, London SE1 9NH, UK
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Kato R, Ijiri Y, Hayashi T, Uetrecht J. The 2-Hydroxyiminostilbene Metabolite of Carbamazepine or the Supernatant from Incubation of Hepatocytes with Carbamazepine Activates Inflammasomes: Implications for Carbamazepine-Induced Hypersensitivity Reactions. Drug Metab Dispos 2019; 47:1093-1096. [DOI: 10.1124/dmd.119.087981] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Accepted: 07/10/2019] [Indexed: 12/29/2022] Open
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Research Progress on the Animal Models of Drug-Induced Liver Injury: Current Status and Further Perspectives. BIOMED RESEARCH INTERNATIONAL 2019; 2019:1283824. [PMID: 31119149 PMCID: PMC6500714 DOI: 10.1155/2019/1283824] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Accepted: 03/26/2019] [Indexed: 02/07/2023]
Abstract
Drug-induced liver injury (DILI) is a major concern in clinical studies as well as in postmarketing surveillance. It is necessary to establish an animal model of DILI for thorough investigation of mechanisms of DILI and searching for protective medications. This article reviews the current status and future perspective on establishment of DILI models based on different hepatotoxic drugs, as well as the underlying mechanisms of liver function damage induced by specific medicine. Therefore, information from this article can help researchers make a suitable selection of animal models for further study.
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Jiang W, Xia T, Yun Y, Li M, Zhang F, Gao S, Chen W. UHPLC-MS/MS method for simultaneous determination of carbamazepine and its seven major metabolites in serum of epileptic patients. J Chromatogr B Analyt Technol Biomed Life Sci 2019; 1108:17-24. [DOI: 10.1016/j.jchromb.2018.12.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Revised: 11/09/2018] [Accepted: 12/13/2018] [Indexed: 01/02/2023]
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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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Yip VLM, Meng X, Maggs JL, Jenkins RE, Marlot PT, Marson AG, Park BK, Pirmohamed M. Mass Spectrometric Characterization of Circulating Covalent Protein Adducts Derived from Epoxide Metabolites of Carbamazepine in Patients. Chem Res Toxicol 2017; 30:1419-1435. [DOI: 10.1021/acs.chemrestox.7b00063] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Affiliation(s)
- Vincent L. M. Yip
- MRC
Centre for Drug Safety Science, Department of Molecular and Clinical
Pharmacology, The University of Liverpool, Liverpool L69 3GE, United Kingdom
- The
Wolfson Centre for Personalized Medicine, Department of Molecular
and Clinical Pharmacology, The University of Liverpool, Liverpool L69 3GL, United Kingdom
| | - Xiaoli Meng
- MRC
Centre for Drug Safety Science, Department of Molecular and Clinical
Pharmacology, The University of Liverpool, Liverpool L69 3GE, United Kingdom
| | - James L. Maggs
- MRC
Centre for Drug Safety Science, Department of Molecular and Clinical
Pharmacology, The University of Liverpool, Liverpool L69 3GE, United Kingdom
| | - Rosalind E. Jenkins
- MRC
Centre for Drug Safety Science, Department of Molecular and Clinical
Pharmacology, The University of Liverpool, Liverpool L69 3GE, United Kingdom
| | - Philippe T. Marlot
- MRC
Centre for Drug Safety Science, Department of Molecular and Clinical
Pharmacology, The University of Liverpool, Liverpool L69 3GE, United Kingdom
- The
Wolfson Centre for Personalized Medicine, Department of Molecular
and Clinical Pharmacology, The University of Liverpool, Liverpool L69 3GL, United Kingdom
| | - Anthony G. Marson
- MRC
Centre for Drug Safety Science, Department of Molecular and Clinical
Pharmacology, The University of Liverpool, Liverpool L69 3GE, United Kingdom
| | - B. Kevin Park
- MRC
Centre for Drug Safety Science, Department of Molecular and Clinical
Pharmacology, The University of Liverpool, Liverpool L69 3GE, United Kingdom
| | - Munir Pirmohamed
- MRC
Centre for Drug Safety Science, Department of Molecular and Clinical
Pharmacology, The University of Liverpool, Liverpool L69 3GE, United Kingdom
- The
Wolfson Centre for Personalized Medicine, Department of Molecular
and Clinical Pharmacology, The University of Liverpool, Liverpool L69 3GL, United Kingdom
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Das S, Fleming DH, Mathew BS, Winston A B, Prabhakar AT, Alexander M. Determination of serum carbamazepine concentration using dried blood spot specimens for resource-limited settings. Hosp Pract (1995) 2017; 45:46-50. [PMID: 28353375 DOI: 10.1080/21548331.2017.1296318] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
OBJECTIVES Carbamazepine (CBZ) is a commonly used anti-epileptic in rural hospitals in India. These hospitals lack the facilities to measure CBZ concentration; however, in larger hospitals this is performed using high performance liquid chromatography (HPLC). Dried blood spot (DBS) represents a feasible matrix for safe transportation by post/courier. This study was to determine whether the concentration of CBZ in serum can be predicted from that measured in DBS using an inexpensive HPLC method and inexpensive standard filter paper. METHODS CBZ in serum and DBS from 80 epileptic patients were measured using a validated HPLC assay. The data was then randomly divided into two groups; simple Deming regression was performed with the first group and validation was performed using the second. RESULTS There was a good correlation between the serum and DBS concentrations (r = 0.932) in the first group. The regression equation obtained was: predicted serum concentration = DBS concentration x 0.83 + 1.09. In the validation group, the correlation between the predicted and actual serum concentrations was also good (r = 0.958), and the mean difference between them was only 0.28 μg/ml (p = 0.8062). The imprecision and bias in both the groups were acceptable. CONCLUSION Using inexpensive materials, serum CBZ concentrations can be accurately predicted from DBS specimens. This method can be recommended for the therapeutic drug monitoring of CBZ in resource-limited settings.
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Affiliation(s)
- Saibal Das
- a Department of Pharmacology and Clinical Pharmacology , Christian Medical College , Vellore , Tamil Nadu , India
| | - Denise H Fleming
- a Department of Pharmacology and Clinical Pharmacology , Christian Medical College , Vellore , Tamil Nadu , India
| | - Binu S Mathew
- a Department of Pharmacology and Clinical Pharmacology , Christian Medical College , Vellore , Tamil Nadu , India
| | - Blessed Winston A
- a Department of Pharmacology and Clinical Pharmacology , Christian Medical College , Vellore , Tamil Nadu , India
| | - Appaswamy T Prabhakar
- b Department of Neurological Sciences , Christian Medical College , Vellore , Tamil Nadu , India
| | - Mathew Alexander
- b Department of Neurological Sciences , Christian Medical College , Vellore , Tamil Nadu , India
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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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Pharmacokinetic interaction of brivaracetam on carbamazepine in adult patients with epilepsy, with and without valproate co-administration. Epilepsy Res 2016; 128:163-168. [PMID: 27842261 DOI: 10.1016/j.eplepsyres.2016.11.001] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2016] [Revised: 10/21/2016] [Accepted: 11/05/2016] [Indexed: 11/21/2022]
Abstract
OBJECTIVE This Phase I, open-label, dose-escalation study investigated the effects of steady-state brivaracetam on the pharmacokinetics of carbamazepine in patients with epilepsy, with and without valproate co-administration. Valproate and brivaracetam inhibit epoxide hydrolase and increase carbamazepine epoxide levels. METHODS Adult patients with epilepsy being chronically treated with carbamazepine alone (n=9) or with carbamazepine and valproate (n=9) received brivaracetam during successive 1-week periods at doses of 50mg, 100mg, 200mg, and 100mg twice daily (bid). Doses of carbamazepine and valproate must have been stable for at least 3 months. Trough plasma concentrations of carbamazepine, carbamazepine epoxide, and diol metabolites were determined on Days 1, 8, 15, 22, and 29, and at the end of study visit (ESV, 2-3weeks later). RESULTS Eighteen patients with median (range) age of 45 (20-62) years and body weight of 74 (59-124) kg were enrolled and completed the study. In patients treated with carbamazepine alone, brivaracetam dose-dependently increased mean trough levels of carbamazepine epoxide from 1.38μg/mL on Day 1 pre-dose to 2.16μg/mL (+57%) on Day 8 (50mg bid), 2.72μg/mL (+97%) on Day 15 (100mg bid), 3.02μg/mL (+119%) on Day 22 (200mg bid), 2.67μg/mL (+94%) on Day 29 (100mg bid), and 1.22μg/mL (-12%) at ESV, respectively. In patients on carbamazepine and valproate, carbamazepine epoxide increased from 1.98μg/mL at baseline to 2.72μg/mL (+37%), 3.70μg/mL (+87%), 4.43μg/mL (+124%), 3.11μg/mL (+57%), and 1.94μg/mL (-2%), respectively. There was no trend for change in carbamazepine, carbamazepine diol or valproate levels. Brivaracetam levels increased linearly with dose. Brivaracetam was well tolerated. CONCLUSIONS Carbamazepine epoxide plasma concentrations were approximately doubled by brivaracetam 100 or 200mg bid. Data are consistent with a dose-dependent and reversible inhibition of epoxide hydrolase by brivaracetam. Carbamazepine epoxide was approximately 0.7μg/mL higher in presence of valproate. There is no need to limit brivaracetam dosing when used concomitantly with carbamazepine.
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Chbili C, Hassine A, Ben Amor S, Nouira M, Ben Ammou S, Saguem S. Implications of metabolic parameters of carbamazepine in the therapeutic monitoring of Tunisian patients with epilepsy. Rev Neurol (Paris) 2016; 172:313-7. [PMID: 27062293 DOI: 10.1016/j.neurol.2015.12.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2015] [Revised: 11/17/2015] [Accepted: 12/18/2015] [Indexed: 10/22/2022]
Abstract
Carbamazepine (CBZ) is widely used in the control of simple and complex focal seizures and generalized tonic-clonic seizures in patients with epilepsy. The toxic effects of CBZ are not easily predicted, and this is due to the difficulty of delivering the optimal dose and/or plasma concentration of CBZ necessary to achieve beneficial effects, and especially to prevent the onset of toxicity associated with its use. Our study aimed to determine the relationship between the administered daily dose of CBZ and its pharmacokinetic parameters, including concentrations of CBZ and carbamazepine-10,11-epoxide (CBZ-E) plasma levels, and the metabolic ratio of CBZ-E to CBZ, in Tunisian patients with epilepsy. To accomplish this, a high-performance liquid chromatography method with ultraviolet detection was used for quantification in the simultaneous analysis of CBZ and one of its active metabolites, CBZ-E, in human plasma. A statistically significant positive correlation was found between the daily doses administered (mg/kg/day) and plasma concentrations of CBZ and CBZ-E, and the CBZ-E/CBZ ratio increased significantly as a function of the specific dose (in mg/kg/day). The increase in plasma concentrations of CBZ-E was non-linear in relation to plasma concentrations of CBZ, and there was no correlation between the CBZ-E/CBZ metabolic ratio and CBZ plasma concentrations. Our findings suggest that monitoring of CBZ as well as CBZ-E blood levels should be considered, as it may play a useful role in the therapeutic management of patients with epilepsy.
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Affiliation(s)
- C Chbili
- Medicine Faculty of Sousse, Department of Biophysics, Laboratory of Metabolic Biophysics, Professional Toxicology and Applied Environnemental, avenue Mohamed Karoui, Sousse, Tunisia.
| | - A Hassine
- Central Hospital University (CHU), Neurology Department, Sousse, Tunisia
| | - S Ben Amor
- Central Hospital University (CHU), Neurology Department, Sousse, Tunisia
| | - M Nouira
- Medicine Faculty of Sousse, Department of Biophysics, Laboratory of Metabolic Biophysics, Professional Toxicology and Applied Environnemental, avenue Mohamed Karoui, Sousse, Tunisia
| | - S Ben Ammou
- Central Hospital University (CHU), Neurology Department, Sousse, Tunisia
| | - S Saguem
- Medicine Faculty of Sousse, Department of Biophysics, Laboratory of Metabolic Biophysics, Professional Toxicology and Applied Environnemental, avenue Mohamed Karoui, Sousse, Tunisia.
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Abstract
This chapter includes the aspects of carbamazepine. The drug is synthesized by the use of 5H-dibenz[b,f]azepine and phosgene followed by subsequent reaction with ammonia. Carbamazepine is generally used for the treatment of seizure disorders and neuropathic pain, it is also important as off-label for a second-line treatment for bipolar disorder and in combination with an antipsychotic in some cases of schizophrenia when treatment with a conventional antipsychotic alone has failed. Other uses may include attention deficit hyperactivity disorder, schizophrenia, phantom limb syndrome, complex regional pain syndrome, borderline personality disorder, and posttraumatic stress disorder. The chapter discusses the drug metabolism and pharmacokinetics and presents various methods of analysis of this drug such electrochemical analysis, spectroscopic analysis, and chromatographic techniques of separation. It also discusses its physical properties such as solubility characteristics, X-ray powder diffraction pattern, and thermal methods of analysis. The chapter is concluded with a discussion on its biological properties such as activity, toxicity, and safety.
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Effects of glutathione S-transferase M1 and T1 deletions on carbamazepine metabolism among a Tunisian population. Genes Genomics 2015. [DOI: 10.1007/s13258-015-0330-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Burianová I, Bořecká K. Routine therapeutic monitoring of the active metabolite of carbamazepine: Is it really necessary? Clin Biochem 2015; 48:866-9. [DOI: 10.1016/j.clinbiochem.2015.05.014] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2015] [Revised: 05/01/2015] [Accepted: 05/15/2015] [Indexed: 11/27/2022]
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23
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Therapeutic drug monitoring of carbamazepine and its metabolite in children from dried blood spots using liquid chromatography and tandem mass spectrometry. J Pharm Biomed Anal 2015; 109:164-70. [DOI: 10.1016/j.jpba.2015.02.045] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2014] [Revised: 02/20/2015] [Accepted: 02/22/2015] [Indexed: 11/23/2022]
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Interaction of carbamazepine with herbs, dietary supplements, and food: a systematic review. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2013; 2013:898261. [PMID: 24023584 PMCID: PMC3760091 DOI: 10.1155/2013/898261] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/26/2013] [Accepted: 07/17/2013] [Indexed: 11/17/2022]
Abstract
Background. Carbamazepine (CBZ) is a first-line antiepileptic drug which may be prone to drug interactions. Systematic review of herb- and food-drug interactions on CBZ is warranted to provide guidance for medical professionals when prescribing CBZ. Method. A systematic review was conducted on six English databases and four Chinese databases. Results. 196 out of 3179 articles fulfilled inclusion criteria, of which 74 articles were reviewed and 33 herbal products/dietary supplement/food interacting with CBZ were identified. No fatal or severe interactions were documented. The majority of the interactions were pharmacokinetic-based (80%). Traditional Chinese medicine accounted for most of the interactions (n = 17), followed by food (n = 10), dietary supplements (n = 3), and other herbs/botanicals (n = 3). Coadministration of 11 and 12 of the studied herbal products/dietary supplement/food significantly decreased or increased the plasma concentrations of CBZ. Regarding pharmacodynamic interaction, Xiao-yao-san, melatonin, and alcohol increased the side effects of CBZ while caffeine lowered the antiepileptic efficacy of CBZ. Conclusion. This review provides a comprehensive summary of the documented interactions between CBZ and herbal products/food/dietary supplements which assists healthcare professionals to identify potential herb-drug and food-drug interactions, thereby preventing potential adverse events and improving patients' therapeutic outcomes when prescribing CBZ.
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25
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Impact of interferences including metabolite crossreactivity on therapeutic drug monitoring results. Ther Drug Monit 2013; 34:496-506. [PMID: 22846896 DOI: 10.1097/ftd.0b013e318261c2c9] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Therapeutic drug monitoring is an integral part of services offered by toxicology laboratories because certain drugs require routine monitoring for dosage adjustment to achieve optimal therapeutic response and avoid adverse drug reactions. Immunoassays are widely used for therapeutic drug monitoring. However, immunoassays suffer from interferences from both exogenous and endogenous compounds including metabolites of the parent drug. Digoxin immunoassays are affected more commonly than any other immunoassays used for therapeutic drug monitoring. Digoxin immunoassays are affected by endogenous digoxin-like immunoreactive substances and exogenous compounds such as various drugs, certain herbal supplements, and Digibind. Carbamazepine is metabolized to carbamazepine 10, 11-epoxide, and the crossreactivity of this metabolite with carbamazepine immunoassay may vary from 0% to 94%. Immunoassays used for measuring concentrations of tricyclic antidepressants are affected by tricyclic antidepressant metabolites and by a number of other drugs. Immunoassays for immunosuppressants are also subjected to significant interferences from metabolites, and liquid chromatography combined with mass spectrometry or tandem mass spectrometry is recommended for therapeutic drug monitoring of immunosuppressants. However, liquid chromatography combined with mass spectrometry may also suffer from interferences, for example, due to ion suppression or from isobaric ions.
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Elliott EC, Regan SL, Maggs JL, Bowkett ER, Parry LJ, Williams DP, Park BK, Stachulski AV. Haloarene Derivatives of Carbamazepine with Reduced Bioactivation Liabilities: 2-Monohalo and 2,8-Dihalo Derivatives. J Med Chem 2012; 55:9773-84. [DOI: 10.1021/jm301013n] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
| | - Sophie L. Regan
- MRC Centre for Drug Safety Science,
Institute of Translational Medicine, University of Liverpool, Liverpool L69 3GE, U.K
| | - James L. Maggs
- MRC Centre for Drug Safety Science,
Institute of Translational Medicine, University of Liverpool, Liverpool L69 3GE, U.K
| | | | - Laura J. Parry
- Department of Chemistry, University of Liverpool, Liverpool L69 7ZD, U.K
| | - Dominic P. Williams
- MRC Centre for Drug Safety Science,
Institute of Translational Medicine, University of Liverpool, Liverpool L69 3GE, U.K
| | - B. Kevin Park
- MRC Centre for Drug Safety Science,
Institute of Translational Medicine, University of Liverpool, Liverpool L69 3GE, U.K
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The effect of poor compliance on the pharmacokinetics of carbamazepine and its epoxide metabolite using Monte Carlo simulation. Acta Pharmacol Sin 2012; 33:1431-40. [PMID: 23103621 DOI: 10.1038/aps.2012.135] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
AIM To study the effects of delayed and missed doses (poor compliance) on the pharmacokinetics of carbamazepine (CBZ) and its main active metabolite carbamazepine-10,11-epoxide (CBZE) in Chinese epilepsy patients using Monte Carlo simulation. METHODS CBZ and CBZE time-concentration profiles in various scenarios were generated based on a population pharmacokinetic study in Chinese epilepsy patients using Monte Carlo simulation. The scenarios included patients given multiple doses of CBZ that ranged from 100 to 300 mg three times daily or from 200 to 300 mg every 12 h. The therapeutic range of CBZ and CBZE for each scenario was estimated to assess the effect of delayed or missed doses and to design corresponding rescue regimens. Moreover, the impact of body weight, absorption rate and co-therapy with other antiepileptic drugs (phenytoin, phenobarbital and valproic acid) on the dosage recommendation was investigated in the event of poor compliance. RESULTS The risk for a sub-therapeutic range of CBZ and CBZE was increased in a dose-dependent manner in both two and three times daily regimens when delayed or missed doses occurred. The effects of poor compliance was less prominent on the lower daily doses compared with those on the higher daily doses. The dose recommendations, in the event of poor compliance, were time related and dose dependent. Patient body weight, absorption rate and co-therapy with phenytoin, phenobarbital and valproic acid had no significant impact on the dose recommendation. CONCLUSION Patients with epilepsy should take the delayed doses as soon as they remember, and partial missed doses may need to be taken near or at the next scheduled time.
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Abstract
The topic of central nervous system intoxicants encompasses a multitude of agents. This article focuses on three classes of therapeutic drugs, with specific examples in which overdoses require admission to the intensive care unit. Included are some of the newer antidepressants, the atypical neuroleptic agents, and selected anticonvulsant drugs. The importance of understanding pertinent physiology and applicable supportive care is emphasized.
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Affiliation(s)
- Matthew W Hedge
- Department of Emergency Medicine, Detroit Receiving Hospital, Children's Hospital of Michigan Regional Poison Control Center, Wayne State University, Hutzel Building, 4707 Street Antoine, Suite 302, Detroit, MI 48201, USA.
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Wong YC, Qian S, Zuo Z. Regioselective biotransformation of CNS drugs and its clinical impact on adverse drug reactions. Expert Opin Drug Metab Toxicol 2012; 8:833-54. [DOI: 10.1517/17425255.2012.688027] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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30
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McMillin GA, Juenke JM, Johnson MJ, Dasgupta A. Discordant carbamazepine values between two immunoassays: carbamazepine values determined by ADVIA Centaur correlate better with those determined by LC-MS/MS than PETINIA assay. J Clin Lab Anal 2011; 25:212-6. [PMID: 21567471 DOI: 10.1002/jcla.20460] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Discordant carbamazepine values as determined by two different immunoassays may be due to different cross-reactivities with the active metabolite carbamazepine 10, 11-epoxide and may cause confusion in interpreting carbamazepine serum levels. In this study, we compared carbamazepine values in samples containing carbamazepine and the epoxide metabolite, as determined by liquid chromatography coupled to tandem mass spectrometry (LC-MS/MS) and by two commercial carbamazepine immunoassays: the PETINIA and the ADVIA Centaur carbamazepine. Clinical specimens were used for the comparative studies wherein we determined carbamazepine concentrations using the PETINIA, ADVIA Centaur, and LC-MS/MS assays. We observed an excellent correlation between carbamazepine concentrations determined by the ADVIA Centaur and LC-MS/MS methods while carbamazepine values were overestimated using the PETINIA assay. When aliquots of drug-free serum were supplemented with clinically relevant concentrations of the carbamazepine epoxide metabolite, we observed negligible cross-reactivity of epoxide with the ADVIA Centaur assay but over 90% cross-reactivity with the PETINIA assay. We conclude that the ADVIA centaur assay accurately measures carbamazepine concentrations in plasma or serum and that the PETINIA assay significantly overestimates true carbamazepine concentration. Such discordance may cause confusion in interpreting serum carbamazepine levels.
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Affiliation(s)
- Gwendolyn A McMillin
- ARUP Institute for Clinical and Experimental Pathology, Salt Lake City, Utah, USA
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Harder JL, Heung M, Vilay AM, Mueller BA, Segal JH. Carbamazepine and the active epoxide metabolite are effectively cleared by hemodialysis followed by continuous venovenous hemodialysis in an acute overdose. Hemodial Int 2011; 15:412-5. [PMID: 21676154 DOI: 10.1111/j.1542-4758.2011.00563.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Hemodialysis (HD) and continuous venovenous hemodialysis (CVVHD) have an unproven role in the management of carbamazepine overdose. Albumin-enhanced CVVHD may accelerate carbamazepine (CBZ) clearance, but no pharmacokinetic data has been reported for traditional CVVHD without albumin enhancement. In addition, it is unclear whether the active CBZ-epoxide metabolite is removed with either mode of dialysis. We present a case of CBZ intoxication successfully managed with sequential HD and CVVHD. The CBZ half-life during CVVHD was 14.7 hours, compared with the patient's endogenous half-life of 30.8 hours. The CBZ-epoxide half-life was 3.2 hours during HD. We conclude that HD and CVVHD provide effective clearance of CBZ and the epoxide metabolite and should be considered in the management of an acute toxic ingestion.
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Affiliation(s)
- Jennifer L Harder
- Department of Internal Medicine, Division of Nephrology, University of Michigan School of Medicine, Ann Arbor, Michigan 48109-0725, USA
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Vuckovic D, de Lannoy I, Gien B, Yang Y, Musteata FM, Shirey R, Sidisky L, Pawliszyn J. In vivo solid-phase microextraction for single rodent pharmacokinetics studies of carbamazepine and carbamazepine-10,11-epoxide in mice. J Chromatogr A 2011; 1218:3367-75. [DOI: 10.1016/j.chroma.2010.07.060] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2010] [Revised: 07/19/2010] [Accepted: 07/24/2010] [Indexed: 10/19/2022]
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Tonic – Ribarska J, Sterjev Z, Cvetkovska E, Kuzmanovski I, Kiteva G, Suturkova L, Trajkovic - Jolevska S. Optimization and validation of bioanalytical SPE – HPLC method for the simultaneous determination of carbamazepine and its main metabolite, carbamazepine-10, 11-epoxide, in plasma. MAKEDONSKO FARMACEVTSKI BILTEN 2011. [DOI: 10.33320/maced.pharm.bull.2011.57.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Carbamazepine is widely used as an antiepileptic drug in the treatment of partial and generalized tonic-clonic seizures. Carbamazepine 10,11-epoxide is the most important metabolite of carbamazepine, because it is a pharmacologically active compound with anticonvulsant properties. According to that, the routine analysis of carbamazepine 10,11-epoxide along with carbamazepine may provide optimal therapeutic monitoring of carbamazepine treatment. The aim of this study was to optimize and validate a simple and reliable solid - phase extraction method followed by RP-HPLC for the simultaneous determination of plasma levels of carbamazepine and carbamazepine-10,11-epoxide, in order to assure the implementation of the method for therapeutic monitoring. The extraction of the analytes from the plasma samples was performed by means of a solid-phase extraction procedure. The separation was carried out on a reversed-phase column using isocratic elution with acetonitrile and water (35:65, v/v) as a mobile phase. The temperature was 30°C and UV detection was set at 220 nm. The extraction yield values were more than 98% for all analytes, measured at four concentration levels of the linear concentration range. The method displayed excellent selectivity, sensitivity, linearity, precision and accuracy. Stability studies indicate that stock solutions and plasma samples were stabile under different storage conditions at least during the observed period. The method was successfully applied to determine the carbamazepine and carbamazepine-10,11-epoxide in plasma of epileptic patients treated with carbamazepine as monotherapy and in polytherapy. In conclusion, the proposed method is suitable for application in therapeutic drug monitoring of epileptic patients undergoing treatment with carbamazepine.
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Lerche MH, Meier S, Jensen PR, Hustvedt SO, Karlsson M, Duus JØ, Ardenkjaer-Larsen JH. Quantitative dynamic nuclear polarization-NMR on blood plasma for assays of drug metabolism. NMR IN BIOMEDICINE 2011; 24:96-103. [PMID: 20862657 DOI: 10.1002/nbm.1561] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/10/2009] [Revised: 02/09/2010] [Accepted: 04/14/2010] [Indexed: 05/29/2023]
Abstract
Analytical platforms for the fast detection, identification and quantification of circulating drugs with a narrow therapeutic range are vital in clinical pharmacology. As a result of low drug concentrations, analytical tools need to provide high sensitivity and specificity. Dynamic nuclear polarization-NMR (DNP-NMR) in the form of the hyperpolarization-dissolution method should afford the sensitivity and spectral resolution for the direct detection and quantification of numerous isotopically labeled circulating drugs and their metabolites in single liquid-state NMR transients. This study explores the capability of quantitative in vitro DNP-NMR to assay drug metabolites in blood plasma. The lower limit of detection for the anti-epileptic drug (13)C-carbamazepine and its pharmacologically active metabolite (13)C-carbamazepine-10,11-epoxide is 0.08 µg/mL in rabbit blood plasma analyzed by single-scan (13)C DNP-NMR. An internal standard is used for the accurate quantification of drug and metabolite. Comparison of quantitative DNP-NMR data with an established analytical method (liquid chromatography-mass spectrometry) yields a Pearson correlation coefficient r of 0.99. Notably, all DNP-NMR determinations were performed without analyte derivatization or sample purification other than plasma protein precipitation. Quantitative DNP-NMR is an emerging methodology which requires little sample preparation and yields quantitative data with high sensitivity for therapeutic drug monitoring.
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Kang MJ, Song WH, Shim BH, Oh SY, Lee HY, Chung EY, Sohn Y, Lee J. Pharmacologically active metabolites of currently marketed drugs: potential resources for new drug discovery and development. YAKUGAKU ZASSHI 2010; 130:1325-37. [PMID: 20930485 DOI: 10.1248/yakushi.130.1325] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Biotransformation is the major clearance mechanism of therapeutic agents from the body. Biotransformation is known not only to facilitate the elimination of drugs by changing the molecular structure to more hydrophilic, but also lead to pharmacological inactivation of therapeutic compounds. However, in some cases, the biotransformation of drugs can lead to the generation of pharmacologically active metabolites, responsible for the pharmacological actions. This review provides an update of the kinds of pharmacologically active metabolites and some of their individual pharmacological and pharmacokinetic aspects, and describes their importance as resources for drug discovery and development.
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Affiliation(s)
- Myung Joo Kang
- Division of Pharmaceutical Sciences, College of Pharmacy, Chung-Ang University, Seoul, South Korea
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McMillin GA, Juenke JM, Tso G, Dasgupta A. Estimation of carbamazepine and carbamazepine-10,11-epoxide concentrations in plasma using mathematical equations generated with two carbamazepine immunoassays. Am J Clin Pathol 2010; 133:728-36. [PMID: 20395519 DOI: 10.1309/ajcpfahvb26vvvte] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
Carbamazepine is metabolized to an active metabolite known as carbamazepine-10,11-epoxide, or simply the "epoxide" metabolite. The presence of this metabolite can have clinically significant implications in therapeutic drug monitoring of carbamazepine, but accurate quantification of the epoxide metabolite is currently limited to chromatographic techniques. In this study, mathematical equations are proposed for the estimation of carbamazepine and epoxide metabolite concentrations based on values generated by common carbamazepine immunoassays. Three immunoassays were studied: particle-enhanced turbidimetric inhibition immunoassay (PETINIA, Siemens Healthcare Diagnostics, Deerfield, IL), ADVIA Centaur (Siemens Healthcare Diagnostics), and a cloned enzyme donor immunoassay (CEDIA; Roche, Indianapolis, IN). Equations were based on observed cross-reactivity of epoxide with the PETINIA (average, 96.2%; range, 86.6%-105.7%) and epoxide cross-reactivity with the ADVIA Centaur assay (average, 6.5%; range, 5.3%-7.7%). In addition, equations were developed using average cross-reactivity of epoxide with the PETINIA and with the CEDIA. Values determined by calculation correlated well with carbamazepine and epoxide concentrations in supplemented and patient samples, for which values of carbamazepine (2.2-12.0 microg/mL [9-51 micromol/L]) and the epoxide metabolite (0.6-2.4 microg/mL) were also verified by liquid chromatography-tandem mass spectrometry.
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Leite CE, Petersen GO, Lunardelli A, Thiesen FV. A high-performance liquid chromatography method for the determination of carbamazepine and carbamazepine-10,11-epoxide and its comparison with chemiluminescent immunoassay. Clin Chem Lab Med 2009; 47:458-63. [DOI: 10.1515/cclm.2009.105] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Tutor-Crespo MJ, Hermida J, Tutor JC. Relative proportions of serum carbamazepine and its pharmacologically active 10,11-epoxy derivative: effect of polytherapy and renal insufficiency. Ups J Med Sci 2008; 113:171-80. [PMID: 18509811 DOI: 10.3109/2000-1967-225] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The proposed action mechanism and pharmacological activity of carbamazepine (CBZ) and its major metabolite, carbamazepine-10,11-epoxide (CBZE), are the same. The aim of our study was the investigation of the effect of concomitant antiepileptic treatment and renal insufficiency on the relative proportions of serum CBZ and CBZE. METHODS Serum trough steady-state CBZ and CBZE concentrations were determined by high-performance liquid chromatography (HPLC) in 140 epileptic patients treated with CBZ in monotherapy (n=100) and polytherapy with phenytoin, phenobarbital and valproate (n=40). The levels of CBZ were also determined using the Dade Behring enzyme multiplied immunoassay technique (EMIT). The glomerular filtration rate (GFR) was estimated from serum cystatin C using the Dade Behring nephelometric immunoassay. RESULTS The CBZE/CBZ and CBZ+CBZE/CBZEMIT ratios were significantly increased in 7 cases (3 in monotherapy and 4 in polytherapy) with GFR<60 mL/min/1.73m2 in relation to the patients treated in monotherapy or polytherapy having normal or mildly decreased renal function (p<0.001). CONCLUSIONS In patients with moderate to severe renal insufficiency the relative proportion of CBZE with respect to the parent drug is significantly increased. In these cases, the CBZ concentrations obtained using the EMIT, or other immunoassays having low CBZE cross-reactivity, may have an inadequate diagnostic efficiency.
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Affiliation(s)
- María J Tutor-Crespo
- Unidad Monitorización Fármacos, Laboratorio Central, Hospital Clínico Universitario, 15706 Santiago de Compostela, Galicia, Spain
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Budakova L, Brozmanova H, Grundmann M, Fischer J. Simultaneous determination of antiepileptic drugs and their two active metabolites by HPLC. J Sep Sci 2007; 31:1-8. [DOI: 10.1002/jssc.200700253] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Dasgupta A. Usefulness of monitoring free (unbound) concentrations of therapeutic drugs in patient management. Clin Chim Acta 2007; 377:1-13. [PMID: 17026974 DOI: 10.1016/j.cca.2006.08.026] [Citation(s) in RCA: 113] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2006] [Revised: 08/11/2006] [Accepted: 08/24/2006] [Indexed: 11/28/2022]
Abstract
Drugs are bound to various serum proteins in different degrees and only unbound or free drug is pharmacologically active. Although free drug concentration can be estimated from total concentration, for strongly bound drugs, prediction of free level is not always possible. Conditions like uremia, liver disease and hypoalbuminemia can lead to significant increases in free drug resulting in drug toxicity even if the concentration of total drug is within therapeutic range. Drug-drug interactions may also lead to a disproportionate increase in free drug concentrations. Elderly patients may have increased free drug concentrations due to hypoalbuminemia. Elevated free phenytoin concentrations have also been reported in patients with AIDS and pregnancy. Currently free drug concentrations of anticonvulsants such as phenytoin, carbamazepine and valproic acid are widely measured in clinical laboratories. Newer drugs such as mycophenolic acid mofetil and certain protease inhibitors are also considered as candidates for monitoring free drug concentration.
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Affiliation(s)
- Amitava Dasgupta
- Department of Pathology and Laboratory Medicine, University of Texas-Houston Medical School, 6431 Fannin, MSB 2.292, Houston, TX 77030, United States.
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Abstract
Brivaracetam (UCB 34714) is chemically related to levetiracetam (LEV, Keppra). It possesses a binding affinity for the synaptic vesicle protein 2A (SV2A) ten-fold above that of LEV and also shows an ability to inhibit Na+ channels. This correlates with a higher potency in suppressing epileptiform responses in vitro and a more potent and complete suppression of different seizure types in animals with an acquired or genetic epilepsy. Brivaracetam has been tested in a comprehensive safety pharmacology, toxicology, developmental toxicology, and genotoxicity program. It is of low acute toxicity, target organ for toxic effects is the hepatobiliary tract. Carcinogenicity studies are ongoing. Human pharmacology studies have shown that brivaracetam has a half-life of 8 h and nearly complete bioavailability. Brivaracetam is primarily metabolized via hydrolysis of the acetamide group and CYP2C8-mediated hydroxylation. Its metabolites are not pharmacologically active. Excretion of over 95% of the dose, including metabolites, occurs renally within 72 h. Healthy volunteer studies demonstrated a favorable tolerability profile. Treatment emergent adverse events were mild to moderate, mostly of CNS origin, and resolved within 24 hrs, with decreasing incidence after repeated intake. Drug-drug interaction studies with high dose of brivaracetam (400 mg/d) showed a dose-dependent increase of carbamazepine-epoxide levels. No significant interaction with low doses of phenytoin was observed at the same high dose levels of brivaracetam, and only a moderate pharmacokinetic interaction with an oral contraceptive, without impact on hormonal levels or ovulation, was observed. The pharmacokinetic profile of brivaracetam is unaltered in elderly subjects or those with impaired renal function. Clearance of brivaracetam is reduced in patients with hepatic insufficiency. In the photoparoxysmal response model in patients with photosensitive epilepsy brivaracetam was effective at all tested doses (10 - 80 mg) in reducing or abolishing EEG discharges evoked by a photic stimulus. Phase 2 studies in patients with refractory partial onset seizures have recently been completed.
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Bialer M, Johannessen SI, Kupferberg HJ, Levy RH, Perucca E, Tomson T. Progress report on new antiepileptic drugs: a summary of the Eigth Eilat Conference (EILAT VIII). Epilepsy Res 2006; 73:1-52. [PMID: 17158031 DOI: 10.1016/j.eplepsyres.2006.10.008] [Citation(s) in RCA: 220] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2006] [Accepted: 10/30/2006] [Indexed: 12/15/2022]
Abstract
The Eigth Eilat Conference on New Antiepileptic Drugs (AEDs)-EILAT VII, took place in Sitges, Barcelona from the 10th to 14th September, 2006. Basic scientists, clinical pharmacologists and neurologists from 24 countries attended the conference, whose main themes included a focus on status epilepticus (epidemiology, current and future treatments), evidence-based treatment guidelines and the potential of neurostimulation in refractory epilepsy. Consistent with previous formats of this conference, the central part of the conference was devoted to a review of AEDs in development, as well as updates on marketed AEDs introduced since 1989. This article summarizes the information presented on drugs in development, including brivaracetam, eslicarbazepine acetate (BIA-2-093), fluorofelbamate, ganaxolone, huperzine, lacosamide, retigabine, rufinamide, seletracetam, stiripentol, talampanel, valrocemide, JZP-4, NS1209, PID and RWJ-333369. Updates on felbamate, gabapentin, lamotrigine, levetiracetam, oxcarbazepine and new extended release oxcarbazepine formulations, pregabalin, tiagabine, topiramate, vigabatrin, zonisamide and new extended release valproic acid formulations, and the antiepileptic vagal stimulator device are also presented.
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Affiliation(s)
- Meir Bialer
- Department of Pharmaceutics, School of Pharmacy, David R. Bloom Center for Pharmacy, The Hebrew University of Jerusalem, 91120 Jerusalem, Israel.
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Yoshida T, Imai K, Motohashi S, Hamano SI, Sato M. Simultaneous determination of zonisamide, carbamazepine and carbamazepine-10,11-epoxide in infant serum by high-performance liquid chromatography. J Pharm Biomed Anal 2006; 41:1386-90. [PMID: 16597494 DOI: 10.1016/j.jpba.2006.02.044] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2005] [Revised: 02/13/2006] [Accepted: 02/17/2006] [Indexed: 11/26/2022]
Abstract
This study developed a simple method for the simultaneous determination of zonisamide (ZNS), carbamazepine (CBZ) and its active metabolite, carbamazepine-10,11-epoxide (CBZE) in infant serum using reversed-phase high-performance liquid chromatograph (HPLC). The method involves a single-step protein precipitation procedure that uses no solid-phase or liquid-liquid extraction. The HPLC separation was carried out on a Cadenza CD-C18 column (3 microm, 4.6 mm x 150 mm) with potassium phosphate buffer (pH 4.6; 25 mM)-methanol-acetonitrile (65:20:15 (v/v/v)) as a mobile phase at a 1.0 ml/min flow rate: ZNS was detectable using a UV detector at 235 nm, and both CBZ and CBZE were at 215 nm. The quantification limits were established in accordance with each therapeutic range at 2.5 microg/ml for ZNS, 0.5 microg/ml for CBZ, and 0.25 microg/ml for CBZE. The respective coefficients of variation were 1.3-6.0% and 2.2-7.7% for the intra- and inter-assay.
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Affiliation(s)
- Terumitsu Yoshida
- Division of Clinical Research, Saitama Prefectural Institute of Children's Medical Center, 2100 Magome, Iwatsuki-ku, Saitama-shi, Saitama 339-8551, Japan.
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Abstract
Pharmacologically active metabolites can contribute significantly to the overall therapeutic and adverse effects of drugs. Therefore, to fully understand the mechanism of action of drugs, it is important to recognize the role of active metabolites. Active metabolites can also be developed as drugs in their own right. Using illustrative examples, this paper discusses a variety of biotransformation reactions that produce active metabolites and their structure-activity relationships. The paper also describes the role and significance of active metabolites in drug discovery and development, various experimental observations that can be used as indicators of their presence, and methods that can be used to assess their biological activities and contribution to the overall therapeutic and adverse effects of drugs.
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Affiliation(s)
- Aberra Fura
- Department of Metabolism and Pharmacokinetics, Pharmaceutical Research Institute, Bristol Myers Squibb, P.O. Box 5400, Princeton, NJ 08534, USA.
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McLaren KD, Marangell LB. Special considerations in the treatment of patients with bipolar disorder and medical co-morbidities. ANNALS OF GENERAL HOSPITAL PSYCHIATRY 2004; 3:7. [PMID: 15104799 PMCID: PMC420249 DOI: 10.1186/1475-2832-3-7] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/21/2003] [Accepted: 04/22/2004] [Indexed: 11/10/2022]
Abstract
BACKGROUND: The pharmacological treatment of bipolar disorder has dramatically improved with multiple classes of agents being used as mood-stabilizers, including lithium, anticonvulsants, and atypical antipsychotics. However, the use of these medications is not without risk, particularly when a patient with bipolar disorder also has comorbid medical illness. As the physician who likely has the most contact with patients with bipolar disorder, psychiatrists must have a high index of suspicion for medical illness, as well as a basic knowledge of the risks associated with the use of medications in this patient population. METHODS: A review of the literature was conducted and papers addressing this topic were selected by the authors. RESULTS AND DISCUSSION: Common medical comorbidities and treatment-emergent illnesses, including obesity, diabetes mellitus, dyslipidemia, cardiac disease, hepatic disease, renal disease, pulmonary disease and cancer are reviewed with respect to concomitant use of mood stabilizers. Guidance to clinicians regarding effective monitoring and treatment is offered. CONCLUSIONS: Mood-stabilizing medications are necessary in treating patients with bipolar disorder and often must be used in the face of medical illness. Their safe use is possible, but requires increased vigilance in monitoring for treatment-emergent illnesses and effects on comorbid medical illness.
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Affiliation(s)
- Kimberly D McLaren
- Mood Disorders Center, Menninger Department of Psychiatry, Baylor College of Medicine, Houston, TX, USA
| | - Lauren B Marangell
- Mood Disorders Center, Menninger Department of Psychiatry, Baylor College of Medicine, Houston, TX, USA
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Kaufman KR, Gerner R. Adjunctive oxcarbazepine in comorbid anxiety and affective disorder with hyponatremic seizure: case analysis and literature review. Epilepsy Behav 2003; 4:766-70. [PMID: 14698716 DOI: 10.1016/j.yebeh.2003.08.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Rational polypharmacy is required for management of refractory psychiatric disorders. Antiepileptic drugs are increasingly used as primary or adjunctive agents in the treatment of affective, schizoaffective, anxiety, and impulse control disorders. In this case report, the authors present the first case of hyponatremic seizure associated with oxcarbazepine in adjunctive treatment of comorbid affective/anxiety disorders.
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Affiliation(s)
- Kenneth R Kaufman
- Department of Psychiatry, UMDNJ-Robert Wood Johnson Medical School, 125 Paterson Street, Suite 2200, 08901, New Brunswick, NJ, USA.
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Hermida J, Tutor JC. How suitable are currently used carbamazepine immunoassays for quantifying carbamazepine-10,11-epoxide in serum samples? Ther Drug Monit 2003; 25:384-8. [PMID: 12766569 DOI: 10.1097/00007691-200306000-00021] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The pharmacologic activity of the metabolite carbamazepine-10,11-epoxide (CBZ-E) is similar to that of carbamazepine (CBZ). As a result, determining the CBZ + CBZ-E concentration would offer a better correlation with therapeutic or toxic effects than measurement of the parent drug alone. However, the most upto-date CBZ immunoassays are not able to quantitatively measure CBZ-E. Trough serum concentrations of CBZ were measured in 116 patients either in monotherapy (n = 66) or in polytherapy with other antiepileptic drugs (n = 50) using the Dade Dimension and Roche Cobas Integra immunoassays. The results were compared with those obtained for CBZ + CBZ-E by high-performance liquid chromatography (HPLC). The Dade Dimension immunoassay gave a concentration-dependent CBZ-E cross-reactivity for the metabolite levels present in the samples studied (mean, 1.41 mg/L; range, 0.0-7.6 mg/L), whereas the Roche Cobas Integra gave a negligible cross-reactivity. The results provided by the Dade Dimension immunoassay only presented a clinically significant difference with regard to the CBZ + CBZ-E value in the group of patients comedicated with valproic acid. The results of this immunoassay revealed a high correlation and small standard error of the estimate for the total group of patients with the composite results of parent drug + metabolite obtained by HPLC (r = 0.993, ma68 = 0.22 mg/L), with a regression line CBZ + CBZ-E = 1.09 CBZ(Dade Dimension) + 0.07. By using the Dade Dimension immunoassay, it is possible to make a clinically valid estimate of the CBZ + CBZ-E concentrations in patients treated with CBZ in monotherapy and polytherapy. However, other immunoassays with a lower CBZ-E cross-reactivity are not suitable for this estimate to be made at increased metabolite levels.
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Affiliation(s)
- Jesús Hermida
- Laboratorio Central, Hospitak Clínico Universitario, Santiago de Compostela, Spain
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Parant F, Bossu H, Gagnieu MC, Lardet G, Moulsma M. Cross-reactivity assessment of carbamazepine-10,11-epoxide, oxcarbazepine, and 10-hydroxy-carbazepine in two automated carbamazepine immunoassays: PETINIA and EMIT 2000. Ther Drug Monit 2003; 25:41-5. [PMID: 12548143 DOI: 10.1097/00007691-200302000-00006] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This study was conducted to compare the cross-reactivity of two commercially available carbamazepine (CBZ) immunoassays (PETINIA and EMIT 2000) with carbamazepine-10,11-epoxide (CBZ-E), the active metabolite of CBZ. Oxcarbazepine (OCBZ) and its main metabolite 10-hydroxy-carbazepine (HCBZ) have a chemical structure closely related to that of CBZ. The cross-reactivities of these two drugs were also investigated. In the first part of the study, Lyphocheck blank human serum and Chemonitor quality controls (containing CBZ without CBZ-E) were spiked with variable amounts of CBZ-E. The apparent CBZ levels were measured by PETINIA and EMIT 2000 methods. The interference from OCBZ and HCBZ was directly assessed by measuring the apparent CBZ levels in Chromsystems Trileptal quality controls (containing OCBZ and HCBZ). In the second part of the study, the CBZ levels of serum samples from 49 patients, including 2 patients with massive CBZ ingestion, were measured by immunoassays and compared with a high-pressure liquid chromatography (HPLC) reference technique allowing the simultaneous measurement of CBZ and CBZ-E. The antibody used in the PETINIA assay cross-reacts (about 90%) with CBZ-E. In one case of CBZ poisoning (CBZ and CBZ-E levels measured by HPLC were 26.2 and 18.2 mg/L, respectively), CBZ level measured by PETINIA was falsely elevated (42.5 mg/L). In contrast, the specificity of EMIT 2000 was satisfactory (29.5 mg/L). The two immunoassays tested showed low cross-reactivity with OCBZ and HCBZ. In conclusion, it appears that the CBZ-E metabolite present in samples can falsely increase CBZ levels measured by the PETINIA assay.
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Affiliation(s)
- François Parant
- Laboratory of Biochemistry, Pharmacology and Toxicology, Edouard Herriot Hospital, Lyon, France.
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Koren G. Comment on antiepileptics and antipsychotics. TERATOLOGY 2002; 66:273; author reply 274. [PMID: 12486757 DOI: 10.1002/tera.10115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Abstract
A 52-year-old woman and a 56-year-old man who were receiving carbamazepine experienced markedly elevated levels of its active metabolite, carbamazepine-10,11-epoxide (CBZ-E), after starting quetiapine therapy. The CBZ-E:carbamazepine ratio increased 3-4-fold in each patient. Levels of CBZ-E returned to baseline after discontinuing this drug combination. The metabolite can accumulate and cause neurotoxicity. The woman experienced ataxia and agitation while receiving quetiapine, which resolved after carbamazepine was switched to oxcarbazepine. The man was asymptomatic. To our knowledge, these are the first two case reports describing this interaction. Quetiapine may inhibit epoxide hydrolase and/or glucuronidation of carbamazepine-10,11-trans-diol in the same way as valproate and possibly lamotrigine do. If carbamazepine and quetiapine are administered concurrently, clinicians should consider monitoring CBZ-E concentrations.
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Affiliation(s)
- Brian J Fitzgerald
- Fircrest Residential Habilitation Center, School of Pharmacy, University of Washington, Seattle 98155, USA.
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