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Abdelaziz SMH, Abdelgalil RM, Abdelmohsen SR. Morphological, biochemical, and histopathological effects of levetiracetam on pregnant albino rats and their offspring. Ultrastruct Pathol 2023; 47:278-291. [PMID: 37132626 DOI: 10.1080/01913123.2023.2185719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 02/24/2023] [Indexed: 05/04/2023]
Abstract
One of the most widely used medications for epilepsy is the broad-spectrum antiseizure levetiracetam. The study aimed to evaluate the impact of levetiracetam on the bodyweight and liver of pregnant rats and their offspring. The study involved treating the rats during pregnancy and lactation and then examining the pregnant rats and their offspring. Two groups of 40 pregnant rats were created (I, II). Each group was split up into two smaller groups (A, B). About 1.5 mL/day of distilled water was gavaged to the rats in group I, either continuously throughout pregnancy (IA) or continuously throughout pregnancy and 15 days after delivery (IB). Group II rats received 1.5 ml/day of distilled water (containing levetiracetam) either during pregnancy (IIA) or during pregnancy plus 15 days postpartum (IIB). At the end of the work, blood samples were taken from the adult rats, body weight of different groups were recorded, and then, their liver was subjected for histological and morphometric analysis. Levetiracetam treatment showed reduction in the body weight of adult rats and their offspring and pathological changes in their liver. These changes were in the form of distortion of the hepatic architecture, cytoplasmic vacuolation, nuclear changes, and swollen mitochondria with loss of their cristae. Such changes were proved by alteration in alanine aminotransferase (ALT) and aspartate aminotransferase (AST) enzyme levels of the liver. It is advised to monitor the liver functions continuously when using levetiracetam.
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Affiliation(s)
- Safaa M H Abdelaziz
- Department of Anatomy, Faculty of Medicine (Girls), Al-Azhar University, Egypt
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2
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Michael AM, Lotfy HM, Nessim CK. Greenness profile and whiteness assessment of the stability-indicating HPLC method for the assay of levetiracetam. Microchem J 2023. [DOI: 10.1016/j.microc.2023.108669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023]
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Shi M, Liu C, He L, Wu H, Wu Y. Therapeutic drug monitoring and the therapeutic reference range of levetiracetam for Chinese patients: Problems and issues. Seizure 2023; 109:26-33. [PMID: 37192596 DOI: 10.1016/j.seizure.2023.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Revised: 05/09/2023] [Accepted: 05/11/2023] [Indexed: 05/18/2023] Open
Abstract
BACKGROUND Levetiracetam (LEV) is widely used in the clinical monotherapy or multi-drug combination treatment of seizures due to its good tolerability and efficacy. Due to a lack of large-scale clinical studies, the relationship between levetiracetam concentrations, disease activity and adverse is unclear, limiting the usefulness of therapeutic drug monitoring (TDM) based LEV plasma levels. This study was intended to investigate factors influencing the pharmacokinetics of and the appropriate reference range of LEV concentration using available LEV TDM data. METHODS A rapid, accurate and sensitive high-performance liquid chromatography-tandem mass spectrometry (HPLC-MS) method was established to determine LEV plasma concentrations. In this study, the levetiracetam plasma concentration monitoring data from 352 samples (taken from 248 patients) were used to explore the relationship between levetiracetam dose, age, combined administration with other antiseizure medications in patients with epilepsy. RESULTS Age and combined administration emerged as important affecting factors for the correlation of LEV concentration and dose. The correlation between concentration and dose was better in monotherapy. Combined administration may affect LEV concentration, especially when LEV is combined with oxcarbazepine, which might decrease the LEV concentration. CONCLUSION These findings emphasize the need to monitor LEV routinely LEV, especially among children and older adults when other antiseizure comedications are prescribed in the treatment regimen. LEV TDM is a well-established tool for the management of patients with epilepsy.
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Affiliation(s)
- Min Shi
- Department of Pharmacy, Hebei General Hospital, Shijiazhuang 050051, China; Graduate School, Hebei Medical University, Shijiazhuang 050017, China
| | - Chenxi Liu
- Graduate School, Hebei Medical University, Shijiazhuang 050017, China
| | - Lien He
- Department of Pharmacy, Hebei General Hospital, Shijiazhuang 050051, China
| | - Huizheng Wu
- Department of Pharmacy, Hebei General Hospital, Shijiazhuang 050051, China
| | - Yin Wu
- Department of Pharmacy, Hebei General Hospital, Shijiazhuang 050051, China; Graduate School, Hebei Medical University, Shijiazhuang 050017, China.
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Development and Validation of a Simple HPLC-UV Assay Method for Determination of Levetiracetam Concentrations in Human Plasma. ANALYTICA 2023. [DOI: 10.3390/analytica4010001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Levetiracetam (LEV) is a broad spectrum antiseizure medication that is used in various seizure types. There is evidence that therapeutic drug monitoring (TDM) of LEV is of value in selected patient populations, therefore determination of LEV plasma concentrations is essential. Herein we developed and validated a simple, reproducible, and practical method for the quantification of LEV concentrations in human plasma samples using high performance liquid chromatography (HPLC). Plasma samples (0.3 mL) deproteinization was done using acetonitrile. HPLC chromatographic separation of plasma samples was accomplished by reversed phase C18 column. The mobile phase constituted water and acetonitrile (90:10, v/v) ran at flow rate of 1 mL/min. Signal acquisition was conducted at a wavelength of 192 nm. Calibration curves showed excellent linearity (Correlation coefficient r2 > 0.99) over a concentration range of 3–80 μg/mL. Both inter and intraday assay accuracy and precision were less than 8% (except for the lowest limit of quantification was within 20%). Elution time was 15 min. The developed method excluded the use of buffers and utilized small volumes of plasma samples with simple mobile phase composition. Therefore, our method could be practically applied to routine TDM.
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Evaluating Therapeutic Equivalence of Generic and Original Levetiracetam in Patients with Epilepsy: A Retrospective Study. Neurol Int 2022; 14:271-283. [PMID: 35324578 PMCID: PMC8953522 DOI: 10.3390/neurolint14010022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Revised: 03/02/2022] [Accepted: 03/11/2022] [Indexed: 02/01/2023] Open
Abstract
The brand interchangeability of antiepileptic drugs (AEDs) is a topic of debate, especially regarding their therapeutic equivalence. This study evaluates the efficacy and tolerability of generic levetiracetam compared to the brand-name equivalent in a routine clinical setting. We conducted a retrospective study, examining patients with stable seizure frequency who received generic levetiracetam after the brand-name drug. During the six-month substitution period, changes in seizure frequency, hospitalization due to seizure exacerbation, adverse events, composite outcomes related to adjusting the AED dosage, and switching back to original levetiracetam were analyzed. Seventy-five patients were enrolled; the majority (85.3%) had focal onset seizures, and almost half (49.3%) had refractory epilepsy. Six months after the substitution, the mean seizure frequency per month was not significantly different (3.15 ± 14.47 vs. 2.77 ± 11.41; p = 0.970). In patients with controlled seizures before the change, the seizure frequency increased significantly (0.56 ± 1.83 vs. 0.03 ± 0.16; p = 0.012). Adverse events occurred in six patients. We have observed recurrent seizures or adverse events from 14 days after the transition. The original drug return rates due to recurrent seizures and adverse events were 5.3% and 1.3%, respectively. Generic levetiracetam might not show therapeutic equivalence to the original molecule, especially in patients adequately controlled by the brand-name drug.
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WHAT IS THE THERAPEUTIC REFERENCE RANGE FOR LEVETIRACETAM? Ther Drug Monit 2022; 44:363-365. [DOI: 10.1097/ftd.0000000000000972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 01/02/2022] [Indexed: 11/25/2022]
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Ha C, Lee HS, Joo EY, Shon YM, Hong SB, Seo DW, Lee SY. Levetiracetam Therapeutic Drug Monitoring in a Large Cohort of Korean Epileptic Patients. Pharmaceuticals (Basel) 2021; 14:ph14080826. [PMID: 34451923 PMCID: PMC8401685 DOI: 10.3390/ph14080826] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 08/12/2021] [Accepted: 08/19/2021] [Indexed: 12/04/2022] Open
Abstract
Levetiracetam is a new antiepileptic drug (AED) used for treating and preventing partial or generalized seizures. The usefulness of levetiracetam therapeutic drug monitoring (TDM) is related to inter- or intra-individual pharmacokinetic variability, drug interactions, and patient noncompliance. We aimed to investigate the levetiracetam TDM status in Korean epilepsy patients. Serum trough levetiracetam concentrations were measured using liquid chromatography–tandem mass spectrometry in 710 samples from 550 patients. The median (range) daily and weight-adjusted levetiracetam doses were 1500 (20–5000) mg and 25.5 (3.03–133.0) mg/kg, respectively. Patients on levetiracetam monotherapy constituted only 19.5% of the population, while 30.1% were on co-medication with valproate and 56.0% with enzyme-inducing AEDs (EIAEDs). Observed levetiracetam concentrations were widely distributed, ranging 0.8–95 mg/L, with a median of 17.3 mg/L. Levetiracetam concentrations were therapeutic, supra-therapeutic, and sub-therapeutic in 58.5% (n = 393), 11.6% (n = 78), and 29.9% (n = 201) of samples, respectively. There was a strong correlation between weight-adjusted levetiracetam dosage and concentrations (ρ = 0.6896, p < 0.0001). In this large-scale clinical study, a large inter-individual difference in levetiracetam pharmacokinetics was observed, and levetiracetam concentrations were influenced by EIAEDs. For individual dose adjustments and monitoring compliance, routine levetiracetam TDM is needed in epilepsy patients.
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Affiliation(s)
- Changhee Ha
- Samsung Medical Center, Department of Laboratory Medicine and Genetics, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 06351, Korea; (C.H.); (H.-S.L.)
| | - Hyun-Seung Lee
- Samsung Medical Center, Department of Laboratory Medicine and Genetics, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 06351, Korea; (C.H.); (H.-S.L.)
| | - Eun Yeon Joo
- Neuroscience Center, Samsung Medical Center, Department of Neurology, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 06351, Korea; (E.Y.J.); (Y.-M.S.); (S.B.H.)
| | - Young-Min Shon
- Neuroscience Center, Samsung Medical Center, Department of Neurology, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 06351, Korea; (E.Y.J.); (Y.-M.S.); (S.B.H.)
| | - Seung Bong Hong
- Neuroscience Center, Samsung Medical Center, Department of Neurology, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 06351, Korea; (E.Y.J.); (Y.-M.S.); (S.B.H.)
| | - Dae-Won Seo
- Neuroscience Center, Samsung Medical Center, Department of Neurology, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 06351, Korea; (E.Y.J.); (Y.-M.S.); (S.B.H.)
- Correspondence: (D.-W.S.); (S.-Y.L.); Tel.: +82-2-3410-3595 (D.-W.S.); +82-2-3410-1834 (S.-Y.L.); Fax: +82-2-3410-0052 (D.-W.S.); +82-2-3410-2719 (S.-Y.L.)
| | - Soo-Youn Lee
- Samsung Medical Center, Department of Laboratory Medicine and Genetics, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 06351, Korea; (C.H.); (H.-S.L.)
- Samsung Medical Center, Department of Clinical Pharmacology and Therapeutics, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 06351, Korea
- Correspondence: (D.-W.S.); (S.-Y.L.); Tel.: +82-2-3410-3595 (D.-W.S.); +82-2-3410-1834 (S.-Y.L.); Fax: +82-2-3410-0052 (D.-W.S.); +82-2-3410-2719 (S.-Y.L.)
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Pérez-Pérez D, Frías-Soria CL, Rocha L. Drug-resistant epilepsy: From multiple hypotheses to an integral explanation using preclinical resources. Epilepsy Behav 2021; 121:106430. [PMID: 31378558 DOI: 10.1016/j.yebeh.2019.07.031] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Revised: 06/12/2019] [Accepted: 07/06/2019] [Indexed: 01/07/2023]
Abstract
Drug-resistant epilepsy affects approximately one-third of the patients with epilepsy. The pharmacoresistant condition in epilepsy is mainly explained by six hypotheses. In addition, several experimental models have been used to understand the mechanisms involved in pharmacoresistant epilepsy and to identify novel therapies to control this condition. However, the global prevalence of this disease persists without changes. Several factors can explain this situation. First of all, the pharmacoresistant epilepsy is explained by different and independent hypotheses. Each hypothesis indicates specific mechanisms to explain the drug-resistant condition in epilepsy. However, there are different findings suggesting common mechanisms between the different hypotheses. Other important situation is that the experimental models designed for the screening of drugs with potential anticonvulsant effect do not consider factors such as age, gender, type of epilepsy, and comorbid disorders. The present review focuses on indicating the limitations for each hypothesis and the relationships among them. The relevance to consider central and peripheral phenomena associated with the drug-resistant condition in different types of epilepsy is also indicated. The necessity to establish a global hypothesis that integrates all the phenomena associated with the pharmacoresistant epilepsy is proposed. This article is part of the Special Issue "NEWroscience 2018".
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Affiliation(s)
- Daniel Pérez-Pérez
- PECEM (MD/PhD), Faculty of Medicine, National Autonomous University of Mexico, Mexico City, Mexico
| | | | - Luisa Rocha
- Pharmacobiology Department, Center of Research and Advanced Studies, Mexico City, Mexico.
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Önal C, Kul A, Ozdemir M, Sagirli O. Determination of levetiracetam in human plasma by online heart-cutting liquid chromatography: Application to therapeutic drug monitoring. J Sep Sci 2020; 43:3590-3596. [PMID: 32644231 DOI: 10.1002/jssc.202000504] [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: 05/02/2020] [Revised: 07/04/2020] [Accepted: 07/07/2020] [Indexed: 11/08/2022]
Abstract
Levetiracetam is an antiepileptic drug for the treatment of psychiatric patients. In this study, a selective, straightforward, and rapid online heart-cutting liquid chromatography method was developed for the therapeutic drug monitoring of levetiracetam. This method allows for the determination of levetiracetam in human plasma without complex sample preparation. The mobile phases consisted of 30 mM aq. orthophosphoric acid solution/methanol (70:30) at a flow rate of 1 mL/min for the first system and 10 mM aq. orthophosphoric acid solution/methanol (55:45) at a flow rate of 1 mL/min for the second system. The first separation was carried out on a GL Sciences Intersil ODS-3 column (4.6 mm × 150 mm, 3 µm) and the second separation was carried out on a Restek Ultra PFPP column (4.6 mm × 150 mm, 5 µm). The detection was carried out at 205 nm for both systems. The method was validated for selectivity and linearity, which were in the 6-60 µg/mL range. Intra- and interassay accuracies were <112.6%, and the intra- and interassay precisions were <6.4% for all quality control samples. The lower limit of quantitation was 6 µg/mL. The developed method was successfully applied for therapeutic drug monitoring of plasma samples from patients.
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Affiliation(s)
- Cem Önal
- CinnaGen Pharmaceutical, Atasehir, Istanbul, Turkey
| | - Aykut Kul
- Department of Analytical Chemistry, Faculty of Pharmacy, Istanbul University, Istanbul, Turkey
| | - Murat Ozdemir
- Health Application and Research Center Medical Biochemistry Laboratory, Üsküdar University, Istanbul, Turkey
| | - Olcay Sagirli
- Department of Analytical Chemistry, Faculty of Pharmacy, Istanbul University, Istanbul, Turkey
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Harby SA, Nassra RA, Mekky JF, Ali SM, Ismail CA. Correlation of levetiracetam concentration in peripheral blood mononuclear cells with clinical efficacy: A sensitive monitoring biomarker in patients with epilepsy. Seizure 2020; 78:71-77. [DOI: 10.1016/j.seizure.2020.03.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2019] [Revised: 02/20/2020] [Accepted: 03/14/2020] [Indexed: 12/11/2022] Open
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Dried Blood Spot Self-Sampling by Guardians of Children With Epilepsy Is Feasible: Comparison With Plasma for Multiple Antiepileptic Drugs. Ther Drug Monit 2019; 41:509-518. [DOI: 10.1097/ftd.0000000000000605] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Giri TK, Ghosh B, Bose P, Saha S, Sarkar A. Extraction of levetiracetam for therapeutic drug monitoring by transdermal reverse iontophoresis. Eur J Pharm Sci 2019; 128:54-60. [PMID: 30468869 DOI: 10.1016/j.ejps.2018.11.020] [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: 07/05/2018] [Revised: 10/26/2018] [Accepted: 11/19/2018] [Indexed: 10/27/2022]
Abstract
Recently, transdermal reverse iontophoresis across the skin has been investigated as a novel technology for the purpose of diagnosis as well as therapeutic drug monitoring. Accordingly, the objective of this study was to investigate ex vivo and in vivo transdermal extraction of levetiracetam, an antiepileptic drug, across the pig ear skin by reverse iontophoresis. Reverse iontophoresis experiments were performed using three chambered diffusion cells. Extractions profiles were generated in phosphate buffers at different current intensities, pH and ionic strength as well donor drug concentrations. This was followed by ex vivo extraction in gels and in vivo extractions using New Zealand rabbits. Results indicate that levetiracetam was extracted at both anode and cathode. Flux values were unaffected by increase in current intensities (0.5 mA and 0.6 mA) but affected by pH and ionic strength. Neither in cathodal nor in anodal extraction, flux values did show a proportional relationship with the donor drug concentration. At low and medium concentration levels, flux values did not show any major change but the extraction flux at high donor concentration was much higher. In contrast, in vivo experiment with rabbits resulted in wide variation of fluxes with very high fluxes recorded at the cathodal end. Reasons attributed to this difference may include lower current intensity, and species variation. The most significant finding of this study is that measurable amounts of the levetiracetam were extracted at both the ends indicating its feasibility for non-invasive drug monitoring.
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Affiliation(s)
- Tapan Kumar Giri
- NSHM Knowledge Campus, Kolkata-Group of Institutions, 124 BL Saha Road, Kolkata 700053, West Bengal, India
| | - Bijaya Ghosh
- NSHM Knowledge Campus, Kolkata-Group of Institutions, 124 BL Saha Road, Kolkata 700053, West Bengal, India.
| | - Preeta Bose
- NSHM Knowledge Campus, Kolkata-Group of Institutions, 124 BL Saha Road, Kolkata 700053, West Bengal, India
| | - Sumana Saha
- NSHM Knowledge Campus, Kolkata-Group of Institutions, 124 BL Saha Road, Kolkata 700053, West Bengal, India
| | - Arijit Sarkar
- NSHM Knowledge Campus, Kolkata-Group of Institutions, 124 BL Saha Road, Kolkata 700053, West Bengal, India
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High incidence of persistent subtherapeutic levels of the most common AEDs in children with epilepsy receiving polytherapy. Epilepsy Res 2018; 148:107-114. [DOI: 10.1016/j.eplepsyres.2018.09.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Revised: 08/14/2018] [Accepted: 09/15/2018] [Indexed: 11/18/2022]
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Gulcebi MI, Kendirli T, Turgan ZA, Patsalos PN, Onat Yilmaz F. The effect of serum levetiracetam concentrations on therapeutic response and IL1-beta concentration in patients with epilepsy. Epilepsy Res 2018; 148:17-22. [PMID: 30326332 DOI: 10.1016/j.eplepsyres.2018.09.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Revised: 09/07/2018] [Accepted: 09/26/2018] [Indexed: 12/31/2022]
Abstract
OBJECTIVE Assessment of the relevance between serum drug concentration to its therapeutic response is a valid monitoring strategy for the clinical efficacy of antiepileptic drugs (AEDs). Levetiracetam (LEV) is a broad spectrum AED with a possible anti-inflammatory effect. We aimed to determine the relationship between LEV concentrations and its therapeutic response, and the effect of LEV on IL1-beta concentrations in patients with epilepsy. METHODS Patients on monotherapy (n = 7) or polytherapy (n = 15) with LEV for their seizures management were included. Blood samples of each patient were collected: just before LEV intake, 1 h, 2 h, 4 h and 8 h following the last dose. Serum LEV concentrations were measured by liquid chromatography mass spectrometry and IL1-beta concentrations by chemiluminescent immunometric assay. Concentration to dose (C/D) ratio values was used for analyses. LEV concentrations were compared between responders (≤1 seizure/month) and non-responders (>1 seizure/month) and patients with or without adverse reactions. IL1-beta concentrations before and at 2 h following LEV ingestion were compared in order to detect the effect of the increase in serum LEV concentration on IL1-beta. RESULTS Although there was no change in LEV (C/D) ratio or LEV maximum concentration (Cmax)/D ratio of the responders and non-responders, the C/D ratio following 1 h of LEV intake (2.17 ± 0.59 kg.day/L) and Cmax/D ratio (2.25 ± 0.56 kg.day/L) in the patients with adverse effects was significantly higher than for the patients without adverse effects (1.09 ± 0.12 kg.day/L and 1.49 ± 0.14 kg.day/L respectively). A statistically significant decrease was found in the IL1-beta concentration to LEV (C/D) ratio with the increase in LEV concentration in patients on LEV monotherapy. CONCLUSION The possible relationship between LEV Cmax and its therapeutic response or IL1-beta concentrations may be an importance indication of LEV antiepileptic efficacy. Consequently, monitoring LEV Cmax values may enhance LEV adherence because patients would be less likely to develop adverse effects.
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Affiliation(s)
- Medine I Gulcebi
- Department of Medical Pharmacology, School of Medicine, University of Marmara, Istanbul, Turkey
| | - Tansel Kendirli
- Department of Neurology, School of Medicine, University of Health Sciences, Istanbul, Turkey
| | - Zehra Asik Turgan
- Department of Medical Pharmacology, School of Medicine, University of Marmara, Istanbul, Turkey
| | - Philip N Patsalos
- Department of Clinical & Experimental Epilepsy, NIHR University College London Hospitals Biomedical Research Centre, UCL Institute of Neurology, London, United Kingdom; Therapeutic Drug Monitoring Unit, Chalfont Centre for Epilepsy, Chalfont St. Peter, United Kingdom
| | - Filiz Onat Yilmaz
- Department of Medical Pharmacology, School of Medicine, University of Marmara, Istanbul, Turkey.
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Development and validation of a HPLC-UV assay for quantification of levetiracetam concentrations in critically ill patients undergoing continuous renal replacement therapy. Biomed Chromatogr 2018; 32:e4257. [DOI: 10.1002/bmc.4257] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Revised: 03/21/2018] [Accepted: 03/29/2018] [Indexed: 11/07/2022]
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Development and full validation of an innovative HPLC-diode array detection technique to simultaneously quantify lacosamide, levetiracetam and zonisamide in human plasma. Bioanalysis 2018; 10:541-557. [DOI: 10.4155/bio-2017-0199] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Aim: To implement pharmacokinetic drug monitoring and individualize the posology of new antiepileptic drugs, the first HPLC-diode array detection method was developed and validated to simultaneously quantify lacosamide, levetiracetam and zonisamide in human plasma. Materials & methods: Preceded by a reproducible liquid–liquid extraction, chromatographic separation was achieved by using a C18 column of 5 cm length and a mobile phase of water/acetonitrile. Full validation was performed according to international guidelines. Results: The method was linear within 0.5–30, 2.5–40.0 and 0.5–50.0 μg ml-1 for lacosamide, levetiracetam and zonisamide, respectively (r2 ≥ 0.998), accurate (-12.411–8.303%), precise (≤8.875%). Conclusion: This innovative HPLC-diode array detection method was successfully employed in clinical practice and is expected to empower epileptic patients with a personalized pharmacotherapy service. [Formula: see text]
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Karesova I, Simko J, Fekete S, Zimcikova E, Malakova J, Zivna H, Pavlikova L, Palicka V. The effect of levetiracetam on rat bone mineral density, bone structure and biochemical markers of bone metabolism. Eur J Pharmacol 2018; 824:115-119. [DOI: 10.1016/j.ejphar.2018.02.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Revised: 12/14/2017] [Accepted: 02/07/2018] [Indexed: 11/27/2022]
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18
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Jenjirattithigarn N, Worachat N, Horsuwan S, Puangpetch A, Prempunpong C, Khongkhatithum C, Thampratankul L, Prommas S, Visudtibhan A, Sukasem C. Determination of plasma Levetiracetam level by Liquid Chromatography-Tandem Mass Spectrometry (LC-MS-MS) and its application in pharmacokinetics studies in neonates. J Chromatogr B Analyt Technol Biomed Life Sci 2018; 1085:13-20. [PMID: 29626789 DOI: 10.1016/j.jchromb.2018.03.037] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Revised: 03/05/2018] [Accepted: 03/24/2018] [Indexed: 11/16/2022]
Abstract
BACKGROUND Levetiracetam (LEV) is an antiepileptic drug which has good safety and efficacy in neonatal seizure (NS), a common incident in neonates with weight <1500 g. The pharmacokinetics for LEV in neonatal populations is yet to be clearly understood. In this study, we developed and validated a method for determination of LEV in plasma by liquid chromatography tandem mass spectrometry for the purpose of pharmacokinetic study. METHODS Plasma LEV was spiked with Lamivudine as internal standard before extraction by C18 solid-phase extraction (SPE) cartridge. Chromatography was performed using isocratic elution with mobile phase A: B (10: 90) for 2.0 min with flow rate 0.4 mL/min. The mobile phase was composed of 0.1% formic acid in 10.0 mM ammonium acetate (A) and 100% methanol (B). The injection volume was 1.0 μL and the total run time was 2.0 min. Multiple reaction monitoring (MRM) with electro spray in positive mode was used. The mass transition for LEV was 171.2/126.0 and 230.0/112.0 for IS with retention time of 0.73 and 0.72 min, respectively. RESULTS A calibration curve range from 0.50-80.0 μg/mL was obtained with a correlation coefficient >0.99 in the quadratic model. Precision and accuracy was within the acceptable range and the intra- and inter-day %CV for three concentrations of QCs were <10%. CONCLUSION This method was reliable, accurate and applicable for LEV pharmacokinetic study in neonates with seizure.
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Affiliation(s)
- Nuttawut Jenjirattithigarn
- Division of Pharmacogenomics and Personalized Medicine, Department of Pathology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; Laboratory for Pharmacogenomics, Somdech Phra Debaratana Medical Center (SDMC), Ramathibodi Hospital, Bangkok, Thailand
| | - Nattha Worachat
- Division of Neonatology, Department of Pediatrics, Faculty of Medicine, Ramathibodi Hospital, Bangkok 10400, Thailand
| | - Suchawadee Horsuwan
- Division of Neurology, Department of Pediatrics, Faculty of Medicine, Ramathibodi Hospital, Bangkok 10400, Thailand
| | - Apichaya Puangpetch
- Division of Pharmacogenomics and Personalized Medicine, Department of Pathology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; Laboratory for Pharmacogenomics, Somdech Phra Debaratana Medical Center (SDMC), Ramathibodi Hospital, Bangkok, Thailand
| | - Chatchay Prempunpong
- Division of Neonatology, Department of Pediatrics, Faculty of Medicine, Ramathibodi Hospital, Bangkok 10400, Thailand
| | - Chaiyos Khongkhatithum
- Division of Neurology, Department of Pediatrics, Faculty of Medicine, Ramathibodi Hospital, Bangkok 10400, Thailand
| | - Lunliya Thampratankul
- Division of Neurology, Department of Pediatrics, Faculty of Medicine, Ramathibodi Hospital, Bangkok 10400, Thailand
| | - Santirat Prommas
- Division of Pharmacogenomics and Personalized Medicine, Department of Pathology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; Laboratory for Pharmacogenomics, Somdech Phra Debaratana Medical Center (SDMC), Ramathibodi Hospital, Bangkok, Thailand
| | - Anannit Visudtibhan
- Division of Neurology, Department of Pediatrics, Faculty of Medicine, Ramathibodi Hospital, Bangkok 10400, Thailand
| | - Chonlaphat Sukasem
- Division of Pharmacogenomics and Personalized Medicine, Department of Pathology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; Laboratory for Pharmacogenomics, Somdech Phra Debaratana Medical Center (SDMC), Ramathibodi Hospital, Bangkok, Thailand.
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Ibrahim FA, El-Yazbi AF, Wagih MM, Barary MA. Sensitive inexpensive spectrophotometric and spectrofluorimetric analysis of ezogabine, levetiracetam and topiramate in tablet formulations using Hantzsch condensation reaction. SPECTROCHIMICA ACTA. PART A, MOLECULAR AND BIOMOLECULAR SPECTROSCOPY 2017; 184:47-60. [PMID: 28482206 DOI: 10.1016/j.saa.2017.04.078] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Revised: 02/27/2017] [Accepted: 04/26/2017] [Indexed: 06/07/2023]
Abstract
Two highly sensitive, simple and selective spectrophotometric and spectrofluorimetric assays have been investigated for the analysis of ezogabine, levetiracetam and topiramate in their pure and in pharmaceutical dosage forms. The suggested methods depend on the condensation of the primary amino-groups in the three drugs with acetylacetone and formaldehyde according to Hantzsch reaction yielding highly fluorescent yellow colored dihydropyridine derivatives. The reaction products of ezogabine, levetiracetam and topiramate were measured spectrophotometrically at 418, 390 and 380nm or spectrofluorimetrically at λem/ex of 495/425nm, 490/415nm and 488/410nm, respectively. Various experimental conditions have been carefully studied to maximize the reaction yield. At the optimum reaction conditions, the calibration curves were rectilinear over the concentration ranges of 8-25, 60-180 and 80-200μg/mL spectrophotometrically and 0.02-0.2, 0.2-1.2 and 0.2-1.5μg/mL spectrofluorimetrically for ezogabine, levetiracetam and topiramate, respectively with good correlation coefficients. The suggested methods were applied successfully for the analysis of ezogabine, levetiracetam and topiramate in their commercial tablets with high percentage recoveries and negligible interference from various excipients in pharmaceutical dosage forms. The results were statistically analyzed and showed the absence of any significant difference between both developed and published methods. The procedures were validated and evaluated by the ICH guidelines revealing good reproducibility and accuracy. Therefore, the two proposed methods may be considered of high interest for practical and reliable analysis of ezogabine, levetiracetam and topiramate in pharmaceutical dosage forms.
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Affiliation(s)
- F A Ibrahim
- Department of Analytical Chemistry, Faculty of Pharmacy, Mansoura University, Mansoura 35516, Egypt
| | - A F El-Yazbi
- Department of Pharmaceutical Analytical Chemistry, Faculty of Pharmacy, Alexandria University, Alexandria 2521, Egypt.
| | - M M Wagih
- Forensic Medicine Authority, Egyptian Ministry of Justice, El Sayeda Zeinab, Zeinhom 11628, Cairo, Egypt
| | - M A Barary
- Department of Pharmaceutical Analytical Chemistry, Faculty of Pharmacy, Alexandria University, Alexandria 2521, Egypt
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Hamdan II, Alsous M, Masri AT. Chromatographic Characterization and Method Development for Determination of Levetiracetam in Saliva: Application to Correlation with Plasma Levels. JOURNAL OF ANALYTICAL METHODS IN CHEMISTRY 2017; 2017:7846742. [PMID: 28848686 PMCID: PMC5564075 DOI: 10.1155/2017/7846742] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Revised: 06/15/2017] [Accepted: 07/02/2017] [Indexed: 06/07/2023]
Abstract
Levetiracetam (LVT) is a widely used antiepileptic drug (AED). A less invasive sampling method for therapeutic drug monitoring (TDM) would be very useful particularly for children. Saliva has been shown as an adequate sample for TDM of some AEDs. Due to the high hydrophilicity of LVT its separation on common stationary phases is quite a challenge so that previous methods for determination of LVT in saliva employed either gradient high performance liquid chromatographic (HPLC) system or mass spectrometer as a detector. In this study the retention behavior of LVT on some common stationary phases was examined, with C8 being the most retentive. A simple isocratic HPLC method that is based on simple protein precipitation was developed and validated for the determination of LVT in saliva. The method was applied to a sample group of epileptic children for the purpose of assessing potential correlation with plasma LVT levels and to investigate patient's compliance. The results confirmed a reasonable correlation between plasma and salivary levels of LVT (R = 0.9) which supports the use of saliva for TDM of LVT. The study also revealed a significant percentage of epileptic patients having LVT levels below the estimated therapeutic range.
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Affiliation(s)
- Imad I. Hamdan
- School of Pharmacy, The University of Jordan, Amman, Jordan
| | - Mervat Alsous
- Department of Clinical Pharmacy and Therapeutics, Faculty of Pharmacy, Applied Sciences Private University, Amman, Jordan
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Company-Albir MJ, Ruíz-Ramos J, Solana Altabella A, Marqués-Miñana MR, Vicent C, Poveda JL. Haemodialysis significantly reduces serum levetiracetam levels inducing epileptic seizures: Case report. J Clin Pharm Ther 2017; 42:774-775. [PMID: 28555936 DOI: 10.1111/jcpt.12568] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2017] [Accepted: 05/04/2017] [Indexed: 12/30/2022]
Abstract
WHAT IS KNOWN AND OBJECTIVE Levetiracetam is used in the treatment of some forms of epilepsy. In renal impairment and patients on chronic haemodialysis, dose adjustment is required. We report a case. CASE DESCRIPTION This case report describes a woman on levetiracetam treatment who presented with generalized tonic-clonic seizures during a haemodialysis session. We report on treatment adjustment and on the impact of dialysis on levetiracetam levels. WHAT IS NEW AND CONCLUSION Haemodialysis reduces serum levetiracetam concentration and can lead to subtherapeutic levels. Close monitoring is necessary when dialysis is used on patients receiving anticonvulsant drugs that are extensively eliminated by the procedure.
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Affiliation(s)
- M J Company-Albir
- Servicio de Farmacia, Área del Medicamento, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - J Ruíz-Ramos
- Unidad de Cuidados Intensivos, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - A Solana Altabella
- Servicio de Farmacia, Área del Medicamento, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - M R Marqués-Miñana
- Servicio de Farmacia, Área del Medicamento, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - C Vicent
- Unidad de Cuidados Intensivos, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - J L Poveda
- Servicio de Farmacia, Área del Medicamento, Hospital Universitari i Politècnic La Fe, Valencia, Spain
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22
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Levetiracetam Clinical Pharmacokinetic Monitoring in Pediatric Patients with Epilepsy. Clin Pharmacokinet 2017; 56:1267-1285. [DOI: 10.1007/s40262-017-0537-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Zelano J, Ben-Menachem E. Treating epileptic emergencies - pharmacological advances. Expert Opin Pharmacother 2016; 17:2227-2234. [PMID: 27686410 DOI: 10.1080/14656566.2016.1241236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Epileptic emergencies are frequently encountered and include ictal events as status epilepticus or seizure clusters, and non-ictal situations like postictal psychosis or acute drug side effects. The aim of this review was to describe recent pharmacological advances in the treatment of epileptic emergencies. Areas covered: Based on clinically relevant questions, a literature search was performed. The search showed that most pharmacological advances have been made in management of status epilepticus, where substantial literature has accumulated on several AEDs with potentially less side-effects than the traditional choices. The use of these drugs; valproate, levetiracetam, and lacosamide, was therefore made the main focus of this review. Pharmacological advances in treatment of other epileptic emergencies were scarce, and were therefore covered more briefly in the Expert Opinion section. Expert opinion: This section outlines our current practice in management of status epilepticus and seizures clusters. Our opinion is that valproate is an equal alternative as second line treatment to fosphenytoin, with levetiracetam considered a good choice in frail and elderly patients. Due to the lack of literature, lacosamide is used mainly as a 2nd line drug after the failure of valproate, fosphenytoin and levetiracetam. Our review underlines the need for more research in management of epileptic emergencies.
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Affiliation(s)
- Johan Zelano
- a Department of Clinical Neuroscience and Department of Neurology, Sahlgrenska Academy , University of Gothenburg, Sahlgrenska University Hospital , Gothenburg , Sweden
| | - Elinor Ben-Menachem
- a Department of Clinical Neuroscience and Department of Neurology, Sahlgrenska Academy , University of Gothenburg, Sahlgrenska University Hospital , Gothenburg , Sweden
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Dupouey J, Doudka N, Belo S, Blin O, Guilhaumou R. Simultaneous determination of four antiepileptic drugs in human plasma samples using an ultra-high-performance liquid chromatography tandem mass spectrometry method and its application in therapeutic drug monitoring. Biomed Chromatogr 2016; 30:2053-2060. [DOI: 10.1002/bmc.3789] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2016] [Revised: 06/17/2016] [Accepted: 07/08/2016] [Indexed: 01/20/2023]
Affiliation(s)
- Julien Dupouey
- Service de Pharmacologie clinique et Pharmacovigilance; Hôpital de la Timone; 264 rue Saint Pierre 13385 Marseille Cedex 5 France
- Pharmacologie intégrée et Interface clinique et industriel, Institut des Neurosciences Timone - CNRS 7289; Aix Marseille Université; Marseille 13385 France
| | - Natalia Doudka
- Service de Pharmacologie clinique et Pharmacovigilance; Hôpital de la Timone; 264 rue Saint Pierre 13385 Marseille Cedex 5 France
| | - Séphora Belo
- Service de Pharmacologie clinique et Pharmacovigilance; Hôpital de la Timone; 264 rue Saint Pierre 13385 Marseille Cedex 5 France
| | - Olivier Blin
- Service de Pharmacologie clinique et Pharmacovigilance; Hôpital de la Timone; 264 rue Saint Pierre 13385 Marseille Cedex 5 France
- Pharmacologie intégrée et Interface clinique et industriel, Institut des Neurosciences Timone - CNRS 7289; Aix Marseille Université; Marseille 13385 France
| | - Romain Guilhaumou
- Service de Pharmacologie clinique et Pharmacovigilance; Hôpital de la Timone; 264 rue Saint Pierre 13385 Marseille Cedex 5 France
- Pharmacologie intégrée et Interface clinique et industriel, Institut des Neurosciences Timone - CNRS 7289; Aix Marseille Université; Marseille 13385 France
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Dexamethasone alone and in combination with desipramine, phenytoin, valproic acid or levetiracetam interferes with 5-ALA-mediated PpIX production and cellular retention in glioblastoma cells. J Neurooncol 2015; 127:15-21. [PMID: 26643803 DOI: 10.1007/s11060-015-2012-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Accepted: 11/22/2015] [Indexed: 10/22/2022]
Abstract
Extent of resection of glioblastoma (GBM) correlates with overall survival. Fluorescence-guided resection (FGR) using 5-aminolevulinic acid (5-ALA) can improve the extent of resection. Unfortunately not all patients given 5-ALA accumulate sufficient quantities of protoporphyrin IX (PpIX) for successful FGR. In this study, we investigated the effects of dexamethasone, desipramine, phenytoin, valproic acid, and levetiracetam on the production and accumulation of PpIX in U87MG cells. All of these drugs, except levetiracetam, reduce the total amount of PpIX produced by GBM cells (p < 0.05). When dexamethasone is mixed with another drug (desipramine, phenytoin, valproic acid or levetiracetam) the amount of PpIX produced is further decreased (p < 0.01). However, when cells are analyzed for PpIX cellular retention, dexamethasone accumulated significantly more PpIX than the vehicle control (p < 0.05). Cellular retention of PpIX was not different from controls in cells treated with dexamethasone plus desipramine, valproic acid or levetiracetam, but was significantly less for dexamethasone plus phenytoin (p < 0.01). These data suggest that medications given before and during surgery may interfere with PpIX accumulation in malignant cells. At this time, levetiracetam appears to be the best medication in its class (anticonvulsants) for patients undergoing 5-ALA-mediated FGR.
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Iwasaki T, Toki T, Nonoda Y, Ishii M. The efficacy of levetiracetam for focal seizures and its blood levels in children. Brain Dev 2015; 37:773-9. [PMID: 25579248 DOI: 10.1016/j.braindev.2014.11.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2013] [Revised: 10/10/2014] [Accepted: 11/28/2014] [Indexed: 10/24/2022]
Abstract
AIM To evaluate the efficacy of levetiracetam (LEV) and the usefulness of measurement of its blood levels during the follow-up of patients with focal seizures. METHODS Twenty-four patients (13 cases without impairment of consciousness or awareness and 11 cases with them or evolving to a bilateral, convulsive seizure) treated with LEV had their peak blood levels measured. The blood concentrations were measured at 2 weeks, 1 year and 2 years after reaching the LEV maintenance dosage. The efficacy of LEV was evaluated with repeated blood sampling to determine the seizure reduction rate. The patients were classified as effective cases (seizure reduction rate>50%) and ineffective cases (⩽50%). RESULTS In Japanese children treated with LEV, the dosage and blood level showed positive correlations. The blood levels were higher in effective cases than in ineffective cases at all time points (p<0.05). In effective cases, the blood concentration was 23.26±6.88 μg/mL (mean±SD) 2 weeks later, 23.59±8.23 μg/mL 1 year later, and 24.46±7.57 μg/mL 2 years later. However, the blood levels and efficacies showed positive correlations only at 2 weeks and 1 year later. No patients had any side effects. CONCLUSIONS No precise definition of the therapeutic range was possible because of the incomplete correlation between the blood level and seizure frequency. Instead of a therapeutic range, we recommend an optimal range for LEV of 20-30 μg/mL as a therapeutic target without any side effects.
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Affiliation(s)
- Toshiyuki Iwasaki
- Department of Pediatrics, Kitasato University School of Medicine, Kanagawa, Japan.
| | - Taira Toki
- Department of Pediatrics, Kitasato University School of Medicine, Kanagawa, Japan
| | - Yutaka Nonoda
- Department of Pediatrics, Kitasato University School of Medicine, Kanagawa, Japan
| | - Masahiro Ishii
- Department of Pediatrics, Kitasato University School of Medicine, Kanagawa, Japan
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Sheinberg R, Heyman E, Dagan Z, Youngster I, Kohn E, Gandelman-Marton R, Berkovitch M. Correlation between efficacy of levetiracetam and serum levels among children with refractory epilepsy. Pediatr Neurol 2015; 52:624-8. [PMID: 25791893 DOI: 10.1016/j.pediatrneurol.2015.01.012] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2014] [Revised: 01/20/2015] [Accepted: 01/23/2015] [Indexed: 11/30/2022]
Abstract
BACKGROUND Levetiracetam is used as adjunctive therapy in various types of seizures. Studies evaluating the effect of levetiracetam on children with refractory epilepsy are scarce. The aim of this study was to evaluate the correlation between serum concentration of levetiracetam and either efficacy or tolerability in children with refractory epilepsy, and to determine the value of levetiracetam blood level monitoring. METHODS Medical records of 50 children with refractory epilepsy treated with levetiracetam and regularly followed at Assaf Harofeh Medical Center were retrospectively reviewed. Trough serum levetiracetam concentration was determined using high-performance liquid chromatography and correlated with the administered dose and clinical report. RESULTS No correlation between levetiracetam serum levels and clinical efficacy, tolerability or administered dosage was found. The average dose of levetiracetam was 43.7 ± 20.0 (range 14-100) mg/kg/day and the average serum concentration was 16.0 ± 9.5 (range 2.5-38.5) μg/mL. Forty-five patients (95%) had more than a 50% reduction of seizure frequency, with 22 (44%) patients becoming seizure-free for at least 6 months. Adverse events related to levetiracetam were reported in 15 (30%) patients. No correlation between serum concentrations and adverse events was found. These results were not affected by gender, age, type of seizure, and other drugs. CONCLUSIONS Determination of serum concentration is not needed in all children treated with levetiracetam. Serum concentrations may be valuable either in patients with refractory epilepsy for compliance evaluation or in patients with satisfactory control of seizures for determination of their therapeutic baseline.
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Affiliation(s)
- Revital Sheinberg
- Department of Pediatrics, Assaf Harofeh Medical Center, Zerifin, Israel
| | - Eli Heyman
- Department of Pediatric Neurology, Assaf Harofeh Medical Center, Zerifin, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Zahi Dagan
- Department of Pediatrics, Assaf Harofeh Medical Center, Zerifin, Israel; Clinical Pharmacology Unit, Assaf Harofeh Medical Center, Zerifin, Israel
| | - Ilan Youngster
- Department of Pediatrics, Assaf Harofeh Medical Center, Zerifin, Israel
| | - Elkana Kohn
- Clinical Pharmacology Unit, Assaf Harofeh Medical Center, Zerifin, Israel
| | - Revital Gandelman-Marton
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; Electroencephalography Laboratory, Department of Neurology, Assaf Harofeh Medical Center, Zerifin, Israel
| | - Matitiahu Berkovitch
- Department of Pediatrics, Assaf Harofeh Medical Center, Zerifin, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; Clinical Pharmacology Unit, Assaf Harofeh Medical Center, Zerifin, Israel.
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Freitas-Lima P, Ferreira FIS, Bertucci C, Alexandre Júnior V, Dreossi SAC, Pereira LRL, Sakamoto AC, Queiroz RHC. Stir bar-sorptive extraction, solid phase extraction and liquid-liquid extraction for levetiracetam determination in human plasma: comparing recovery rates. BRAZ J PHARM SCI 2015. [DOI: 10.1590/s1984-82502015000200017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
<p>Levetiracetam (LEV), an antiepileptic drug (AED) with favorable pharmacokinetic profile, is increasingly being used in clinical practice, although information on its metabolism and disposition are still being generated. Therefore a simple, robust and fast liquid-liquid extraction (LLE) followed by high-performance liquid chromatography method is described that could be used for both pharmacokinetic and therapeutic drug monitoring (TDM) purposes. Moreover, recovery rates of LEV in plasma were compared among LLE, stir bar-sorptive extraction (SBSE), and solid-phase extraction (SPE). Solvent extraction with dichloromethane yielded a plasma residue free from usual interferences such as commonly co-prescribed AEDs, and recoveries around 90% (LLE), 60% (SPE) and 10% (SBSE). Separation was obtained using reverse phase Select B column with ultraviolet detection (235 nm). Mobile phase consisted of methanol:sodium acetate buffer 0.125 M pH 4.4 (20:80, v/v). The method was linear over a range of 2.8-220.0 µg mL<sup>-1</sup>. The intra- and inter-assay precision and accuracy were studied at three concentrations; relative standard deviation was less than 10%. The limit of quantification was 2.8 µg mL<sup>-1</sup>. This robust method was successfully applied to analyze plasma samples from patients with epilepsy and therefore might be used for pharmacokinetic and TDM purposes.</p>
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Yeap LL, Lo YL. Rapid and simultaneous quantification of levetiracetam and its carboxylic metabolite in human plasma by liquid chromatography tandem mass spectrometry. PLoS One 2014; 9:e111544. [PMID: 25375249 PMCID: PMC4223074 DOI: 10.1371/journal.pone.0111544] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2014] [Accepted: 08/29/2014] [Indexed: 11/29/2022] Open
Abstract
A simple liquid chromatography tandem mass spectrometry method was developed and validated according to the guidelines of the US Food and Drug Administration and the European Medicines Agency for a simultaneous quantification of levetiracetam (LEV) and its metabolite, UCB L057 in the plasma of patients. A 0.050 mL plasma sample was prepared by a simple and direct protein precipitation with 0.450 mL acetonitrile (ACN) containing 1 µg/mL of internal standard (IS, diphenhydramine), then vortex mixed and centrifuged. A 0.100 mL of the clear supernatant was diluted with 0.400 mL water and well mixed. A 0.010 mL of the resultant solution was injected into an Agilent Zorbax SB-C18 (2.1 mm×100 mm, 3.5 µm) column with an isocratic elution at 0.5 mL/min using a mixture of 0.1% formic acid in water and ACN (40:60 v/v). Detection was performed using an AB Sciex API 3000 triple quadrupole mass spectrometer, equipped with a Turbo Ion Spray source, operating in a positive mode: LEV at transition 171.1>154.1, UCB L057 at 172.5>126.1, and IS at 256.3>167.3; with an assay run time of 2 minutes. The lower limit of quantification (LLOQ) for both LEV and UCB L057 was validated at 0.5 µg/mL, while their lower limit of detection (LOD) was 0.25 µg/mL. The calibration curves were linear between 0.5 and 100 µg/mL for both analytes. The inaccuracy and imprecision of both intra-assay and inter-assay were less than 10%. Matrix effects were consistent between sources of plasma and the recoveries of all compounds were between 100% and 110%. Stability was established under various storage and processing conditions. The carryovers from both LEV and UCB L057 were less than 6% of the LLOQ and 0.13% of the IS. This assay method has been successfully applied to a population pharmacokinetic study of LEV in patients with epilepsy.
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Affiliation(s)
- Li-Ling Yeap
- Department of Pharmacy, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Yoke-Lin Lo
- Department of Pharmacy, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
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Bhattacharya P, Ghosh M, Chatterjee A, Bangal S, Saha A. Development of a Validated Stability-Indicating High-Performance Thin-Layer Chromatographic Method for the Quantification of Levetiracetam. JPC-J PLANAR CHROMAT 2014. [DOI: 10.1556/jpc.27.2014.2.11] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Stockis A, Lu S, Tonner F, Otoul C. Clinical pharmacology of levetiracetam for the treatment of epilepsy. Expert Rev Clin Pharmacol 2014; 2:339-50. [DOI: 10.1586/ecp.09.16] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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The effect of levetiracetam on rat bone mass, structure and metabolism. Epilepsy Res 2013; 107:56-60. [DOI: 10.1016/j.eplepsyres.2013.08.012] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2013] [Revised: 06/25/2013] [Accepted: 08/08/2013] [Indexed: 11/15/2022]
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33
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Moreno AMJ, Navas MJ, Asuero AG. HPLC-DAD Determination of CNS-Acting Drugs in Human Blood, Plasma, and Serum. Crit Rev Anal Chem 2013; 44:68-106. [DOI: 10.1080/10408347.2013.828570] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Abstract
PURPOSE OF REVIEW Various antiepileptics, sedative and anesthetic agents are used in the neurocritical care setting and therapeutic drug monitoring (TDM) has been proposed as a means to individualize dosing to ensure efficacy, avoid toxicity, and to account for drug-drug interactions. The purpose of this review is to highlight key articles relating to TDM published in the last 5 years with a focus on drug therapy for seizures, status epilepticus, and traumatic brain injury. RECENT FINDINGS Current evidence supports TDM of first-generation antiepileptics, and free-level monitoring for phenytoin and valproic acid is recommended in the neurocritical care population. There are insufficient data to recommend routine TDM of second-generation antiepileptics at this time. In traumatic brain injury, routine TDM of barbiturate infusions appears to be of little value in guiding or evaluating patient response to therapy except to differentiate between drug-induced coma and brain death. Although TDM of sedative agents has been studied, the use of clinical sedation scales is preferred over TDM in evaluating a patient's level of sedation. SUMMARY Therapeutic drug monitoring plays an important role in the care of patients in the neurocritical care setting but is applicable only to a limited number of drugs.
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Population pharmacokinetics modeling of levetiracetam in Chinese children with epilepsy. Acta Pharmacol Sin 2012; 33:845-51. [PMID: 22669118 DOI: 10.1038/aps.2012.57] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
AIM To establish a population pharmacokinetics (PPK) model of levetiracetam in Chinese children with epilepsy. METHODS A total of 418 samples from 361 epileptic children in Peking University First Hospital were analyzed. These patients were divided into two groups: the PPK model group (n=311) and the PPK validation group (n=50). Levetiracetam concentrations were determined by HPLC. The PPK model of levetiracetam was established using NONMEM, according to a one-compartment model with first-order absorption and elimination. To validate the model, the mean prediction error (MPE), mean squared prediction error (MSPE), root mean-squared prediction error (RMSPE), weight residues (WRES), and the 95% confidence intervals (95% CI) were calculated. RESULTS A regression equation of the basic model of levetiracetam was obtained, with clearance (CL/F)=0.988 L/h, volume of distribution (V/F)=12.3 L, and K(a)=1.95 h(-1). The final model was as follows: K(a)=1.56 h(-1), V/F=12.1 (L), CL/F=1.04×(WEIG/25)(0.583) (L/h). For the basic model, the MPE, MSPE, RMSPE, WRES, and the 95%CI were 9.834 (-0.587-197.720), 50.919 (0.012-1286.429), 1.680 (0.021-34.184), and 0.0621 (-1.100-1.980). For the final model, the MPE, MSPE, RMSPE, WRES, and the 95% CI were 0.199 (-0.369-0.563), 0.002082 (0.00001-0.01054), 0.0293 (0.001-0.110), and 0.153 (-0.030-1.950). CONCLUSION A one-compartment model with first-order absorption adequately described the levetiracetam concentrations. Body weight was identified as a significant covariate for levetiracetam clearance in this study. This model will be valuable to facilitate individualized dosage regimens.
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Bishop-Freeman SC, Kornegay NC, Winecker RE. Postmortem levetiracetam (Keppra®) data from North Carolina. J Anal Toxicol 2012; 36:422-8. [PMID: 22635608 DOI: 10.1093/jat/bks052] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
Levetiracetam (Keppra®) is one of the newer anticonvulsant drugs used to treat seizures. Since 2003, the North Carolina Office of the Chief Medical Examiner Toxicology Laboratory has collected quantitative levetiracetam data in samples for 56 postmortem cases. The data presented herein will provide the forensic community with concentrations to assist in the interpretation of levetiracetam in postmortem blood. Decedents were divided into two groups according to manner of death as determined by the medical examiner for the purposes of studying levetiracetam concentrations. There were equal numbers of natural (N = 28) and non-natural deaths (N = 28). These data were subsequently divided into subgroups for further study to explore the therapeutic range of levetiracetam and how it relates to postmortem data. The cases not certified as natural were investigated to study levetiracetam concentrations in cases where it was determined to contribute to the cause of death (attributed) and those where it was not (unattributed). Until now, the literature has only reported levetiracetam overdoses in which the individuals have recovered with respiratory support. Discussed are two suicidal drug deaths from 2010 that are noted to have elevated levels of levetiracetam, 190 and 35 mg/L. Also included in the complete data set are postmortem concentrations for five patients under the age of 10 with levetiracetam ranging from 1.4 to 50 mg/L. This paper will also address the adverse effects of the drug and explore its potential risk for suicide.
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Muñana K, Thomas W, Inzana K, Nettifee-Osborne J, McLucas K, Olby N, Mariani C, Early P. Evaluation of Levetiracetam as Adjunctive Treatment for Refractory Canine Epilepsy: A Randomized, Placebo-Controlled, Crossover Trial. J Vet Intern Med 2012; 26:341-8. [DOI: 10.1111/j.1939-1676.2011.00866.x] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2011] [Revised: 11/07/2011] [Accepted: 12/02/2011] [Indexed: 11/28/2022] Open
Affiliation(s)
- K.R. Muñana
- Department of Clinical Sciences; College of Veterinary Medicine; North Carolina State University; Raleigh; NC
| | - W.B. Thomas
- Department of Small Animal Clinical Sciences; College of Veterinary Medicine; University of Tennessee; Knoxville; TN
| | - K.D. Inzana
- Department of Small Animal Clinical Sciences; Virginia-Maryland Regional College of Veterinary Medicine; Virginia Tech; Blacksburg; VA
| | - J.A. Nettifee-Osborne
- Department of Clinical Sciences; College of Veterinary Medicine; North Carolina State University; Raleigh; NC
| | - K.J. McLucas
- Department of Small Animal Clinical Sciences; College of Veterinary Medicine; University of Tennessee; Knoxville; TN
| | - N.J. Olby
- Department of Clinical Sciences; College of Veterinary Medicine; North Carolina State University; Raleigh; NC
| | - C.J. Mariani
- Department of Clinical Sciences; College of Veterinary Medicine; North Carolina State University; Raleigh; NC
| | - P.J. Early
- Department of Clinical Sciences; College of Veterinary Medicine; North Carolina State University; Raleigh; NC
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Monitorización farmacocinética de antiepilépticos. FARMACIA HOSPITALARIA 2011; 35:326-39. [DOI: 10.1016/j.farma.2010.10.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2010] [Revised: 09/20/2010] [Accepted: 10/25/2010] [Indexed: 11/15/2022] Open
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A prospective open-labeled trial with levetiracetam in pediatric epilepsy syndromes: Continuous spikes and waves during sleep is definitely a target. Seizure 2011; 20:320-5. [DOI: 10.1016/j.seizure.2010.12.017] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2010] [Revised: 12/17/2010] [Accepted: 12/27/2010] [Indexed: 11/20/2022] Open
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Kang J, Park YS, Kim SH, Kim SH, Jun MY. Modern methods for analysis of antiepileptic drugs in the biological fluids for pharmacokinetics, bioequivalence and therapeutic drug monitoring. THE KOREAN JOURNAL OF PHYSIOLOGY & PHARMACOLOGY : OFFICIAL JOURNAL OF THE KOREAN PHYSIOLOGICAL SOCIETY AND THE KOREAN SOCIETY OF PHARMACOLOGY 2011; 15:67-81. [PMID: 21660146 DOI: 10.4196/kjpp.2011.15.2.67] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/23/2011] [Revised: 04/10/2011] [Accepted: 04/15/2011] [Indexed: 12/20/2022]
Abstract
Epilepsy is a chronic disease occurring in approximately 1.0% of the world's population. About 30% of the epileptic patients treated with availably antiepileptic drugs (AEDs) continue to have seizures and are considered therapy-resistant or refractory patients. The ultimate goal for the use of AEDs is complete cessation of seizures without side effects. Because of a narrow therapeutic index of AEDs, a complete understanding of its clinical pharmacokinetics is essential for understanding of the pharmacodynamics of these drugs. These drug concentrations in biological fluids serve as surrogate markers and can be used to guide or target drug dosing. Because early studies demonstrated clinical and/or electroencephalographic correlations with serum concentrations of several AEDs, It has been almost 50 years since clinicians started using plasma concentrations of AEDs to optimize pharmacotherapy in patients with epilepsy. Therefore, validated analytical method for concentrations of AEDs in biological fluids is a necessity in order to explore pharmacokinetics, bioequivalence and TDM in various clinical situations. There are hundreds of published articles on the analysis of specific AEDs by a wide variety of analytical methods in biological samples have appears over the past decade. This review intends to provide an updated, concise overview on the modern method development for monitoring AEDs for pharmacokinetic studies, bioequivalence and therapeutic drug monitoring.
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Affiliation(s)
- Juseop Kang
- Pharmacology & Clinical Pharmacology Lab, College of Medicine, Hanyang University, Seoul 133-791, Korea
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Performance Characteristics of a New Levetiracetam Immunoassay and Method Comparison With a High-Performance Liquid Chromatography Method. Ther Drug Monit 2011; 33:124-7. [DOI: 10.1097/ftd.0b013e3182048e05] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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Brandt C, May TW. Therapeutic drug monitoring of newer antiepileptic drugs / Therapeutic drug monitoring bei neueren Antiepileptika. ACTA ACUST UNITED AC 2011. [DOI: 10.1515/jlm.2011.022] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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LC method for therapeutic drug monitoring of levetiracetam: Evaluation of the assay performance and validation of its application in the routine area. Clin Biochem 2010; 43:473-82. [DOI: 10.1016/j.clinbiochem.2009.10.014] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2009] [Revised: 10/22/2009] [Accepted: 10/22/2009] [Indexed: 11/21/2022]
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Dailly E, Bouquié R, Bentué-Ferrer D. Suivi thérapeutique pharmacologique du lévétiracétam. Therapie 2010; 65:67-70. [DOI: 10.2515/therapie/2009071] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2009] [Accepted: 12/01/2009] [Indexed: 11/20/2022]
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Giroux PC, Salas-Prato M, Théorêt Y, Carmant L. Levetiracetam in children with refractory epilepsy: lack of correlation between plasma concentration and efficacy. Seizure 2009; 18:559-63. [PMID: 19546014 DOI: 10.1016/j.seizure.2009.05.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2009] [Revised: 05/11/2009] [Accepted: 05/15/2009] [Indexed: 10/20/2022] Open
Abstract
PURPOSE The goals of this study are to evaluate the efficacy and tolerability of levetiracetam (LEV) as add-on therapy in children with refractory epilepsies and to determine the value of LEV blood level monitoring in this population. METHODS Sixty-nine children (39 males and 30 females) treated with LEV between 2006 and 2007 were selected. Their medical files were reviewed for LEV efficacy and tolerability. In a subgroup of children currently taking LEV, plasma concentrations were determined by high performance liquid chromatography by ultraviolet detection (HPLC-UV) method and correlated with the given dose per kilo as well as clinical response. RESULTS Fifty-one patients (74%) had a more than 50% reduction in seizure frequency with 16 patients (23%) becoming seizure free on LEV. Eighteen (26%) patients had a less than 50% reduction in seizure frequency. Adverse events due to LEV ranged from mild to moderate in only 18 patients (26%). The most frequently observed were drowsiness, behavioral difficulties, increase in seizure frequency and headaches. The majority (60.5%) of the responders received doses between 10 and 50mg/kg/day and had a plasma concentration (PC) between 5 and 40microg/ml. However, we found no clear correlation between PC and efficacy. CONCLUSION Levetiracetam given twice a day in children with refractory epilepsy reduces seizure frequency in all types of epilepsy. In children, LEV is a broad spectrum anticonvulsant with a favourable safety profile.
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Affiliation(s)
- Patricia C Giroux
- Department of Physiology, University of Montreal, C.P. 6128, succursale Centre-ville, Montréal, Québec, Canada.
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Intravenous levetiracetam in critically ill children with status epilepticus or acute repetitive seizures. Pediatr Crit Care Med 2009; 10:505-10. [PMID: 19325512 PMCID: PMC2946960 DOI: 10.1097/pcc.0b013e3181a0e1cf] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Intravenous (IV) levetiracetam (LEV) is approved for use in patients older than 16 years and may be useful in critically ill children, although there is little data available regarding pharmacokinetics. We aim to investigate the safety, an appropriate dosing, and efficacy of IV LEV in critically ill children. DESIGN We describe a cohort of critically ill children who received IV LEV for status epilepticus, including refractory or nonconvulsive status, or acute repetitive seizures. RESULTS There were no acute adverse effects noted. Children had temporary cessation of ongoing refractory status epilepticus, termination of ongoing nonconvulsive status epilepticus, cessation of acute repetitive seizures, or reduction in epileptiform discharges with clinical correlate. CONCLUSIONS IV LEV was effective in terminating status epilepticus or acute repetitive seizures and well tolerated in critically ill children. Further study is needed to elucidate the role of IV LEV in critically ill children.
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Feys P, D'hooghe MB, Nagels G, Helsen WF. The effect of levetiracetam on tremor severity and functionality in patients with multiple sclerosis. Mult Scler 2009; 15:371-8. [PMID: 19168602 DOI: 10.1177/1352458508099142] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Multiple sclerosis (MS) intention tremor is a disabling symptom, which is difficult to treat. OBJECTIVES To investigate the effects of levetiracetam, an antiepileptic drug, on tremor severity and related functionality in MS. METHODS A randomized, double-blind, placebo-controlled, cross-over study examined the effects of 6 weeks of oral levetiracetam administration (starting dose=250 mg/day, maximal dose=2000 mg/day) in 18 MS patients with disabling intention tremor. Primary outcome was Fahn's Tremor Rating Scale (FTRS) A&B. Secondary outcome measures were the nine-hole peg test, patient's opinion rated with the visual analog scale, FTRS C, and an activities of daily life questionnaire and validated tremor indexes derived during the performance of a digitized spiral drawing task and a wrist step-tracking task. Repeated measures analysis of variance and Friedman tests were applied. RESULTS In all, 14 patients completed the trial. Maximal dose intake ranged from 1000 to most commonly 2000 mg, depending on patients' tolerance level. No significant effects of levetiracetam were found for any outcome measure. Further analyses on subgroups with different tremor severity showed no differential effects. Eight patients reported adverse events such as fatigue and stomach ache. CONCLUSIONS Levetiracetam intake of 2000 mg/day did not affect tremor severity or functionality in patients with MS.
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Affiliation(s)
- P Feys
- Department of Biomedical Kinesiology, Katholieke Universiteit Leuven, Leuven, Belgium
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Contin M, Mohamed S, Albani F, Riva R, Baruzzi A. Simple and validated HPLC–UV analysis of levetiracetam in deproteinized plasma of patients with epilepsy. J Chromatogr B Analyt Technol Biomed Life Sci 2008; 873:129-32. [DOI: 10.1016/j.jchromb.2008.08.007] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2008] [Revised: 07/29/2008] [Accepted: 08/12/2008] [Indexed: 11/26/2022]
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Abstract
Epilepsy is a common chronic disorder that requires long-term antiepileptic drug therapy. Approximately one half of patients fail the initial antiepileptic drug and about 35% are refractory to medical therapy, highlighting the continued need for more effective and better tolerated drugs. Levetiracetam is an antiepileptic drug marketed since 2000. Its novel mechanism of action is modulation of synaptic neurotransmitter release through binding to the synaptic vesicle protein SV2A in the brain. Its pharmacokinetic advantages include rapid and almost complete absorption, minimal insignificant binding to plasma protein, absence of enzyme induction, absence of interactions with other drugs, and partial metabolism outside the liver. The availability of an intravenous preparation is yet another advantage. It has been demonstrated effective as adjunctive therapy for refractory partial-onset seizures, primary generalized tonic-clonic seizures, and myoclonic seizures of juvenile myoclonic epilepsy. In addition, it was found equivalent to controlled release carbamazepine as first-line therapy for partial-onset seizures, both in efficacy and tolerability. Its main adverse effects in randomized adjunctive trials in adults have been somnolence, asthenia, infection, and dizziness. In children, the behavioral adverse effects of hostility and nervousness were also noted. Levetiracetam is an important addition to the treatment of epilepsy.
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Affiliation(s)
- Bassel Abou-Khalil
- Department of Neurology, Vanderbilt University Medical Center, A-0118 Medical Center North, Nashville, Tennessee, USA.
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