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Morley KC, Kranzler HR, Luquin N, Jamshidi N, Adams C, Montebello M, Tremonti C, Dali G, Logge W, Baillie A, Teesson M, Trent R, Haber PS. Topiramate Versus Naltrexone for Alcohol Use Disorder: A Genotype-Stratified Double-Blind Randomized Controlled Trial. Am J Psychiatry 2024; 181:403-411. [PMID: 38706338 DOI: 10.1176/appi.ajp.20230666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/07/2024]
Abstract
OBJECTIVE There have been no well-controlled and well-powered comparative trials of topiramate with other pharmacotherapies for alcohol use disorder (AUD), such as naltrexone. Moreover, the literature is mixed on the effects of two polymorphisms-rs2832407 (in GRIK1) and rs1799971 (in OPRM1)-on response to topiramate and naltrexone, respectively. The authors sought to examine the comparative effectiveness of topiramate and naltrexone in improving outcomes in AUD and to examine the role of the rs2832407 and rs1799971 polymorphisms, respectively, on response to these medications. METHODS In a 12-week, double-blind, placebo-controlled, randomized, multisite, genotype-stratified (rs2832407 and rs1799971) clinical trial comparing topiramate and naltrexone in treating AUD, 147 patients with AUD were randomly assigned to treatment with topiramate or naltrexone, stratified by genotype (rs2832407*CC and *AC/AA genotypes and rs1799971*AA and *AG/GG genotypes). The predefined primary outcome was number of heavy drinking days per week. Predefined secondary outcomes included standard drinks per drinking day per week, body mass index (BMI), craving, markers of liver injury, mood, and adverse events. RESULTS For the number of heavy drinking days per week, there was a near-significant time-by-treatment interaction. For the number of standard drinks per drinking day per week, there was a significant time-by-treatment interaction, which favored topiramate. There were significant time-by-treatment effects, with greater reductions observed with topiramate than naltrexone for BMI, craving, and gamma-glutamyltransferase level. Withdrawal due to side effects occurred in 8% and 5% of the topiramate and naltrexone groups, respectively. Neither polymorphism showed an effect on treatment response. CONCLUSIONS Topiramate is at least as effective and safe as the first-line medication, naltrexone, in reducing heavy alcohol consumption, and superior in reducing some clinical outcomes. Neither rs2832407 nor rs1799971 had effects on topiramate and naltrexone treatments, respectively.
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Affiliation(s)
- Kirsten C Morley
- Specialty of Addiction Medicine, Sydney Medical School (Morley, Adams, Montebello, Tremonti, Dali, Logge, Haber), School of Health Sciences (Baillie), and Matilda Centre for Mental Health and Substance Use (Teesson), Faculty of Medicine and Health, University of Sydney, Sydney, Australia; Edith Collins Centre for Translational Research in Alcohol, Drugs, and Toxicology (Morley, Jamshidi, Logge, Haber) and Department of Medical Genomics (Luquin, Trent), Royal Prince Alfred Hospital, Camperdown, Australia; Center for Studies of Addiction, Perelman School of Medicine, University of Pennsylvania, and Mental Illness Research, Education, and Clinical Center, Crescenz VA Medical Center, Philadelphia (Kranzler); Northern Sydney Local Health District Drug and Alcohol Services, St Leonards, Australia (Montebello); St Vincent's Hospital Sydney, Sydney, Australia (Tremonti)
| | - Henry R Kranzler
- Specialty of Addiction Medicine, Sydney Medical School (Morley, Adams, Montebello, Tremonti, Dali, Logge, Haber), School of Health Sciences (Baillie), and Matilda Centre for Mental Health and Substance Use (Teesson), Faculty of Medicine and Health, University of Sydney, Sydney, Australia; Edith Collins Centre for Translational Research in Alcohol, Drugs, and Toxicology (Morley, Jamshidi, Logge, Haber) and Department of Medical Genomics (Luquin, Trent), Royal Prince Alfred Hospital, Camperdown, Australia; Center for Studies of Addiction, Perelman School of Medicine, University of Pennsylvania, and Mental Illness Research, Education, and Clinical Center, Crescenz VA Medical Center, Philadelphia (Kranzler); Northern Sydney Local Health District Drug and Alcohol Services, St Leonards, Australia (Montebello); St Vincent's Hospital Sydney, Sydney, Australia (Tremonti)
| | - Natasha Luquin
- Specialty of Addiction Medicine, Sydney Medical School (Morley, Adams, Montebello, Tremonti, Dali, Logge, Haber), School of Health Sciences (Baillie), and Matilda Centre for Mental Health and Substance Use (Teesson), Faculty of Medicine and Health, University of Sydney, Sydney, Australia; Edith Collins Centre for Translational Research in Alcohol, Drugs, and Toxicology (Morley, Jamshidi, Logge, Haber) and Department of Medical Genomics (Luquin, Trent), Royal Prince Alfred Hospital, Camperdown, Australia; Center for Studies of Addiction, Perelman School of Medicine, University of Pennsylvania, and Mental Illness Research, Education, and Clinical Center, Crescenz VA Medical Center, Philadelphia (Kranzler); Northern Sydney Local Health District Drug and Alcohol Services, St Leonards, Australia (Montebello); St Vincent's Hospital Sydney, Sydney, Australia (Tremonti)
| | - Nazila Jamshidi
- Specialty of Addiction Medicine, Sydney Medical School (Morley, Adams, Montebello, Tremonti, Dali, Logge, Haber), School of Health Sciences (Baillie), and Matilda Centre for Mental Health and Substance Use (Teesson), Faculty of Medicine and Health, University of Sydney, Sydney, Australia; Edith Collins Centre for Translational Research in Alcohol, Drugs, and Toxicology (Morley, Jamshidi, Logge, Haber) and Department of Medical Genomics (Luquin, Trent), Royal Prince Alfred Hospital, Camperdown, Australia; Center for Studies of Addiction, Perelman School of Medicine, University of Pennsylvania, and Mental Illness Research, Education, and Clinical Center, Crescenz VA Medical Center, Philadelphia (Kranzler); Northern Sydney Local Health District Drug and Alcohol Services, St Leonards, Australia (Montebello); St Vincent's Hospital Sydney, Sydney, Australia (Tremonti)
| | - Claire Adams
- Specialty of Addiction Medicine, Sydney Medical School (Morley, Adams, Montebello, Tremonti, Dali, Logge, Haber), School of Health Sciences (Baillie), and Matilda Centre for Mental Health and Substance Use (Teesson), Faculty of Medicine and Health, University of Sydney, Sydney, Australia; Edith Collins Centre for Translational Research in Alcohol, Drugs, and Toxicology (Morley, Jamshidi, Logge, Haber) and Department of Medical Genomics (Luquin, Trent), Royal Prince Alfred Hospital, Camperdown, Australia; Center for Studies of Addiction, Perelman School of Medicine, University of Pennsylvania, and Mental Illness Research, Education, and Clinical Center, Crescenz VA Medical Center, Philadelphia (Kranzler); Northern Sydney Local Health District Drug and Alcohol Services, St Leonards, Australia (Montebello); St Vincent's Hospital Sydney, Sydney, Australia (Tremonti)
| | - Mark Montebello
- Specialty of Addiction Medicine, Sydney Medical School (Morley, Adams, Montebello, Tremonti, Dali, Logge, Haber), School of Health Sciences (Baillie), and Matilda Centre for Mental Health and Substance Use (Teesson), Faculty of Medicine and Health, University of Sydney, Sydney, Australia; Edith Collins Centre for Translational Research in Alcohol, Drugs, and Toxicology (Morley, Jamshidi, Logge, Haber) and Department of Medical Genomics (Luquin, Trent), Royal Prince Alfred Hospital, Camperdown, Australia; Center for Studies of Addiction, Perelman School of Medicine, University of Pennsylvania, and Mental Illness Research, Education, and Clinical Center, Crescenz VA Medical Center, Philadelphia (Kranzler); Northern Sydney Local Health District Drug and Alcohol Services, St Leonards, Australia (Montebello); St Vincent's Hospital Sydney, Sydney, Australia (Tremonti)
| | - Chris Tremonti
- Specialty of Addiction Medicine, Sydney Medical School (Morley, Adams, Montebello, Tremonti, Dali, Logge, Haber), School of Health Sciences (Baillie), and Matilda Centre for Mental Health and Substance Use (Teesson), Faculty of Medicine and Health, University of Sydney, Sydney, Australia; Edith Collins Centre for Translational Research in Alcohol, Drugs, and Toxicology (Morley, Jamshidi, Logge, Haber) and Department of Medical Genomics (Luquin, Trent), Royal Prince Alfred Hospital, Camperdown, Australia; Center for Studies of Addiction, Perelman School of Medicine, University of Pennsylvania, and Mental Illness Research, Education, and Clinical Center, Crescenz VA Medical Center, Philadelphia (Kranzler); Northern Sydney Local Health District Drug and Alcohol Services, St Leonards, Australia (Montebello); St Vincent's Hospital Sydney, Sydney, Australia (Tremonti)
| | - Gezelle Dali
- Specialty of Addiction Medicine, Sydney Medical School (Morley, Adams, Montebello, Tremonti, Dali, Logge, Haber), School of Health Sciences (Baillie), and Matilda Centre for Mental Health and Substance Use (Teesson), Faculty of Medicine and Health, University of Sydney, Sydney, Australia; Edith Collins Centre for Translational Research in Alcohol, Drugs, and Toxicology (Morley, Jamshidi, Logge, Haber) and Department of Medical Genomics (Luquin, Trent), Royal Prince Alfred Hospital, Camperdown, Australia; Center for Studies of Addiction, Perelman School of Medicine, University of Pennsylvania, and Mental Illness Research, Education, and Clinical Center, Crescenz VA Medical Center, Philadelphia (Kranzler); Northern Sydney Local Health District Drug and Alcohol Services, St Leonards, Australia (Montebello); St Vincent's Hospital Sydney, Sydney, Australia (Tremonti)
| | - Warren Logge
- Specialty of Addiction Medicine, Sydney Medical School (Morley, Adams, Montebello, Tremonti, Dali, Logge, Haber), School of Health Sciences (Baillie), and Matilda Centre for Mental Health and Substance Use (Teesson), Faculty of Medicine and Health, University of Sydney, Sydney, Australia; Edith Collins Centre for Translational Research in Alcohol, Drugs, and Toxicology (Morley, Jamshidi, Logge, Haber) and Department of Medical Genomics (Luquin, Trent), Royal Prince Alfred Hospital, Camperdown, Australia; Center for Studies of Addiction, Perelman School of Medicine, University of Pennsylvania, and Mental Illness Research, Education, and Clinical Center, Crescenz VA Medical Center, Philadelphia (Kranzler); Northern Sydney Local Health District Drug and Alcohol Services, St Leonards, Australia (Montebello); St Vincent's Hospital Sydney, Sydney, Australia (Tremonti)
| | - Andrew Baillie
- Specialty of Addiction Medicine, Sydney Medical School (Morley, Adams, Montebello, Tremonti, Dali, Logge, Haber), School of Health Sciences (Baillie), and Matilda Centre for Mental Health and Substance Use (Teesson), Faculty of Medicine and Health, University of Sydney, Sydney, Australia; Edith Collins Centre for Translational Research in Alcohol, Drugs, and Toxicology (Morley, Jamshidi, Logge, Haber) and Department of Medical Genomics (Luquin, Trent), Royal Prince Alfred Hospital, Camperdown, Australia; Center for Studies of Addiction, Perelman School of Medicine, University of Pennsylvania, and Mental Illness Research, Education, and Clinical Center, Crescenz VA Medical Center, Philadelphia (Kranzler); Northern Sydney Local Health District Drug and Alcohol Services, St Leonards, Australia (Montebello); St Vincent's Hospital Sydney, Sydney, Australia (Tremonti)
| | - Maree Teesson
- Specialty of Addiction Medicine, Sydney Medical School (Morley, Adams, Montebello, Tremonti, Dali, Logge, Haber), School of Health Sciences (Baillie), and Matilda Centre for Mental Health and Substance Use (Teesson), Faculty of Medicine and Health, University of Sydney, Sydney, Australia; Edith Collins Centre for Translational Research in Alcohol, Drugs, and Toxicology (Morley, Jamshidi, Logge, Haber) and Department of Medical Genomics (Luquin, Trent), Royal Prince Alfred Hospital, Camperdown, Australia; Center for Studies of Addiction, Perelman School of Medicine, University of Pennsylvania, and Mental Illness Research, Education, and Clinical Center, Crescenz VA Medical Center, Philadelphia (Kranzler); Northern Sydney Local Health District Drug and Alcohol Services, St Leonards, Australia (Montebello); St Vincent's Hospital Sydney, Sydney, Australia (Tremonti)
| | - Ronald Trent
- Specialty of Addiction Medicine, Sydney Medical School (Morley, Adams, Montebello, Tremonti, Dali, Logge, Haber), School of Health Sciences (Baillie), and Matilda Centre for Mental Health and Substance Use (Teesson), Faculty of Medicine and Health, University of Sydney, Sydney, Australia; Edith Collins Centre for Translational Research in Alcohol, Drugs, and Toxicology (Morley, Jamshidi, Logge, Haber) and Department of Medical Genomics (Luquin, Trent), Royal Prince Alfred Hospital, Camperdown, Australia; Center for Studies of Addiction, Perelman School of Medicine, University of Pennsylvania, and Mental Illness Research, Education, and Clinical Center, Crescenz VA Medical Center, Philadelphia (Kranzler); Northern Sydney Local Health District Drug and Alcohol Services, St Leonards, Australia (Montebello); St Vincent's Hospital Sydney, Sydney, Australia (Tremonti)
| | - Paul S Haber
- Specialty of Addiction Medicine, Sydney Medical School (Morley, Adams, Montebello, Tremonti, Dali, Logge, Haber), School of Health Sciences (Baillie), and Matilda Centre for Mental Health and Substance Use (Teesson), Faculty of Medicine and Health, University of Sydney, Sydney, Australia; Edith Collins Centre for Translational Research in Alcohol, Drugs, and Toxicology (Morley, Jamshidi, Logge, Haber) and Department of Medical Genomics (Luquin, Trent), Royal Prince Alfred Hospital, Camperdown, Australia; Center for Studies of Addiction, Perelman School of Medicine, University of Pennsylvania, and Mental Illness Research, Education, and Clinical Center, Crescenz VA Medical Center, Philadelphia (Kranzler); Northern Sydney Local Health District Drug and Alcohol Services, St Leonards, Australia (Montebello); St Vincent's Hospital Sydney, Sydney, Australia (Tremonti)
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Kamp-Jensen C, Donslund LN, Styrishave B, Jensen RH, Westgate CSJ. Exposure to topiramate and acetazolamide causes endocrine disrupting effects in female rats during estrus. Toxicol Appl Pharmacol 2024; 486:116919. [PMID: 38580201 DOI: 10.1016/j.taap.2024.116919] [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: 01/09/2024] [Revised: 03/20/2024] [Accepted: 03/31/2024] [Indexed: 04/07/2024]
Abstract
BACKGROUND Idiopathic intracranial hypertension (IIH) is a disease characterized by elevated intracranial pressure (ICP) and is a disease of young females. The first line pharmacological treatments include acetazolamide and topiramate and given the nature of IIH patients and the dosing regimen of these drugs, their effect on the endocrine system is important to evaluate. We aimed to assess the effects of acetazolamide and topiramate on steroid profiles in relevant endocrine tissues. METHODS Female Sprague Dawley rats received chronic clinically equivalent doses of acetazolamide or topiramate by oral gavage and were sacrificed in estrus. Tissue specific steroid profiles of lateral ventricle CP, 4th ventricle CP, CSF, serum, uterine horn and fundus, ovaries, adrenal glands and pituitary glands were assessed by quantitative targeted LC-MS/MS. We determined luteinizing hormone (LH) and follicle stimulating hormones (FSH) levels in paired serum by ELISA. RESULTS Topiramate increased the concentration of estradiol and decreased the concentration of DHEA in lateral choroid plexus. Moreover, it decreased the concentration of androstenediol in the pituitary gland. Topiramate increased serum LH. Acetazolamide decreased progesterone levels in serum and uterine fundus and increased corticosteroid levels in the adrenal glands. CONCLUSION These results demonstrate that both acetazolamide and topiramate have endocrine disrupting effects in rats. Topiramate primarily targeted the choroid plexus and the pituitary gland while acetazolamide had broader systemic effects. Furthermore, topiramate predominantly targeted sex hormones, whereas acetazolamide widely affected all classes of hormones. A similar effect in humans has not yet been documented but these concerning findings warrants further investigations.
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Affiliation(s)
- Christina Kamp-Jensen
- Danish Headache Center, Department of Neurology, Glostrup Research Institute, Rigshospitalet-Glostrup, University of Copenhagen, Denmark; Translational Research Centre, Rigshospitalet, Denmark.
| | - Louise Norgil Donslund
- Danish Headache Center, Department of Neurology, Glostrup Research Institute, Rigshospitalet-Glostrup, University of Copenhagen, Denmark; Translational Research Centre, Rigshospitalet, Denmark
| | - Bjarne Styrishave
- Department of Pharmacy, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark..
| | - Rigmor Højland Jensen
- Danish Headache Center, Department of Neurology, Glostrup Research Institute, Rigshospitalet-Glostrup, University of Copenhagen, Denmark; Translational Research Centre, Rigshospitalet, Denmark.
| | - Connar Stanley James Westgate
- Danish Headache Center, Department of Neurology, Glostrup Research Institute, Rigshospitalet-Glostrup, University of Copenhagen, Denmark; Translational Research Centre, Rigshospitalet, Denmark.
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Wei S, Li X, Zhang Q, Wu H, Wu Y, Zhao Z, Mei S, Feng W. Population pharmacokinetics of topiramate in Chinese children with epilepsy. Eur J Clin Pharmacol 2023; 79:1401-1415. [PMID: 37597080 DOI: 10.1007/s00228-023-03549-6] [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: 05/30/2023] [Accepted: 08/05/2023] [Indexed: 08/21/2023]
Abstract
OBJECTIVE Topiramate, a broad-spectrum antiepileptic drug, exhibits substantial inter-individual variability in both its pharmacokinetics and therapeutic response. The aim of this study was to investigate the influence of patient characteristics and genetic variants on topiramate clearance using population pharmacokinetic (PPK) models in a cohort of Chinese pediatric patients with epilepsy. METHOD The PPK model was constructed using a nonlinear mixed-effects modeling approach, utilizing a dataset comprising 236 plasma concentrations of topiramate obtained from 181 pediatric patients with epilepsy. A one-compartment model combined with a proportional residual model was employed to characterize the pharmacokinetics of topiramate. Covariate analysis was performed using forward addition and backward elimination to assess the influence of covariates on the model parameters. The model was thoroughly evaluated through goodness-of-fit analysis, bootstrap, visual predictive checks, and normalized prediction distribution errors. Monte Carlo simulations were utilized to devise topiramate dosing strategies. RESULT In the final PPK models of topiramate, body weight, co-administration with oxcarbazepine, and a combined genotype of GKIR1-UGT (GRIK1 rs2832407, UGT2B7 rs7439366, and UGT1A1 rs4148324) were identified as significant covariates affecting the clearance (CL). The clearance was estimated using the formulas CL (L/h) = 0.44 × (BW⁄11.7)0.82 × eOXC for the model without genetic variants and CL (L/h) = 0.49 × (BW⁄11.7)0.81 × eOXC × eGRIK1-UGT for the model incorporating genetic variants. The volume of distribution (Vd) was estimated using the formulas Vd (L) = 6.6 × (BW⁄11.7). The precision of all estimated parameters was acceptable. Furthermore, the model demonstrated good predictability, exhibiting stability and effectiveness in describing the pharmacokinetics of topiramate. CONCLUSION The clearance of topiramate in pediatric patients with epilepsy may be subject to the influence of factors such as body weight, co-administration with oxcarbazepine, and genetic polymorphism. In this study, PPK models were developed to better understand and account for these factors, thereby improving the precision and individualization of topiramate therapy in children with epilepsy.
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Affiliation(s)
- Shifeng Wei
- Department of Pharmacy, Beijing Tiantan Hospital, Capital Medical University, 119 Nansihuan West Road, Fengtai District, Beijing, 100070, People's Republic of China
- Department of Clinical Pharmacology, College of Pharmaceutical Sciences, Capital Medical University, Beijing, 100069, People's Republic of China
| | - Xingmeng Li
- Department of Neurology, Beijing Children's Hospital, Capital Medical University, 56 Nanlishi Road, Xicheng District, Beijing, 100045, People's Republic of China
| | - Qiang Zhang
- Department of Pharmacy, Beijing Tiantan Hospital, Capital Medical University, 119 Nansihuan West Road, Fengtai District, Beijing, 100070, People's Republic of China
- Department of Clinical Pharmacology, College of Pharmaceutical Sciences, Capital Medical University, Beijing, 100069, People's Republic of China
| | - Han Wu
- Department of Pharmacy, Beijing Tiantan Hospital, Capital Medical University, 119 Nansihuan West Road, Fengtai District, Beijing, 100070, People's Republic of China
- Department of Clinical Pharmacology, College of Pharmaceutical Sciences, Capital Medical University, Beijing, 100069, People's Republic of China
| | - Yun Wu
- Department of Neurology, Beijing Children's Hospital, Capital Medical University, 56 Nanlishi Road, Xicheng District, Beijing, 100045, People's Republic of China
| | - Zhigang Zhao
- Department of Pharmacy, Beijing Tiantan Hospital, Capital Medical University, 119 Nansihuan West Road, Fengtai District, Beijing, 100070, People's Republic of China.
- Department of Clinical Pharmacology, College of Pharmaceutical Sciences, Capital Medical University, Beijing, 100069, People's Republic of China.
| | - Shenghui Mei
- Department of Pharmacy, Beijing Tiantan Hospital, Capital Medical University, 119 Nansihuan West Road, Fengtai District, Beijing, 100070, People's Republic of China.
- Department of Clinical Pharmacology, College of Pharmaceutical Sciences, Capital Medical University, Beijing, 100069, People's Republic of China.
| | - Weixing Feng
- Department of Neurology, Beijing Children's Hospital, Capital Medical University, 56 Nanlishi Road, Xicheng District, Beijing, 100045, People's Republic of China.
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Ben Chabchoubi I, Lam SS, Pane SE, Ksibi M, Guerriero G, Hentati O. Hazard and health risk assessment of exposure to pharmaceutical active compounds via toxicological evaluation by zebrafish. ENVIRONMENTAL POLLUTION (BARKING, ESSEX : 1987) 2023; 324:120698. [PMID: 36435277 DOI: 10.1016/j.envpol.2022.120698] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Revised: 11/15/2022] [Accepted: 11/17/2022] [Indexed: 06/16/2023]
Abstract
The uncontrolled or continuous release of effluents from wastewater treatment plants leads to the omnipresence of pharmaceutical active compounds (PhACs) in the aquatic media. Today, this is a confirmed problem becoming a main subject of twin public and scientific concerns. However, still little information is available about the long-term impacts of these PhACs on aquatic organisms. In this review, efforts were made to reveal correlation between the occurrence in the environment, ecotoxicological and health risks of different PhACs via toxicological evaluation by zebrafish (Danio rerio). This animal model served as a bioindicator for any health impacts after the exposure to these contaminants and to better understand the responses in relation to human diseases. This review paper focused on the calculation of Risk Quotients (RQs) of 34 PhACs based on environmental and ecotoxicological data available in the literature and prediction from the ECOSAR V2.2 software. To the best of the authors' knowledge, this is the first report on the risk assessment of PhACs by the two different methods as mentioned above. RQs showed greater difference in potential environmental risks of the PhACs. These differences in risk values underline the importance of environmental and experimental factors in exposure conditions and the interpretation of RQ values. While the results showed high risk to Danio rerio of the majority of PhACs, risk qualification of the others varied between moderate to insignifiant. Further research is needed to assess pharmaceutical hazards when present in wastewater before discharge and monitor the effectiveness of treatment processes. The recent new advances in the morphological assessment of toxicant-exposed zebrafish larvae for the determination of test compounds effects on the developmental endpoints were also discussed. This review emphasizes the need for strict regulations on the release of PhACs into environmental media in order to minimize their toxicity to aquatic organisms.
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Affiliation(s)
- Imen Ben Chabchoubi
- Institut Supérieur de Biotechnologie de Monastir, Université de Monastir, Rue Taher Haddad, 5000, Monastir, Tunisia; Laboratoire Génie de l'Environnement et Ecotechnologie (GEET), Université de Sfax, Ecole Nationale d'Ingénieurs de Sfax (ENIS), Route de Soukra, Km 3.5, B.P. 1173, 3038, Sfax, Tunisia
| | - Su Shiung Lam
- Higher Institution Center of Excellence (HICoE), Institute of Tropical Aquaculture and Fisheries (AKUATROP), University Malaysia Terengganu, Kuala Nerus, 21030, Terengganu, Malaysia; Sustainability Cluster, School of Engineering, University of Petroleum & Energy Studies, Dehradun, Uttarakhand, 248007, India
| | - Stacey Ellen Pane
- Department of Biology, Federico II University of Naples, Via Cinthia 26, 80126, Napoli, Italy
| | - Mohamed Ksibi
- Laboratoire Génie de l'Environnement et Ecotechnologie (GEET), Université de Sfax, Ecole Nationale d'Ingénieurs de Sfax (ENIS), Route de Soukra, Km 3.5, B.P. 1173, 3038, Sfax, Tunisia
| | - Giulia Guerriero
- Department of Biology, Federico II University of Naples, Via Cinthia 26, 80126, Napoli, Italy
| | - Olfa Hentati
- Laboratoire Génie de l'Environnement et Ecotechnologie (GEET), Université de Sfax, Ecole Nationale d'Ingénieurs de Sfax (ENIS), Route de Soukra, Km 3.5, B.P. 1173, 3038, Sfax, Tunisia; Institut Supérieur de Biotechnologie de Sfax, Université de Sfax, Route de Soukra, Km 4.5, B.P 1175, 3038, Sfax, Tunisia.
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Nucera B, Brigo F, Trinka E, Kalss G. Treatment and care of women with epilepsy before, during, and after pregnancy: a practical guide. Ther Adv Neurol Disord 2022; 15:17562864221101687. [PMID: 35706844 PMCID: PMC9189531 DOI: 10.1177/17562864221101687] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Accepted: 05/03/2022] [Indexed: 01/16/2023] Open
Abstract
Women with epilepsy (WWE) wishing for a child represent a highly relevant subgroup of epilepsy patients. The treating epileptologist needs to delineate the epilepsy syndrome and choose the appropriate anti-seizure medication (ASM) considering the main goal of seizure freedom, teratogenic risks, changes in drug metabolism during pregnancy and postpartum, demanding for up-titration during and down-titration after pregnancy. Folic acid or vitamin K supplements and breastfeeding are also discussed in this review. Lamotrigine and levetiracetam have the lowest teratogenic potential. Data on teratogenic risks are also favorable for oxcarbazepine, whereas topiramate tends to have an unfavorable profile. Valproate needs special emphasis. It is most effective in generalized seizures but should be avoided whenever possible due to its teratogenic effects and the negative impact on neuropsychological development of in utero-exposed children. Valproate still has its justification in patients not achieving seizure freedom with other ASMs or if a woman decides to or cannot become pregnant for any reason. When valproate is the most appropriate treatment option, the patient and caregiver must be fully informed of the risks associated with its use during pregnancies. Folate supplementation is recommended to reduce the risk of major congenital malformations. However, there is insufficient information to address the optimal dose and it is unclear whether higher doses offer greater protection. There is currently no general recommendation for a peripartum vitamin K prophylaxis. During pregnancy most ASMs (e.g. lamotrigine, oxcarbazepine, and levetiracetam) need to be increased to compensate for the decline in serum levels; exceptions are valproate and carbamazepine. Postpartum, baseline levels are reached relatively fast, and down-titration is performed empirically. Many ASMs in monotherapy are (moderately) safe for breastfeeding and women should be encouraged to do so. This review provides a practically oriented overview of the complex management of WWE before, during, and after pregnancy.
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Affiliation(s)
- Bruna Nucera
- Department of Neurology, Hospital of Merano (SABES-ASDAA), Merano-Meran, Italy
| | - Francesco Brigo
- Department of Neurology, Hospital of Merano (SABES-ASDAA), Merano-Meran, Italy
| | - Eugen Trinka
- Department of Neurology, Christian Doppler University Hospital, Paracelsus Medical University and Centre for Cognitive Neuroscience, Member of the ERN EpiCARE, Salzburg, Austria
| | - Gudrun Kalss
- Department of Neurology, Christian Doppler University Hospital, Paracelsus Medical University and Centre for Cognitive Neuroscience, Member of the ERN EpiCARE, Ignaz-Harrer-Str. 79, 5020 Salzburg, Austria
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Heal DJ, Smith SL. Prospects for new drugs to treat binge-eating disorder: Insights from psychopathology and neuropharmacology. J Psychopharmacol 2022; 36:680-703. [PMID: 34318734 PMCID: PMC9150143 DOI: 10.1177/02698811211032475] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND Binge-eating disorder (BED) is a common psychiatric condition with adverse psychological and metabolic consequences. Lisdexamfetamine (LDX) is the only approved BED drug treatment. New drugs to treat BED are urgently needed. METHODS A comprehensive review of published psychopathological, pharmacological and clinical findings. RESULTS The evidence supports the hypothesis that BED is an impulse control disorder with similarities to ADHD, including responsiveness to catecholaminergic drugs, for example LDX and dasotraline. The target product profile (TPP) of the ideal BED drug combines treating the psychopathological drivers of the disorder with an independent weight-loss effect. Drugs with proven efficacy in BED have a common pharmacology; they potentiate central noradrenergic and dopaminergic neurotransmission. Because of the overlap between pharmacotherapy in attention deficit hyperactivity disorder (ADHD) and BED, drug-candidates from diverse pharmacological classes, which have already failed in ADHD would also be predicted to fail if tested in BED. The failure in BED trials of drugs with diverse pharmacological mechanisms indicates many possible avenues for drug discovery can probably be discounted. CONCLUSIONS (1) The efficacy of drugs for BED is dependent on reducing its core psychopathologies of impulsivity, compulsivity and perseveration and by increasing cognitive control of eating. (2) The analysis revealed a large number of pharmacological mechanisms are unlikely to be productive in the search for effective new BED drugs. (3) The most promising areas for new treatments for BED are drugs, which augment noradrenergic and dopaminergic neurotransmission and/or those which are effective in ADHD.
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Affiliation(s)
- David J Heal
- David J Heal, DevelRx Ltd, BioCity, Nottingham, NG1 1GF, UK.
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Alcohol Use Disorder: Neurobiology and Therapeutics. Biomedicines 2022; 10:biomedicines10051192. [PMID: 35625928 PMCID: PMC9139063 DOI: 10.3390/biomedicines10051192] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 05/18/2022] [Accepted: 05/20/2022] [Indexed: 02/04/2023] Open
Abstract
Alcohol use disorder (AUD) encompasses the dysregulation of multiple brain circuits involved in executive function leading to excessive consumption of alcohol, despite negative health and social consequences and feelings of withdrawal when access to alcohol is prevented. Ethanol exerts its toxicity through changes to multiple neurotransmitter systems, including serotonin, dopamine, gamma-aminobutyric acid, glutamate, acetylcholine, and opioid systems. These neurotransmitter imbalances result in dysregulation of brain circuits responsible for reward, motivation, decision making, affect, and the stress response. Despite serious health and psychosocial consequences, this disorder still remains one of the leading causes of death globally. Treatment options include both psychological and pharmacological interventions, which are aimed at reducing alcohol consumption and/or promoting abstinence while also addressing dysfunctional behaviours and impaired functioning. However, stigma and social barriers to accessing care continue to impact many individuals. AUD treatment should focus not only on restoring the physiological and neurological impairment directly caused by alcohol toxicity but also on addressing psychosocial factors associated with AUD that often prevent access to treatment. This review summarizes the impact of alcohol toxicity on brain neurocircuitry in the context of AUD and discusses pharmacological and non-pharmacological therapies currently available to treat this addiction disorder.
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Heal DJ, Gosden J. What pharmacological interventions are effective in binge-eating disorder? Insights from a critical evaluation of the evidence from clinical trials. Int J Obes (Lond) 2022; 46:677-695. [PMID: 34992243 DOI: 10.1038/s41366-021-01032-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 11/01/2021] [Accepted: 11/18/2021] [Indexed: 11/09/2022]
Abstract
Binge-eating disorder (BED) is the commonest eating disorder and an important causal factor in obesity. Lisdexamfetamine is the only approved pharmacological treatment. Many drugs have been clinically evaluated and several were described as potentially promising treatments. A comprehensive reassessment of the evidence from these clinical trials has been performed. The questions to be answered were: (1) Does the evidence support claims of efficacy? (2) What pharmacological mechanisms show promise for developing new BED drugs? (3) What are the clinical implications for treating BED? PubMed and internal database searches identified every available published drug trial in BED. The trials and their results were summarised and reviewed to re-evaluate the evidence. Factors taken into consideration included psychiatric diagnosis, primary endpoint, secondary outcome measures, trial size, blinding and controls, drop-out rates, placebo response rates and weight-loss. Drugs were classified according to their pharmacology and therapeutic indication to determine which mechanisms were effective and to provide insights into the psychopathology of BED. For most drugs, robust evidence of efficacy in BED is insubstantial or absent. Some catecholaminergic drugs developed for ADHD are also effective in BED; other pharmacological mechanisms are weakly efficacious at best. Reducing BED severity has little impact on weight. Conversely, weight-loss from anti-obesity therapy is ineffective in ameliorating the psychopathological drivers of BED. (1) BED is a psychiatric not a metabolic disorder. (2) Weight-loss drugs are generally ineffective in BED. (3) Efficacy in BED is restricted to powerful catecholaminergic drugs. (4) Drugs acting via noradrenaline, 5-HT, GABA, carbonic anhydrase inhibition, opioid receptors and various ion channels are generally minimally effective at best. (5) Efficacy in BED is dependent on treating its core psychopathology; reducing impulsivity and compulsivity and increasing cognitive restraint over eating. (6) Obese subjects with BED may benefit from separate treatments for these two disorders.
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Affiliation(s)
- David J Heal
- DevelRx Ltd, BioCity, Nottingham, NG1 1GF, UK. .,Department of Pharmacy & Pharmacology, University of Bath, Bath, BA2 7AY, UK.
| | - Jane Gosden
- DevelRx Ltd, BioCity, Nottingham, NG1 1GF, UK
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Lotfy N, Elsawah H, Hassan M. Topiramate for smoking cessation: Systematic review and meta-analysis. Tob Prev Cessat 2020; 6:14. [PMID: 32548351 PMCID: PMC7291892 DOI: 10.18332/tpc/115167] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2019] [Revised: 12/04/2019] [Accepted: 12/09/2019] [Indexed: 01/01/2023]
Abstract
INTRODUCTION Topiramate is an antiepileptic drug that has been used for many labeled and off-labeled indications. It may be useful in reducing withdrawal symptoms of various addictive agents such as alcohol, cocaine, cannabis and smoking. To date, some studies have examined the effectiveness of topiramate for smoking cessation. The present review aims to synthesize the results from those studies and determine topiramate effectiveness in smoking cessation. METHODS A comprehensive search was conducted in the databases: PubMed/Medline, Cochrane, Egyptian Knowledge Bank, and Google Scholar. All clinical trials that examined the effect of topiramate, compared with the placebo, on smoking cessation rate were included. Statistical analysis using fixed effect models, heterogeneity and sensitivity analysis were conducted using RevMan 5.3. RESULTS Five trials met the inclusion criteria and were included in the meta-analysis. Topiramate non-significantly increased prolonged smoking abstinence rate (OR=1.19, 95% CI: 0.57–2.5) compared with the placebo. On the other hand, topiramate significantly increased the abstinence rate at weeks 4, 6, 8 and 12 (OR=3.07, 95% CI: 1.19–7.93; OR=4.03, 95% CI: 1.98–8.2; OR=2.29, 95% CI: 1.23–4.28; and OR=2.45, 95% CI: 1.37–4.39; respectively) compared with the placebo. CONCLUSIONS Based on the five trials, where publication bias cannot be excluded, the current evidence is not sufficient to show a significant difference to favor topiramate in prolonged smoking cessation over the placebo, although the 12th week point prevalence favored topiramate.
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Affiliation(s)
- Nesma Lotfy
- High Institute of Public Health, Alexandria University, Alexandria, Egypt
| | - Hozaifa Elsawah
- High Institute of Public Health, Alexandria University, Alexandria, Egypt
| | - Mona Hassan
- High Institute of Public Health, Alexandria University, Alexandria, Egypt
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10
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Nasir M, Trujillo D, Levine J, Dwyer JB, Rupp ZW, Bloch MH. Glutamate Systems in DSM-5 Anxiety Disorders: Their Role and a Review of Glutamate and GABA Psychopharmacology. Front Psychiatry 2020; 11:548505. [PMID: 33329087 PMCID: PMC7710541 DOI: 10.3389/fpsyt.2020.548505] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 10/12/2020] [Indexed: 12/14/2022] Open
Abstract
Serotonin reuptake inhibitors and benzodiazepines are evidence-based pharmacological treatments for Anxiety Disorders targeting serotonin and GABAergic systems, respectively. Although clearly effective, these medications fail to improve anxiety symptoms in a significant proportion of patients. New insights into the glutamate system have directed attention toward drugs that modulate glutamate as potential alternative treatments for anxiety disorders. Here we summarize the current understanding of the potential role of glutamate neurotransmission in anxiety disorders and highlight specific glutamate receptors that are potential targets for novel anxiety disorder treatments. We also review clinical trials of medications targeting the glutamate system in DSM-5 anxiety disorders. Understanding the role of the glutamate system in the pathophysiology of anxiety disorder may aid in developing novel pharmacological agents that are effective in treating anxiety disorders.
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Affiliation(s)
- Madeeha Nasir
- Yale Child Study Center, Yale University School of Medicine, New Haven, CT, United States
| | - Daniel Trujillo
- Yale Child Study Center, Yale University School of Medicine, New Haven, CT, United States
| | - Jessica Levine
- Yale Child Study Center, Yale University School of Medicine, New Haven, CT, United States
| | - Jennifer B Dwyer
- Yale Child Study Center, Yale University School of Medicine, New Haven, CT, United States.,Yale Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, CT, United States
| | - Zachary W Rupp
- Yale Child Study Center, Yale University School of Medicine, New Haven, CT, United States.,Frank H. Netter School of Medicine, Quinnipiac University, North Haven, CT, United States
| | - Michael H Bloch
- Yale Child Study Center, Yale University School of Medicine, New Haven, CT, United States.,Yale Department of Psychiatry, Yale University School of Medicine, New Haven, CT, United States
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11
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Abstract
Focal-onset seizures are among the most common forms of seizures in children and adolescents and can be caused by a wide diversity of acquired or genetic etiologies. Despite the increasing array of antiseizure drugs available, treatment of focal-onset seizures in this population remains problematic, with as many as one-third of children having seizures refractory to medications. This review discusses contemporary concepts in focal seizure classification and pathophysiology and describes the antiseizure medications most commonly chosen for this age group. As antiseizure drug efficacy is comparable in children and adults, here we focus on pharmacokinetic aspects, drug-drug interactions, and side effect profiles. Finally, we provide some suggestions for choosing the optimal medication for the appropriate patient.
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Affiliation(s)
- Clare E Stevens
- Division of Pediatric Neurology, Department of Neurology, Johns Hopkins Hospital, The Johns Hopkins University School of Medicine, Rubenstein Bldg 2157, 200N. Wolfe Street, Baltimore, MD, 21287, USA
| | - Carl E Stafstrom
- Division of Pediatric Neurology, Department of Neurology, Johns Hopkins Hospital, The Johns Hopkins University School of Medicine, Rubenstein Bldg 2157, 200N. Wolfe Street, Baltimore, MD, 21287, USA.
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12
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Topiramate Blood Levels During Polytherapy for Epilepsy in Children. Am J Ther 2019; 26:e18-e24. [PMID: 27875371 DOI: 10.1097/mjt.0000000000000529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The therapeutic range of topiramate (TPM) blood level is not set because the efficacy and safety are not considered to be related to the level. However, the therapeutic target without side effects is necessary, so the optimal range of TPM blood level was analyzed in this study. STUDY QUESTION This study was conducted to evaluate the efficacy of TPM over 2 years and the utility of measuring blood levels of TPM during the follow-up of epileptic patients. STUDY DESIGN Thirty patients (18 males, 12 females; age range, 6 months-15 years) were treated with TPM for epilepsy. The initial dosage of TPM was 1-3 mg·kg·d. If the effect proved insufficient after 2 weeks, the dosage was increased to 4-9 mg·kg·d. MEASURES AND OUTCOMES Blood levels of TPM were measured by liquid chromatography-tandem mass spectrometry at 1, 6, 12, and 24 months after levels reached steady state. The efficacy of TPM was evaluated by the reduction in epileptic seizure rate (RR) at the time of blood sampling. Statistical analysis was performed using the Mann-Whitney U test. RESULTS A positive correlation was seen between blood levels and maintenance dosages, but no correlation was observed between blood levels and RR. Any significant difference was not identified in TPM levels between the effective group (RR ≥50%) and the ineffective group (RR <50%; P = 0.159). In the subgroup of patients who did not use valproic acid, a significant difference in TPM levels was apparent between the effective and ineffective groups (P = 0.029). The optimal range of TPM was advocated 3.5-5.0 μg/mL. The optimal range was set, so that ranges did not overlap between the effective and ineffective groups. No patients experienced any side effects. CONCLUSIONS Measuring blood levels of TPM based on the classification of concomitant drugs and adjusting the dosage to reach the optimal range were recommended.
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Amodeo G, Cuomo A, Bolognesi S, Goracci A, Trusso MA, Piccinni A, Neal SM, Baldini I, Federico E, Taddeucci C, Fagiolini A. Pharmacotherapeutic strategies for treating binge eating disorder. Evidence from clinical trials and implications for clinical practice. Expert Opin Pharmacother 2019; 20:679-690. [DOI: 10.1080/14656566.2019.1571041] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Giovanni Amodeo
- Department of Molecular and Developmental Medicine, University of Siena, Siena, Italy
| | - Alessandro Cuomo
- Department of Molecular and Developmental Medicine, University of Siena, Siena, Italy
| | - Simone Bolognesi
- Department of Molecular and Developmental Medicine, University of Siena, Siena, Italy
| | - Arianna Goracci
- Department of Molecular and Developmental Medicine, University of Siena, Siena, Italy
| | - Maria A Trusso
- Department of Molecular and Developmental Medicine, University of Siena, Siena, Italy
| | - Armando Piccinni
- UniCamillus - Saint Camillus International University of Health Sciences, Roma, Italy
| | - Stephen M Neal
- Department of Psychiatry, West Virginia School of Osteopathic Medicine, Lewisburg, WV, USA
| | - Irene Baldini
- Department of Molecular and Developmental Medicine, University of Siena, Siena, Italy
| | - Eugenio Federico
- Department of Molecular and Developmental Medicine, University of Siena, Siena, Italy
| | - Costanza Taddeucci
- Department of Molecular and Developmental Medicine, University of Siena, Siena, Italy
| | - Andrea Fagiolini
- Department of Molecular and Developmental Medicine, University of Siena, Siena, Italy
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Müller TD, Clemmensen C, Finan B, DiMarchi RD, Tschöp MH. Anti-Obesity Therapy: from Rainbow Pills to Polyagonists. Pharmacol Rev 2019; 70:712-746. [PMID: 30087160 DOI: 10.1124/pr.117.014803] [Citation(s) in RCA: 117] [Impact Index Per Article: 23.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
With their ever-growing prevalence, obesity and diabetes represent major health threats of our society. Based on estimations by the World Health Organization, approximately 300 million people will be obese in 2035. In 2015 alone there were more than 1.6 million fatalities attributable to hyperglycemia and diabetes. In addition, treatment of these diseases places an enormous burden on our health care system. As a result, the development of pharmacotherapies to tackle this life-threatening pandemic is of utmost importance. Since the beginning of the 19th century, a variety of drugs have been evaluated for their ability to decrease body weight and/or to improve deranged glycemic control. The list of evaluated drugs includes, among many others, sheep-derived thyroid extracts, mitochondrial uncouplers, amphetamines, serotonergics, lipase inhibitors, and a variety of hormones produced and secreted by the gastrointestinal tract or adipose tissue. Unfortunately, when used as a single hormone therapy, most of these drugs are underwhelming in their efficacy or safety, and placebo-subtracted weight loss attributed to such therapy is typically not more than 10%. In 2009, the generation of a single molecule with agonism at the receptors for glucagon and the glucagon-like peptide 1 broke new ground in obesity pharmacology. This molecule combined the beneficial anorectic and glycemic effects of glucagon-like peptide 1 with the thermogenic effect of glucagon into a single molecule with enhanced potency and sustained action. Several other unimolecular dual agonists have subsequently been developed, and, based on their preclinical success, these molecules illuminate the path to a new and more fruitful era in obesity pharmacology. In this review, we focus on the historical pharmacological approaches to treat obesity and glucose intolerance and describe how the knowledge obtained by these studies led to the discovery of unimolecular polypharmacology.
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Affiliation(s)
- T D Müller
- Institute for Diabetes and Obesity, Helmholtz Diabetes Center, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany (T.D.M., C.C., M.H.T.); German Center for Diabetes Research, Neuherberg, Germany (T.D.M., C.C., M.H.T.); Department of Chemistry, Indiana University, Bloomington, Indiana (B.F., R.D.D.); and Division of Metabolic Diseases, Technische Universität München, Munich, Germany (M.H.T.)
| | - C Clemmensen
- Institute for Diabetes and Obesity, Helmholtz Diabetes Center, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany (T.D.M., C.C., M.H.T.); German Center for Diabetes Research, Neuherberg, Germany (T.D.M., C.C., M.H.T.); Department of Chemistry, Indiana University, Bloomington, Indiana (B.F., R.D.D.); and Division of Metabolic Diseases, Technische Universität München, Munich, Germany (M.H.T.)
| | - B Finan
- Institute for Diabetes and Obesity, Helmholtz Diabetes Center, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany (T.D.M., C.C., M.H.T.); German Center for Diabetes Research, Neuherberg, Germany (T.D.M., C.C., M.H.T.); Department of Chemistry, Indiana University, Bloomington, Indiana (B.F., R.D.D.); and Division of Metabolic Diseases, Technische Universität München, Munich, Germany (M.H.T.)
| | - R D DiMarchi
- Institute for Diabetes and Obesity, Helmholtz Diabetes Center, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany (T.D.M., C.C., M.H.T.); German Center for Diabetes Research, Neuherberg, Germany (T.D.M., C.C., M.H.T.); Department of Chemistry, Indiana University, Bloomington, Indiana (B.F., R.D.D.); and Division of Metabolic Diseases, Technische Universität München, Munich, Germany (M.H.T.)
| | - M H Tschöp
- Institute for Diabetes and Obesity, Helmholtz Diabetes Center, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany (T.D.M., C.C., M.H.T.); German Center for Diabetes Research, Neuherberg, Germany (T.D.M., C.C., M.H.T.); Department of Chemistry, Indiana University, Bloomington, Indiana (B.F., R.D.D.); and Division of Metabolic Diseases, Technische Universität München, Munich, Germany (M.H.T.)
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15
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Babu Henry Samuel I, Barkley C, Marino SE, Wang C, Han SM, Birnbaum AK, Cibula JE, Ding M. Brain's compensatory response to drug-induced cognitive impairment. J Clin Exp Neuropsychol 2018; 40:1000-1012. [PMID: 29720037 PMCID: PMC6141311 DOI: 10.1080/13803395.2018.1458822] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
INTRODUCTION Topiramate (TPM), a frequently prescribed antiseizure medication, can cause severe cognitive side-effects. Though these side-effects have been studied behaviorally, the underlying neural mechanisms are unknown. In a double-blind, randomized, placebo-controlled, crossover study of TPM's impact on cognition, nine healthy volunteers completed three study sessions: a no-drug baseline session and two sessions during which they received either TPM or placebo. Electroencephalogram was recorded during each session while subjects performed a working-memory task with three memory-loads. RESULTS Comparing TPM with baseline we found the following results. (a) TPM administration led to declines in behavioral performance. (b) Fronto-central event-related potentials (ERP) elicited by probe stimuli, representing the primary task network activity, showed strong memory-load modulations at baseline, but the magnitude of these load-dependent modulations was significantly reduced during TPM session, suggesting drug-induced impairments of the primary task network. (c) ERP responses over bilateral fronto-temporal electrodes, which were not load sensitive at baseline, showed significant memory-load modulations after TPM administration, suggesting the drug-related recruitment of additional neural resources. (d) At fronto-central scalp sites, there was significant increase in response amplitude for low memory-load during TPM session compared to baseline, and the amplitude increase was dependent on TPM plasma concentration, suggesting that the primary task network became less efficient under TPM impact. (e) At bilateral fronto-temporal electrodes, there were no ERP differences when comparing low memory-load trials, but TPM administration led to an increase in ERP responses to high load, the magnitude of which was positively correlated with task performance, suggesting that the recruited neural resources were beneficial for task performance. Placebo-TPM comparison yielded similar effects albeit with generally reduced significance and effect sizes. CONCLUSION Our findings support the hypothesis that TPM impairs the primary task network by reducing its efficiency, which triggers compensatory recruitment of additional resources to maintain task performance.
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Affiliation(s)
- Immanuel Babu Henry Samuel
- a J. Crayton Pruitt Family Department of Biomedical Engineering , University of Florida , Gainesville , FL , USA
| | - Christopher Barkley
- b Center for Clinical and Cognitive Neuropharmacology , University of Minnesota , Minneapolis , MN , USA
| | - Susan E Marino
- b Center for Clinical and Cognitive Neuropharmacology , University of Minnesota , Minneapolis , MN , USA
| | - Chao Wang
- a J. Crayton Pruitt Family Department of Biomedical Engineering , University of Florida , Gainesville , FL , USA
| | - Sahng-Min Han
- a J. Crayton Pruitt Family Department of Biomedical Engineering , University of Florida , Gainesville , FL , USA
| | - Angela K Birnbaum
- b Center for Clinical and Cognitive Neuropharmacology , University of Minnesota , Minneapolis , MN , USA
| | - Jean E Cibula
- c Department of Neurology , University of Florida , Gainesville , FL , USA
| | - Mingzhou Ding
- a J. Crayton Pruitt Family Department of Biomedical Engineering , University of Florida , Gainesville , FL , USA
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Öztürk B, Övünç Özön A, Karadaş Ö. Evaluation of cognitive functions in migraineurs treated with topiramate. J Clin Neurosci 2018; 59:89-92. [PMID: 30455137 DOI: 10.1016/j.jocn.2018.10.134] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Accepted: 10/27/2018] [Indexed: 11/28/2022]
Abstract
Topiramate for the treatment of migraine prophylaxis may cause side effects such as cognitive dysfunction. We aimed to investigate the topiramate's efficacy in migraineours and effect on cognitive functions. 24 migraine patients (Group 1) and 24 healthy participants (Group 2) were included. In both groups event-related potentials P300 Latency, Amplitude and N200 Latency, Amplitude's were evaluated. Topiramate treatment was ordered to group 1. Two months after treatment, the same parameters were evaluated. Monthly number of attacks, painful days, analgesic-triptan use and VAS scores were compared before and 2 months after treatment. Evaluation between group 1 and group 2 showed no difference. Group1's before and after treatment values were compared; all parameters after treatment were statistically significantly better. Group 1's number of attacks in a month, the number of painful days in a month, VAS score, the number of analgesic use, the number of triptan use had all decreased after treatment. 100 mg topiramate was effective in the treatment of migraine. However, electrophysiological studies showed that cognitive functions are also affected adversely.
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Affiliation(s)
- Bilgin Öztürk
- Gulhane Training and Research Hospital, Neurology Department, Ankara, Turkey.
| | | | - Ömer Karadaş
- Gulhane Training and Research Hospital, Neurology Department, Ankara, Turkey
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Stoklosa TM, Morley KC, Volovets A, Haber PS. Pharmacotherapy for Alcohol Use Disorder in the Context of Liver Disease. CURRENT ADDICTION REPORTS 2018. [DOI: 10.1007/s40429-018-0211-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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18
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Boyer MG, Kheloufi F, Denis J, Micallef J, Milh M. Urinary retention associated with aripiprazole: Report of a new case and review of the literature. Therapie 2018; 73:287-289. [DOI: 10.1016/j.therap.2017.09.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Revised: 06/28/2017] [Accepted: 09/21/2017] [Indexed: 10/18/2022]
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Franco V, Iudice A, Grillo E, Citraro R, De Sarro G, Russo E. Perspective on the use of perampanel and intravenous carbamazepine for generalized seizures. Expert Opin Pharmacother 2014; 15:637-44. [PMID: 24437529 DOI: 10.1517/14656566.2014.879572] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
INTRODUCTION Several antiepileptic drugs are available for the treatment of epileptic patients. However, the treatment of some seizure types and novel drug formulations deserve further advances in epilepsy research. AREAS COVERED The authors analyze the published evidence on the efficacy of perampanel against secondarily generalized seizures (SGS) and report the currently available development of intravenous (IV) formulations of carbamazepine (CBZ), commenting on their potential in the clinical setting. EXPERT OPINION Perampanel is the first noncompetitive AMPA receptor antagonist to be approved as adjunctive treatment in patients with partial-onset (focal) seizures (POS) with or without secondary generalization. Apart from its efficacy and safety on POS, a consistent body of evidence supports its efficacy in SGS at a minimum dose of 8 mg/day; however, such dose appears close to the best-tolerated dose. CBZ is a poorly water-soluble compound; many efforts to develop a parenteral formulation have not been successful so far. Novel IV CBZ formulations seem to exhibit favorable pharmacokinetics along with good tolerability in animal models and in patients taking oral CBZ. Further studies are needed to assess whether larger doses will be as well tolerated, allowing IV CBZ to be used as bridge therapy when the oral route is not feasible or in patients naïve to CBZ.
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Affiliation(s)
- Valentina Franco
- University of Pavia, Department of Internal Medicine and Therapeutics, Clinical Pharmacology Unit , Pavia , Italy
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Johannessen Landmark C, Patsalos PN. Drug interactions involving the new second- and third-generation antiepileptic drugs. Expert Rev Neurother 2014; 10:119-40. [DOI: 10.1586/ern.09.136] [Citation(s) in RCA: 247] [Impact Index Per Article: 24.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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21
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Addolorato G, Mirijello A, Leggio L, Ferrulli A, Landolfi R. Management of alcohol dependence in patients with liver disease. CNS Drugs 2013; 27:287-99. [PMID: 23456576 PMCID: PMC4979989 DOI: 10.1007/s40263-013-0043-4] [Citation(s) in RCA: 76] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Alcohol dependence represents a chronic and relapsing disease affecting nearly 10 % of the general population both in the USA and in Europe, with a widespread burden of morbidity and mortality. Alcohol dependence represents the most common cause of liver damage in the Western world. Although alcoholic liver disease is associated primarily with heavy drinking, continued alcohol consumption, even in low doses after the onset of liver disease, increases the risk of severe consequences, including mortality. Consequently, the ideal treatment of patients affected by alcohol dependence and alcoholic liver disease should aim at achieving long-term total alcohol abstinence and preventing relapse. The aim of the present review is to provide an update on the management of alcohol dependence in patients with alcoholic liver disease. Increasing evidence suggests the usefulness of psychosocial interventions and medications combined in order to reduce alcohol intake, promote abstinence and prevent relapse in alcohol-dependent patients. Disulfiram, naltrexone and acamprosate have been approved for this indication; gamma-hydroxybutyric acid (GHB) is approved in Italy and Austria. However, these drugs have not been tested in patients with advanced liver disease. Amongst other emerging pharmacotherapies for alcoholism, topiramate, ondansetron, and baclofen seem the most promising ones. Both topiramate and ondansetron have a safe profile in alcoholic patients; however, none of them has been tested in alcoholic patients with advanced liver disease. To date, baclofen represents the only anti-craving medication formally tested in a randomized clinical trial in alcoholic patients affected by liver cirrhosis, although additional confirmatory studies are warranted.
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Affiliation(s)
- Giovanni Addolorato
- Department of Internal Medicine, Institute of Internal Medicine, Catholic University of Rome, Gemelli Hospital, Largo Gemelli 8, 00168 Rome, Italy.
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Factors Influencing Serum Topiramate Concentrations in Routine Therapeutic Drug Monitoring in Korean Adult Patients With Epilepsy. Ther Drug Monit 2013; 35:177-82. [DOI: 10.1097/ftd.0b013e31827efe1d] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Tomson T, Landmark CJ, Battino D. Antiepileptic drug treatment in pregnancy: Changes in drug disposition and their clinical implications. Epilepsia 2013; 54:405-14. [DOI: 10.1111/epi.12109] [Citation(s) in RCA: 197] [Impact Index Per Article: 17.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/19/2012] [Indexed: 11/28/2022]
Affiliation(s)
- Torbjörn Tomson
- Department of Clinical Neuroscience; Karolinska Institutet; Stockholm; Sweden
| | - Cecilie Johannessen Landmark
- Department of Pharmacy and Biomedical Science; Faculty of Health Sciences; Oslo and Akershus University College of Applied Sciences; Oslo; Norway
| | - Dina Battino
- Epilepsy Center; Department of Neurophysiology; IRCCS Foundation Carlo Besta Neurological Institute; Milan; Italy
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What's the role of topiramate in the management of patients with hyperkinetic movement disorders? Pharmacol Rep 2012; 64:24-30. [PMID: 22580517 DOI: 10.1016/s1734-1140(12)70727-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2011] [Revised: 09/05/2011] [Indexed: 11/22/2022]
Abstract
Topiramate (TPM) is an O-alkyl sulfamate derivative of the naturally occurring monosaccharide D-fructose with an epileptic activity. However, it has been suggested that, in addition to its use in epilepsy, TPM could also be used in the treatment of neurological disorders, psychiatric conditions and hyperkinetic movement disorders. The clinical applications of TPM in hyperkinetic movement disorders is consistent with the multiple pharmacodynamic mechanisms e.g., the modulation of both γ-aminobutyric acidergic or glutamatergic neurotransmission and the modulation of voltage-gated ion channels or intracellular signalling pathways. The purpose of the present review is to describe the mechanisms of action of TPM and its clinical efficacy in patients with hyperkinetic movement disorders.
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Okuyaz C, Kursel O, Komur M, Tamer L. Evaluation of appetite-stimulating hormones in prepubertal children with epilepsy during topiramate treatment. Pediatr Neurol 2012; 47:423-6. [PMID: 23127262 DOI: 10.1016/j.pediatrneurol.2012.08.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2012] [Accepted: 08/01/2012] [Indexed: 10/27/2022]
Abstract
We investigated the mechanism of topiramate-related appetite loss and exposed its relationship to body weight, body mass index, body fat index, and serum insulin, lipid, leptin, neuropeptide-Y, cortisol, ghrelin, and adiponectin levels. Twenty children with epilepsy were evaluated at baseline and months 3 and 6 of treatment. Their body fat index, leptin, and neuropeptide-Y levels significantly decreased at month 3, whereas significant decreases occurred in body weight, body mass index, body fat index, neuropeptide-Y, cholesterol, and cortisol levels of patients at month 6 compared with baseline. Weight loss during topiramate treatment was attributed to loss of appetite and reduced food intake caused by reductions in neuropeptide-Y. To the best of our knowledge, this study is the first to describe reductions in neuropeptide-Y with topiramate use in humans.
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Affiliation(s)
- Cetin Okuyaz
- Division of Pediatric Neurology, Department of Pediatrics, Mersin University School of Medicine, Mersin, Turkey
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Sendt KV, Giaroli G, Tracy DK. Beyond dopamine: glutamate as a target for future antipsychotics. ISRN PHARMACOLOGY 2012; 2012:427267. [PMID: 22830044 PMCID: PMC3399404 DOI: 10.5402/2012/427267] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/29/2012] [Accepted: 06/06/2012] [Indexed: 01/25/2023]
Abstract
The dopamine hypothesis of schizophrenia remains the primary theoretical framework for the pharmacological treatment of the disorder. Despite various lines of evidence of dopaminergic abnormalities and reasonable efficacy of current antipsychotic medication, a significant proportion of patients show suboptimal treatment responses, poor tolerability, and a subsequent lack of treatment concordance. In recent decades, intriguing evidence for the critical involvement of other neurotransmitter systems in the pathophysiology of schizophrenia has emerged, most notably of dysfunctions within the glutamate pathways. Consequently, the glutamate synapse has arisen as a promising target for urgently needed novel antipsychotic compounds—particularly in regards to debilitating negative and cognitive symptoms poorly controlled by currently available drugs. In this paper, recent findings integrating glutamatergic and dopaminergic abnormalities in schizophrenia and their implications for novel pharmacological targets are discussed. An overview of compounds in various stages of development is given: drugs enhancing NMDA receptor function as well as metabotropic glutamate receptor (mGluR) agonist and positive allosteric modulators (PAMs) are emphasised. Together with other agents more indirectly affecting glutamatergic neurotransmission, their potential future role in the pharmacotherapy of schizophrenia is critically evaluated.
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Affiliation(s)
- Kyra-Verena Sendt
- Department of Psychosis Studies, Institute of Psychiatry, King's College London, London SE5 8AF, UK
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27
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Therapeutic Drug Monitoring of Classical and Newer Anticonvulsants. Ther Drug Monit 2012. [DOI: 10.1016/b978-0-12-385467-4.00012-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register]
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28
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Lee GM, Lee KS, Lee EH, Chung S. Short term outcomes of topiramate monotherapy as a first-line treatment in newly diagnosed West syndrome. KOREAN JOURNAL OF PEDIATRICS 2011; 54:380-4. [PMID: 22232631 PMCID: PMC3250604 DOI: 10.3345/kjp.2011.54.9.380] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/22/2011] [Revised: 08/04/2011] [Accepted: 08/31/2011] [Indexed: 11/27/2022]
Abstract
Purpose To investigate the efficacy of topiramate monotherapy in West syndrome prospectively. Methods The study population included 28 patients (15 male and 13 female children aged 2 to 18 months) diagnosed with West syndrome. After a 2-week baseline period for documentation of the frequency of spasms, topiramate was initiated at 2 mg/kg/day. The dose was increased by 2 mg/kg every week to a maximum of 12 mg/kg/day. Clinical assessment was based on the parents' report and a neurological examination every 2 weeks for the first 2 months of treatment. The baseline electroencephalograms (EEGs) were compared with the post-treatment EEGs at 2 weeks and 1 month. Results West syndrome was considered to be cryptogenic in 7 of the 28 patients and symptomatic in 21 patients. After treatment, 11 patients (39%) became spasm-free, 6 (21%) had more than 50% spasmsreduction, 3 (11%) showed less than 50% reduction, and 8 (29%) did not respond. The effective daily dose for achieving more than 50% reduction in spasm frequency, including becoming spasm-free, was found to be 5.8±1.1 mg/kg/day. Nine patients (32%) showed complete disappearance of spasms and hypsarrhythmia, and 11 (39%) showed improved EEG results. Despite adverse events (4 instances of irritability, 3 of drowsiness, and 1 of decreased feeding), no patients discontinued the medication. Conclusion Topiramate monotherapy seems to be effective and well tolerated as a first line therapy for West syndrome and is not associated with serious adverse effects.
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Affiliation(s)
- Gyu Min Lee
- Department of Pediatrics, Kyung Hee University School of Medicine, Seoul, Korea
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29
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Abstract
Pregnancy is associated with various physiological changes that may lead to significant alterations in the pharmacokinetic profiles of many drugs. The present study was designed to investigate the potential effects of pregnancy on the pharmacokinetics of topiramate (TPM) in the rabbit model. Nineteen female New Zealand white rabbits (nine pregnant and 10 non-pregnant) were used in this study. Blood samples were collected from the animals just before receiving TPM orally at a dose of 20 mg/kg and then serially for up to 24 h. TPM plasma samples were analysed using a validated tandem mass spectrometric (LC-MS/MS) method. The mean values of TPM pharmacokinetic parameters (t(1/2), T(max), AUC(0-∞), and CL/F) were significantly modified in pregnant rabbits as compared with non-pregnant group. Pregnancy significantly (P < 0.05) increased TPM half-life (t(1/2)), time to attain the maximum plasma concentration (T(max)), and the area under TPM plasma concentration-time curve (AUC(0-∞)) and decreased the drug's oral clearance (CL/F) compared with non-pregnancy state in rabbits. The present study demonstrates that pregnancy alters the pharmacokinetics of TPM in rabbits in late gestational period and considerable inter-animal variability was observed. The findings of the present study indicate that TPM CL/F is decreased during late pregnancy in the rabbit model.
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Affiliation(s)
- Kamal M Matar
- Department of Applied Therapeutics, Faculty of Pharmacy, Kuwait University, Kuwait.
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Beer B, Libiseller K, Oberacher H, Pavlic M. A fatal intoxication case involving topiramate. Forensic Sci Int 2010; 202:e9-11. [DOI: 10.1016/j.forsciint.2010.04.035] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2009] [Revised: 04/08/2010] [Accepted: 04/18/2010] [Indexed: 11/17/2022]
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Abstract
Although the triptan drugs provide effective relief from migraine for many patients, a substantial number of affected individuals are unresponsive to these compounds, and such therapy can also lead to a range of adverse effects. Telcagepant represents a new class of antimigraine drug-the calcitonin gene-related peptide receptor blockers. This compound exerts its effects by blocking receptors for the calcitonin-gene-related peptide at several sites in the trigeminal and central nervous systems, resulting in pain relief. Telcagepant does not cause vasoconstriction, a major limitation in the use of triptans. Comparisons with triptans in clinical trials for acute treatment of migraine attacks revealed clinical effects similar to those of triptans but better than those of placebo. Telcagepant might provide hope for those who have a poor response to, or are unable to use, older drugs. In patients who need prophylaxis because of frequent attacks of migraine, topiramate is a first-line drug for migraine prevention in many countries; it is generally safe and reasonably well tolerated. Data suggest that topiramate could aid reversion of chronic migraine to episodic migraine.
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Affiliation(s)
- Lars Edvinsson
- Department of Internal Medicine, University Hospital, Lund, Sweden.
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32
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Matar KM. Therapeutic drug monitoring of topiramate by liquid chromatography-tandem mass spectrometry. Clin Chim Acta 2010; 411:729-34. [DOI: 10.1016/j.cca.2010.02.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2010] [Revised: 02/01/2010] [Accepted: 02/02/2010] [Indexed: 11/17/2022]
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Abstract
Individuals over 65 years of age experience the new onset of seizures at a prevalence rate of roughly twice that of younger adults. Differences in physiology, need of concomitant medications, and liability for cognitive deficits in this population, make the choice of anticonvulsant drugs especially important. This paper reviews topiramate (TPM), a treatment for many types of seizures, with the above risks in mind. In particular, we discuss efficacy and pharmacokinetics with emphasis on the older patient, and adverse events in both the younger and older adult. With most studies of TPM-induced cognitive deficits having been performed in younger adults and volunteers, we discuss the implications for the older adult. Even in studies of younger individuals, up to 50% discontinue TPM because of intolerable cognitive deficits. Most studies find specific declines in working memory and verbal fluency. In conclusion, we give recommendations for use of this antiepileptic drug in this population.
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Affiliation(s)
- B R Sommer
- Department of Psychiatry, Stanford University School of Medicine, Stanford, California 94305-5723, USA.
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34
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Bentué-Ferrer D, Tribut O, Verdier MC. Suivi thérapeutique pharmacologique du topiramate. Therapie 2010; 65:17-22. [DOI: 10.2515/therapie/2009066] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [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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Vovk T, Jakovljević MB, Kos MK, Janković SM, Mrhar A, Grabnar I. A Nonlinear Mixed Effects Modelling Analysis of Topiramate Pharmacokinetics in Patients with Epilepsy. Biol Pharm Bull 2010; 33:1176-82. [DOI: 10.1248/bpb.33.1176] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Tomaž Vovk
- Department of Biopharmaceutics and Pharmacokinetics, Faculty of Pharmacy, University of Ljubljana
| | | | - Mojca Kerec Kos
- Department of Biopharmaceutics and Pharmacokinetics, Faculty of Pharmacy, University of Ljubljana
| | | | - Aleš Mrhar
- Department of Biopharmaceutics and Pharmacokinetics, Faculty of Pharmacy, University of Ljubljana
| | - Iztok Grabnar
- Department of Biopharmaceutics and Pharmacokinetics, Faculty of Pharmacy, University of Ljubljana
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36
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Kececi H, Atakay S. Effects of topiramate on neurophysiological and neuropsychological tests in migraine patients. J Clin Neurosci 2009; 16:1588-91. [DOI: 10.1016/j.jocn.2009.03.025] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2008] [Revised: 01/23/2009] [Accepted: 03/08/2009] [Indexed: 11/17/2022]
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Goswami D, Kumar A, Khuroo AH, Monif T, Rab S. Bioanalytical LC-MS/MS method validation for plasma determination of topiramate in healthy Indian volunteers. Biomed Chromatogr 2009; 23:1227-41. [DOI: 10.1002/bmc.1273] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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38
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[Current clinical evidence on topiramate pharmacokinetics]. SRP ARK CELOK LEK 2009; 137:444-8. [PMID: 19764603 DOI: 10.2298/sarh0908444j] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Topiramate is biochemically classified as a fructopyranose sulphamate. Discovered as early as 1979, during middle 1980's it was approved in many countries for the treatment of epilepsies and migraine prevention. More recently, in the experimental stage, possible new indications have been disclosed: treatment of obesity, bipolar disorder, also cessation of smoking, neuropathic pain, cerebral pseudotumour, bulimia, periventricular leucomalatia in preterm infants and alcohol addiction. Most epileptologists consider it to be the first choice antiepileptic drug in severe pharmacoresistant epilepsies. A substantial corpus of evidence in paediatric population has been accumulated that confirms its efficiency in the treatment of generalised tonic-clonic seizures, Lenox-Gestaut syndrome, partial, absence and combined seizures. Having a unique monosaccharide chemical structure among other anticonvulsant drugs, characterizes it with special pharmacokinetic features. This substance exhibits a low interindividual variability in plasma levels and hence it features predictable pharmacokinetics. A steady state plasma concentration of topiramate increases linearly with higher dosages. Serum protein binding is approximately 15%, and biologic half-life in healthy volunteers is considered to range from 20 to 30 hours. Mean expected distribution volume rates from 0.55-0.8 l/kg, and accordingly, the drug shows a low and saturable binding capacity toward erythrocytes. It has not been present at the market for a sufficiently long time that would enable us to speak about a significant accumulation of data on its metabolism based on post-registration 4th stage clinical trials. For this purpose, we have done a literature review in order to summarise so far reported experience on topiramate pharmacokinetics in patients and healthy adults. Deeper understanding of its pharmacokinetic profile could enable a better technological design of the produced drug and the choice of the adequate route of its administration, and accordingly a more rational treatment of severe epilepsies resistant to other drugs.
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Paradis PE, Latrémouille-Viau D, Moore Y, Mishagina N, Lafeuille MH, Lefebvre P, Gaudig M, Duh MS. Projected economic impact of clinical findings of generic entry of topiramate on G4 European countries. Curr Med Res Opin 2009; 25:1793-805. [PMID: 19505202 DOI: 10.1185/03007990903044374] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVES To explore the effects of generic substitution of the antiepileptic drug (AED) topiramate (Topamax) in Canada; to convert observed Canadian costs into the settings of France, Germany, Italy, and the United Kingdom (UK); and to forecast the economic impact of generic topiramate entry in these four European countries. DESIGN AND METHODS Health claims from Régie de l'assurance maladie du Québec (RAMQ) plan (1/2006-9/2008) and IMS Health data (1998-2008) were used. Patients with epilepsy and > or = 2 topiramate dispensings were selected. An open-cohort design was used to classify observation into mutually-exclusive periods of branded versus generic use of topiramate. Canadian healthcare utilization and costs (2007 CAN$/person-year) were compared between periods using multivariate models. Annualized per-patient costs (2007 euro or 2007 pound sterling/person-year) were converted using Canadian utilization rates, European prices and service-use ratios. Non-parametric bootstrap served to assess statistical significance of cost differences. Topiramate market was forecasted following generic entry (09/2009-09/2010) using autoregressive models based on the European experience. The economic impact of generic topiramate entry was estimated for each country. RESULTS A total of 1164 patients (mean age: 39.8 years, 61.7% female) were observed for 2.6 years on average. After covariates adjustment, generic-use periods were associated with increased pharmacy dispensings (other AEDs: +0.95/person-year, non-AEDs: +12.28/person-year, p < 0.001), hospitalizations ( + 0.08/person-year, p = 0.015), and lengths of hospital stays (+0.51 days/person-year, p < 0.001). Adjusted costs, excluding topiramate, were CAN$1060/person-year higher during generic use (p = 0.005). Converted per-patient costs excluding topiramate were significantly higher for generic relative to brand periods in all European countries (adjusted cost differences per person-year: 706-815 euro, p < 0.001 for all comparisons). System-wide costs would increase from 3.5 to 24.4% one year after generic entry. LIMITATIONS Study limitations include the absence of indirect costs, possible claim inaccuracies, and IMS data limitations. CONCLUSIONS Higher health costs were projected for G4 European countries from the Canadian experience following the generic entry of topiramate.
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Abstract
Topiramate has already been suggested for treatment of olfactory hallucination. This is a report of a three and a half-year-old boy with idiopathic generalized tonic colonic epilepsy. He had lost his ability to detect and recognize taste and odor during treatment with topiramate. Those abilities improved after discontinuation of topiramate.
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Latzer Y, Edmunds L, Fenig S, Golan M, Gur E, Hochberg Z, Levin-Zamir D, Zubery E, Speiser PW, Stein D. Managing childhood overweight: behavior, family, pharmacology, and bariatric surgery interventions. Obesity (Silver Spring) 2009; 17:411-23. [PMID: 19131937 DOI: 10.1038/oby.2008.553] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Affiliation(s)
- Yael Latzer
- Psychiatric Division, Rambam Medical Center, Haifa, Israel.
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42
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Park JH, Park YS, Lee MH, Rhim SY, Song JC, Lee SJ, Kim JM, Shaw LM, Kang JS. Determination of plasma topiramate concentration using LC-MS/MS for pharmacokinetic and bioequivalence studies in healthy Korean volunteers. Biomed Chromatogr 2008; 22:822-9. [DOI: 10.1002/bmc.995] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Abstract
Topiramate (Topamax) is a structurally novel broad-spectrum antiepileptic drug (AED) with established efficacy as monotherapy or adjunctive therapy in the treatment of adult and paediatric patients with generalised tonic-clonic seizures, partial seizures with or without generalised seizures, and seizures associated with Lennox-Gastaut syndrome. The incidence and severity of many adverse events, including CNS-related events, may be reduced through the use of slow titration to effective and well tolerated dosages. It is associated with few clinically significant interactions with other drugs, is effective when used with other AEDs, is not associated with drug-induced weight gain and, at lower dosages, does not interfere with the effectiveness of oral contraceptives. Therefore, topiramate is a valuable option as monotherapy or adjunctive therapy in the treatment of epilepsy in adult and paediatric patients.
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44
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Bermejo Velasco PE, Velasco Calvo R. Nuevos fármacos antiepilépticos y dolor neuropático. De la medicina molecular a la clínica. Med Clin (Barc) 2007; 129:542-50. [DOI: 10.1157/13111432] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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45
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Arain AM. Medical therapy of epilepsy. Expert Opin Ther Pat 2007. [DOI: 10.1517/13543776.17.8.955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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46
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Abstract
Anxiety disorders are among the most prevalent psychiatric disorders, but they represent a particular challenge for treatment. The standard first-line treatments, including antidepressants, benzodiazepines, and buspirone, result in significant response rates for a majority of patients; however, unfavorable side effect profiles or risk for dependency for particular agents might limit their use by anxious patients, who often have low thresholds for medication discontinuation. Novel pharmacologic agents that modulate particular receptors, ion channels, or transporters relevant to glutamatergic neurotransmission may represent a new approach to the treatment of anxiety disorders, with generally more favorable side effect profiles. Although the role of glutamate in the pathophysiology of anxiety disorders is still being elucidated, the use of these agents in treatment of anxiety disorders and commonly comorbid conditions such as substance abuse and mood disorders will continue to increase.
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Affiliation(s)
- Jonathan M Amiel
- Columbia University Department of Psychiatry, New York State Psychiatric Institute, New York, NY 10032, USA.
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47
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Abstract
Post-traumatic stress disorder (PTSD) is a disruptive, chronic, and relatively common disorder that is often difficult to treat. Many patients with PTSD are unresponsive, have only moderate or marginal responses, or have troubling side effects to first-line serotonin reuptake inhibitor treatment. Studies suggest that antiepileptic drugs (AEDs) may be an effective treatment alternative or adjunctive treatment for the symptoms of PTSD. Recent results from case reports and open and controlled studies on the efficacy and tolerability of AEDs in PTSD are reviewed here, and their methodological limitations are discussed when relevant. AEDs shown to be effective in double-blind, placebo-controlled trials of PTSD include lamotrigine, topiramate, and tiagabine. Other AEDs that appear promising in open-label trials of PTSD include carbamazepine, valproate, gabapentin, vigabatrin, phenytoin, and levetiracetam. Stress-activated limbic kindling may be involved in the pathogenesis of PTSD. The possibility that AEDs may be effective in the treatment of PTSD due to their antikindling effect is discussed, and suggestions for future research are made.
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Affiliation(s)
- Heather A Berlin
- Department of Psychiatry, Mount Sinai School of Medicine, New York, NY 10029, USA.
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48
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Malakova J, Brozmanova H, Vorisek V, Prochazkova V, Palicka V. A Capillary GC Method Using Nitrogen Phosphorus Detection for Determination of Topiramate in Patients with Epilepsy. Chromatographia 2007. [DOI: 10.1365/s10337-007-0310-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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49
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Abstract
Topiramate (TPM) is one of the novel antiepileptic drugs and exhibits a wide range of mechanisms of action. Efficacy of TPM has been demonstrated in partial-onset seizures and primary generalized seizures in adults and children, as both monotherapy and adjunctive therapy. More recently, TPM has been proposed as an add-on treatment for patients with lithium-resistant bipolar disorder, especially those displaying rapid-cycling and mixed states. This paper reviews the multiple mechanisms of action and the tolerability profile of TPM in the light of its therapeutic potential in affective disorders. Studies of TPM in bipolar disorder are evaluated, and the efficacy and tolerability issues as a mood stabilizing agent are discussed.
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Affiliation(s)
- Marco Mula
- The Neuropsychiatry Research Group, Department of Neurology, Amedeo Avogadro University, Novara, Italy.
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50
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Abstract
Infantile spasm is an age-related refractory epilepsy. Topiramate is a new anticonvulsant with multiple mechanisms of action, and it may be effective for treating pediatric epilepsies. To evaluate the efficacy and tolerability of first-line topiramate treatment for infantile spasm, 20 patients received topiramate monotherapy during this study. They were treated with an initial dose of 1mg/kg/day, with a progressive titration of 1 mg/kg a week until their spasms were controlled and a maximum dose of 12 mg/kg/day was achieved. The evaluation of the treatment efficacy was based on the spasm frequency data that was obtained by the scalp and video-EEG, and by the parental count of spasm. Thirty percent of the subjects became spasm-free during the study. Six of 20 subjects (30%) had cessation of spasm and disappearance of hypsarrhythmia as seen via the video EEG; four (50%) of eight idiopathic patients had a response, whereas two (17%) of 12 patients with symptomatic infantile spasm responded. Seventy of the patients, including the spasm-free patients, had a reduction in their seizure frequency of more than 50%, and 10% of the patients had a reduction in their seizure frequency of less than 50%. The clusters of spasm frequency decreased from 10.6 +/- 8.5 to 3.5 +/- 1.4 clusters/day. Topiramate is effective and tolerated in those patients suffering from infantile spasm. Our results suggest that this drug should be considered as a new first-line drug for treating infantile spasm.
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Affiliation(s)
- Young-Se Kwon
- Department of Pediatrics, Pediatric Neurology, Inha University Hospital, 7-206 3-ga, Shinheung-dong, Jung-gu, Incheon 400-103, Korea.
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