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Lee S, Kim HC, Jang Y, Lee HS, Ahn S, Lee S, Jung K, Park K, Jung K, Oh J, Lee S, Yu K, Jang I, Lee S, Chu K, Lee SK. Topiramate dosage optimization for effective antiseizure management via population pharmacokinetic modeling. Ann Clin Transl Neurol 2024; 11:424-435. [PMID: 38062636 PMCID: PMC10863906 DOI: 10.1002/acn3.51962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Revised: 11/07/2023] [Accepted: 11/18/2023] [Indexed: 02/15/2024] Open
Abstract
OBJECTIVE Despite the suggested topiramate serum level of 5-20 mg/L, numerous institutions have observed substantial drug response at lower levels. We aim to investigate the correlation between topiramate serum levels, drug responsiveness, and adverse events to establish a more accurate and tailored therapeutic range. METHODS We retrospectively analyzed clinical data collected between January 2017 and January 2022 at Seoul National University Hospital. Drug responses to topiramate were categorized as "insufficient" or "sufficient" by reduction in seizure frequency ≥ 50%. A population pharmacokinetic model estimated serum levels from spot measurements. ROC curve analysis determined the optimal cutoff values. RESULTS A total of 389 epilepsy patients were reviewed having a mean dose of 178.4 ± 117.9 mg/day and the serum level, 3.9 ± 2.8 mg/L. Only 5.6% samples exhibited insufficient response, with a mean serum level of 3.6 ± 2.5 mg/L while 94.4% demonstrated sufficient response, with a mean 4.0 ± 2.8 mg/L, having no statistical significance. Among the 69 reported adverse events, logistic regression analysis identified a significant association between ataxia and serum concentration (p = 0.04), with an optimal cutoff value of 6.5 mg/L. INTERPRETATION This study proposed an optimal therapeutic concentration for topiramate based on patients' responsiveness to the drug and the incidence of adverse effects. We recommended serum levels below 6.5 mg/L to mitigate the risk of ataxia-related side effects while dose elevation was found unnecessary for suboptimal responders, as the drug's effectiveness plateaus at minimal doses.
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Affiliation(s)
- Seolah Lee
- Laboratory for Neurotherapeutics, Department of Neurology, Comprehensive Epilepsy Center, Center for Medical InnovationBiomedical Research Institute, Seoul National University College of Medicine and HospitalSeoulSouth Korea
| | - Hyun Chul Kim
- Department of Clinical Pharmacology and TherapeuticsSeoul National University College of Medicine and HospitalSeoulSouth Korea
- Integrated Major in Innovative Medical ScienceSeoul National University Graduate SchoolSeoulSouth Korea
| | - Yoonhyuk Jang
- Laboratory for Neurotherapeutics, Department of Neurology, Comprehensive Epilepsy Center, Center for Medical InnovationBiomedical Research Institute, Seoul National University College of Medicine and HospitalSeoulSouth Korea
| | - Han Sang Lee
- Laboratory for Neurotherapeutics, Department of Neurology, Comprehensive Epilepsy Center, Center for Medical InnovationBiomedical Research Institute, Seoul National University College of Medicine and HospitalSeoulSouth Korea
- Center for Hospital MedicineSeoul National University HospitalSeoulSouth Korea
| | - Seon‐Jae Ahn
- Laboratory for Neurotherapeutics, Department of Neurology, Comprehensive Epilepsy Center, Center for Medical InnovationBiomedical Research Institute, Seoul National University College of Medicine and HospitalSeoulSouth Korea
- Center for Hospital MedicineSeoul National University HospitalSeoulSouth Korea
| | - Soon‐Tae Lee
- Laboratory for Neurotherapeutics, Department of Neurology, Comprehensive Epilepsy Center, Center for Medical InnovationBiomedical Research Institute, Seoul National University College of Medicine and HospitalSeoulSouth Korea
| | - Keun‐Hwa Jung
- Laboratory for Neurotherapeutics, Department of Neurology, Comprehensive Epilepsy Center, Center for Medical InnovationBiomedical Research Institute, Seoul National University College of Medicine and HospitalSeoulSouth Korea
| | - Kyung‐Il Park
- Laboratory for Neurotherapeutics, Department of Neurology, Comprehensive Epilepsy Center, Center for Medical InnovationBiomedical Research Institute, Seoul National University College of Medicine and HospitalSeoulSouth Korea
- Division of NeurologySeoul National University Hospital Healthcare System Gangnam CenterSeoulSouth Korea
| | - Ki‐Young Jung
- Laboratory for Neurotherapeutics, Department of Neurology, Comprehensive Epilepsy Center, Center for Medical InnovationBiomedical Research Institute, Seoul National University College of Medicine and HospitalSeoulSouth Korea
| | - Jaeseong Oh
- Department of Clinical Pharmacology and TherapeuticsSeoul National University College of Medicine and HospitalSeoulSouth Korea
- Department of PharmacologyJeju National University College of MedicineJeju Special Self‐Governing ProvinceRepublic of Korea
| | - SeungHwan Lee
- Department of Clinical Pharmacology and TherapeuticsSeoul National University College of Medicine and HospitalSeoulSouth Korea
| | - Kyung‐Sang Yu
- Department of Clinical Pharmacology and TherapeuticsSeoul National University College of Medicine and HospitalSeoulSouth Korea
| | - In‐Jin Jang
- Department of Clinical Pharmacology and TherapeuticsSeoul National University College of Medicine and HospitalSeoulSouth Korea
| | - Soyoung Lee
- Department of Clinical Pharmacology and TherapeuticsSeoul National University College of Medicine and HospitalSeoulSouth Korea
- Integrated Major in Innovative Medical ScienceSeoul National University Graduate SchoolSeoulSouth Korea
| | - Kon Chu
- Laboratory for Neurotherapeutics, Department of Neurology, Comprehensive Epilepsy Center, Center for Medical InnovationBiomedical Research Institute, Seoul National University College of Medicine and HospitalSeoulSouth Korea
| | - Sang Kun Lee
- Laboratory for Neurotherapeutics, Department of Neurology, Comprehensive Epilepsy Center, Center for Medical InnovationBiomedical Research Institute, Seoul National University College of Medicine and HospitalSeoulSouth Korea
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Suetsugu K, Yamamoto N, Shigematsu T, Kobayashi D, Tsuchiya Y, Nakayama Y, Tsuji T, Watanabe H, Kanaya A, Masuda S, Egashira N. [Significant Changes Associated with the Transition from Outsourcing to In-hospital Therapeutic Drug Monitoring of Novel Antiepileptics]. YAKUGAKU ZASSHI 2020; 140:1035-1040. [PMID: 32741861 DOI: 10.1248/yakushi.20-00001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
For many of the novel antiepileptics, immunoassays, used for routine therapeutic drug monitoring (TDM), cannot be used. We could monitor eight novel antiepileptics using an LC/MS method since July 2017. The purpose of this study was to evaluate the significant changes associated with the transition from outsourcing to in-hospital monitoring of novel antiepileptics. The number of measurements of novel antiepileptics was significantly increased during the first (p<0.01) and second (p<0.001) years of in-hospital monitoring as compared to that one year prior to in-hospital monitoring which was outsourced. The proportion of measurements of novel antiepileptics to all antiepileptics was 19.7%, 31.1%, and 38.4% during outsourcing, and first, and second years of in-hospital monitoring, respectively. The measurement cost was significantly reduced during the first (p<0.001) and second (p<0.001) years of in-hospital monitoring as compared to that during outsourcing. In addition, the revenue from TDM of antiepileptic drugs was significantly increased during the first (p<0.05) and second (p<0.01) years of in-hospital monitoring as compared with that during outsourcing. In conclusion, the switch from outsourcing to in-hospital monitoring led to an increase in the number of orders, a reduction in the measurement-related expenses of novel antiepileptics, and an increase in the revenue from TDM of antiepileptic drugs, which could promote the proper use of novel antiepileptics through TDM.
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Affiliation(s)
| | | | | | - Daisuke Kobayashi
- Department of Clinical Pharmacy and Pharmaceutical Care, Graduate School of Pharmaceutical Sciences, Kyushu University
| | | | | | | | | | - Akiko Kanaya
- Department of Pharmacy, Kyushu University Hospital
| | - Satohiro Masuda
- Department of Pharmacy, Kyushu University Hospital.,Department of Pharmacy, International University of Health and Welfare Narita Hospital
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Alcantara GKS, Calixto LA, de Moraes LAB, Queiroz RHC, de Oliveira ARM, de Gaitani CM. Determination of Levetiracetam in Human Plasma by Dispersive Liquid-Liquid Microextraction Followed by Gas Chromatography-Mass Spectrometry. JOURNAL OF ANALYTICAL METHODS IN CHEMISTRY 2016; 2016:5976324. [PMID: 27830105 PMCID: PMC5086507 DOI: 10.1155/2016/5976324] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/26/2016] [Accepted: 09/01/2016] [Indexed: 06/06/2023]
Abstract
Levetiracetam (LEV) is an antiepileptic drug that is clinically effective in generalized and partial epilepsy syndromes. The use of this drug has been increasing in clinical practice and intra- or -interindividual variability has been exhibited for special population. For this reason, bioanalytical methods are required for drug monitoring in biological matrices. So this work presents a dispersive liquid-liquid microextraction method followed by gas chromatography-mass spectrometry (DLLME-GC-MS) for LEV quantification in human plasma. However, due to the matrix complexity a previous purification step is required. Unlike other pretreatment techniques presented in the literature, for the first time, a procedure employing ultrafiltration tubes Amicon® (10 kDa porous size) without organic solvent consumption was developed. GC-MS analyses were carried out using a linear temperature program, capillary fused silica column, and helium as the carrier gas. DLLME optimized parameters were type and volume of extraction and dispersing solvents, salt addition, and vortex agitation time. Under chosen parameters (extraction solvent: chloroform, 130 μL; dispersing solvent: isopropyl alcohol, 400 μL; no salt addition and no vortex agitation time), the method was completely validated and all parameters were in agreement with the literature recommendations. LEV was quantified in patient's plasma sample using less than 550 μL of organic solvent.
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Affiliation(s)
- Greyce Kelly Steinhorst Alcantara
- Department of Pharmaceutical Sciences, Faculty of Pharmaceutical Sciences of Ribeirão Preto, University of São Paulo, 14040-903 Ribeirão Preto, SP, Brazil
| | - Leandro Augusto Calixto
- Department of Exact and Earth Sciences, Institute of Environmental, Chemical and Pharmaceutical Sciences, Federal University of São Paulo, 09972-270 Diadema, SP, Brazil
| | - Luiz Alberto Beraldo de Moraes
- Departament of Chemistry, Faculty of Philosophy, Sciences and Letters of Ribeirão Preto, University of São Paulo, 14040-901 Ribeirão Preto, SP, Brazil
| | - Regina Helena Costa Queiroz
- Department of Clinical Analysis, Toxicology and Food Science, Faculty of Pharmaceutical Sciences of Ribeirão Preto, University of São Paulo, 14040-903 Ribeirão Preto, SP, Brazil
| | - Anderson Rodrigo Moraes de Oliveira
- Departament of Chemistry, Faculty of Philosophy, Sciences and Letters of Ribeirão Preto, University of São Paulo, 14040-901 Ribeirão Preto, SP, Brazil
| | - Cristiane Masetto de Gaitani
- Department of Pharmaceutical Sciences, Faculty of Pharmaceutical Sciences of Ribeirão Preto, University of São Paulo, 14040-903 Ribeirão Preto, SP, Brazil
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Dupouey J, Doudka N, Belo S, Blin O, Guilhaumou R. Simultaneous determination of four antiepileptic drugs in human plasma samples using an ultra-high-performance liquid chromatography tandem mass spectrometry method and its application in therapeutic drug monitoring. Biomed Chromatogr 2016; 30:2053-2060. [DOI: 10.1002/bmc.3789] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2016] [Revised: 06/17/2016] [Accepted: 07/08/2016] [Indexed: 01/20/2023]
Affiliation(s)
- Julien Dupouey
- Service de Pharmacologie clinique et Pharmacovigilance; Hôpital de la Timone; 264 rue Saint Pierre 13385 Marseille Cedex 5 France
- Pharmacologie intégrée et Interface clinique et industriel, Institut des Neurosciences Timone - CNRS 7289; Aix Marseille Université; Marseille 13385 France
| | - Natalia Doudka
- Service de Pharmacologie clinique et Pharmacovigilance; Hôpital de la Timone; 264 rue Saint Pierre 13385 Marseille Cedex 5 France
| | - Séphora Belo
- Service de Pharmacologie clinique et Pharmacovigilance; Hôpital de la Timone; 264 rue Saint Pierre 13385 Marseille Cedex 5 France
| | - Olivier Blin
- Service de Pharmacologie clinique et Pharmacovigilance; Hôpital de la Timone; 264 rue Saint Pierre 13385 Marseille Cedex 5 France
- Pharmacologie intégrée et Interface clinique et industriel, Institut des Neurosciences Timone - CNRS 7289; Aix Marseille Université; Marseille 13385 France
| | - Romain Guilhaumou
- Service de Pharmacologie clinique et Pharmacovigilance; Hôpital de la Timone; 264 rue Saint Pierre 13385 Marseille Cedex 5 France
- Pharmacologie intégrée et Interface clinique et industriel, Institut des Neurosciences Timone - CNRS 7289; Aix Marseille Université; Marseille 13385 France
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Smetana KS, Cook AM, Bastin MLT, Oyler DR. Antiepileptic dosing for critically ill adult patients receiving renal replacement therapy. J Crit Care 2016; 36:116-124. [PMID: 27546759 DOI: 10.1016/j.jcrc.2016.06.023] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2016] [Revised: 06/06/2016] [Accepted: 06/28/2016] [Indexed: 11/28/2022]
Abstract
OBJECTIVES The aim of this review was to evaluate current literature for dosing recommendations for the use of antiepileptic medications in patients receiving renal replacement therapy (RRT). DATA SOURCES With the assistance of an experienced medical librarian specialized in pharmacy and toxicology, we searched MEDLINE, EMBASE, CINAHL, Web of Science, WorldCat, and Scopus through May 2016. STUDY SELECTION AND DATA EXTRACTION Four hundred three articles were screened for inclusion, of which 130 were identified as potentially relevant. Micromedex® DRUGDEX as well as package inserts were used to obtain known pharmacokinetic properties and dosage adjustment recommendations in RRT if known. DATA SYNTHESIS Data regarding antiepileptic drug use in RRT are limited and mostly consist of case reports limiting our proposed dosing recommendations. Known pharmacokinetic parameters should guide dosing, and recommendations are provided where possible. CONCLUSION Additional studies are necessary before specific dosing recommendations can be made for most antiepileptic drugs in critically ill patients receiving RRT, specifically with newer agents.
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Affiliation(s)
- Keaton S Smetana
- University of Kentucky HealthCare, Department of Pharmacy, Lexington, KY.
| | - Aaron M Cook
- University of Kentucky HealthCare, Department of Pharmacy, Lexington, KY; University of Kentucky College of Pharmacy, Department of Pharmacy Practice and Science (UK College of Pharmacy), University of Kentucky, Lexington, KY.
| | - Melissa L Thompson Bastin
- University of Kentucky HealthCare, Department of Pharmacy, Lexington, KY; University of Kentucky College of Pharmacy, Department of Pharmacy Practice and Science (UK College of Pharmacy), University of Kentucky, Lexington, KY.
| | - Douglas R Oyler
- University of Kentucky HealthCare, Department of Pharmacy, Lexington, KY; University of Kentucky College of Pharmacy, Department of Pharmacy Practice and Science (UK College of Pharmacy), University of Kentucky, Lexington, KY.
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Simultaneous Quantitation of Lamotrigine, Levetiracetam, 10-Hydroxycarbazepine, Topiramate, and Zonisamide in Serum Using HPLC-MS/MS. Methods Mol Biol 2016; 1383:29-37. [PMID: 26660171 DOI: 10.1007/978-1-4939-3252-8_4] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Antiepileptic drugs (AEDs) are a diverse group of pharmacological agents used in the treatment of epileptic seizures. Over the past several decades some new AEDs, including lamotrigine (LTG), levetiracetam (LVA), oxcarbazepine (OXC), topiramate (TOP), and zonisamide (ZNS), have become widely used. This chapter describes a very simple and rapid liquid chromatography-tandem mass spectrometry method for simultaneous quantitation of LVA, ZNS, LTG, TOP, and MHD in human serum. The method requires a very small amount of serum (50 μL) for multiple drug measurements and has a total analysis time of 4 min that makes it well suited for routine clinical analysis of several drugs simultaneously. The imprecision (CVs) measured at various concentrations across the analytical measurement range (AMR) are less than 7% for all analytes. The AMR for each analyte is as follows: LVA (1-100 μg/mL), ZNS (0.8-80 μg/mL), TOP (0.5-50 μg/mL), and 0.6-60 μg/mL for LTG and MHD.
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Fazeli-Bakhtiyari R, Panahi-Azar V, Sorouraddin MH, Jouyban A. Determination of valproic acid in human plasma using dispersive liquid-liquid microextraction followed by gas chromatography-flame ionization detection. IRANIAN JOURNAL OF BASIC MEDICAL SCIENCES 2015; 18:979-88. [PMID: 26730332 PMCID: PMC4686582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Dispersive liquid-liquid microextraction coupled with gas chromatography (GC)-flame ionization detector was developed for the determination of valproic acid (VPA) in human plasma. MATERIALS AND METHODS Using a syringe, a mixture of suitable extraction solvent (40 µl chloroform) and disperser (1 ml acetone) was quickly added to 10 ml of diluted plasma sample containing VPA (pH, 1.0; concentration of NaCl, 4% (w/v)), resulting in a cloudy solution. After centrifugation (6000 rpm for 6 min), an aliquot (1 µl) of the sedimented organic phase was removed using a 1-µl GC microsyringe and injected into the GC system for analysis. One variable at a time optimization method was used to study various parameters affecting the extraction efficiency of target analyte. Then, the developed method was fully validated for its accuracy, precision, recovery, stability, and robustness. RESULTS Under the optimum extraction conditions, good linearity range was obtained for the calibration graph, with correlation coefficient higher than 0.998. Limit of detection and lower limit of quantitation were 3.2 and 6 μg/ml, respectively. The relative standard deviations of intra and inter-day analysis of examined compound were less than 11.5%. The relative recoveries were found in the range of 97 to 107.5%. Finally, the validated method was successfully applied to the analysis of VPA in patient sample. CONCLUSION The presented method has acceptable levels of precision, accuracy and relative recovery and could be used for therapeutic drug monitoring of VPA in human plasma.
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Affiliation(s)
- Rana Fazeli-Bakhtiyari
- Liver and Gastrointestinal Diseases Research Center, Tabriz University of Medical Sciences, Tabriz, Iran,Department of Analytical Chemistry, Faculty of Chemistry, University of Tabriz, Tabriz, Iran
| | - Vahid Panahi-Azar
- Drug Applied Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | | | - Abolghasem Jouyban
- Pharmaceutical Analysis Research Center and Faculty of Pharmacy, Tabriz University of Medical Sciences, Tabriz, Iran,Corresponding author: Abolghasem Jouyban. Faculty of Pharmacy, Tabriz University of Medical Sciences, Tabriz, Iran. Tel: +98-41-33379323; Fax: +98-41- 33363231;
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A sensitive and rapid method for quantification of lacosamide and desmethyl lacosamide by LC-MS/MS. Bioanalysis 2015; 6:3161-8. [PMID: 25529884 DOI: 10.4155/bio.14.158] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Monitoring lacosamide (LCM) helps optimize therapeutic dosing in some clinical settings. We developed a novel LC-MS/MS method for measuring serum LCM and O-desmethyl lacosamide (ODL). RESULTS/DISCUSSION The sample preparation was protein precipitation with methanol. The total CV was less than 4.7%. Calibration range was 0.95-30.29 µg/ml and 0.95-30.41 µg/ml while the expanded linear range was 0.41-47.49 µg/ml and 0.34-48.17 µg/ml for LCM and ODL, respectively with analytical accuracy of 87.2-106.0%. 45 random serum samples collected from 23 individuals on either 200 mg/day or 400 mg/day of LCM therapy showed concentrations of 2.2-19.8 µg/ml for LCM and up to 2.5 µg/ml for ODL. CONCLUSION A simple and sensitive LC-MS/MS assay was validated for quantification of LCM and ODL in human serum.
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Freitas-Lima P, Ferreira FIS, Bertucci C, Alexandre Júnior V, Dreossi SAC, Pereira LRL, Sakamoto AC, Queiroz RHC. Stir bar-sorptive extraction, solid phase extraction and liquid-liquid extraction for levetiracetam determination in human plasma: comparing recovery rates. BRAZ J PHARM SCI 2015. [DOI: 10.1590/s1984-82502015000200017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
<p>Levetiracetam (LEV), an antiepileptic drug (AED) with favorable pharmacokinetic profile, is increasingly being used in clinical practice, although information on its metabolism and disposition are still being generated. Therefore a simple, robust and fast liquid-liquid extraction (LLE) followed by high-performance liquid chromatography method is described that could be used for both pharmacokinetic and therapeutic drug monitoring (TDM) purposes. Moreover, recovery rates of LEV in plasma were compared among LLE, stir bar-sorptive extraction (SBSE), and solid-phase extraction (SPE). Solvent extraction with dichloromethane yielded a plasma residue free from usual interferences such as commonly co-prescribed AEDs, and recoveries around 90% (LLE), 60% (SPE) and 10% (SBSE). Separation was obtained using reverse phase Select B column with ultraviolet detection (235 nm). Mobile phase consisted of methanol:sodium acetate buffer 0.125 M pH 4.4 (20:80, v/v). The method was linear over a range of 2.8-220.0 µg mL<sup>-1</sup>. The intra- and inter-assay precision and accuracy were studied at three concentrations; relative standard deviation was less than 10%. The limit of quantification was 2.8 µg mL<sup>-1</sup>. This robust method was successfully applied to analyze plasma samples from patients with epilepsy and therefore might be used for pharmacokinetic and TDM purposes.</p>
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Sanavio B, Krol S. On the Slow Diffusion of Point-of-Care Systems in Therapeutic Drug Monitoring. Front Bioeng Biotechnol 2015; 3:20. [PMID: 25767794 PMCID: PMC4341557 DOI: 10.3389/fbioe.2015.00020] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2014] [Accepted: 02/09/2015] [Indexed: 12/22/2022] Open
Abstract
Recent advancements in point-of-care (PoC) technologies show great transformative promises for personalized preventative and predictive medicine. However, fields like therapeutic drug monitoring (TDM), that first allowed for personalized treatment of patients' disease, still lag behind in the widespread application of PoC devices for monitoring of patients. Surprisingly, very few applications in commonly monitored drugs, such as anti-epileptics, are paving the way for a PoC approach to patient therapy monitoring compared to other fields like intensive care cardiac markers monitoring, glycemic controls in diabetes, or bench-top hematological parameters analysis at the local drug store. Such delay in the development of portable fast clinically effective drug monitoring devices is in our opinion due more to an inertial drag on the pervasiveness of these new devices into the clinical field than a lack of technical capability. At the same time, some very promising technologies failed in the clinical practice for inadequate understanding of the outcome parameters necessary for a relevant technological breakthrough that has superior clinical performance. We hope, by over-viewing both TDM practice and its yet unmet needs and latest advancement in micro- and nanotechnology applications to PoC clinical devices, to help bridging the two communities, the one exploiting analytical technologies and the one mastering the most advanced techniques, into translating existing and forthcoming technologies in effective devices.
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Affiliation(s)
- Barbara Sanavio
- IRCCS Fondazione Istituto Neurologico Carlo Besta, Milan, Italy
| | - Silke Krol
- IRCCS Fondazione Istituto Neurologico Carlo Besta, Milan, Italy
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Brandt C, May TW. Therapeutic drug monitoring of newer antiepileptic drugs / Therapeutic drug monitoring bei neueren Antiepileptika. ACTA ACUST UNITED AC 2011. [DOI: 10.1515/jlm.2011.022] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Salih MRM, Bahari MB, Abd AY. Selected pharmacokinetic issues of the use of antiepileptic drugs and parenteral nutrition in critically ill patients. Nutr J 2010; 9:71. [PMID: 21194458 PMCID: PMC3022641 DOI: 10.1186/1475-2891-9-71] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2010] [Accepted: 12/31/2010] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES To conduct a systematic review for the evidence supporting or disproving the reality of parenteral nutrition- antiepileptic drugs interaction, especially with respect to the plasma protein-binding of the drug. METHODS The articles related to the topic were identified through Medline and PubMed search (1968-Feburary 2010) for English language on the interaction between parenteral nutrition and antiepileptic drugs; the search terms used were anti-epileptic drugs, parenteral nutrition, and/or interaction, and/or in vitro. The search looked for prospective randomized and nonrandomized controlled studies; prospective nonrandomized uncontrolled studies; retrospective studies; case reports; and in vitro studies. Full text of the articles were then traced from the Universiti Sains Malaysia (USM) library subscribed databases, including Wiley-Blackwell Library, Cochrane Library, EBSCOHost, OVID, ScienceDirect, SAGE Premier, Scopus, SpringerLINK, and Wiley InterScience. The articles from journals not listed by USM library were traced through inter library loan. RESULTS There were interactions between parenteral nutrition and drugs, including antiepileptics. Several guidelines were designed for the management of illnesses such as traumatic brain injuries or cancer patients, involving the use of parenteral nutrition and antiepileptics. Moreover, many studies demonstrated the in vitro and in vivo parenteral nutrition -drugs interactions, especially with antiepileptics. CONCLUSIONS There was no evidence supporting the existence of parenteral nutrition-antiepileptic drugs interaction. The issue has not been studied in formal researches, but several case reports and anecdotes demonstrate this drug-nutrition interaction. However, alteration in the drug-free fraction result from parenteral nutrition-drug (i.e. antiepileptics) interactions may necessitate scrupulous reassessment of drug dosages in patients receiving these therapies. This reassessment may be particularly imperative in certain clinical situations characterized by hypoalbuminemia (e.g., burn patients).
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Affiliation(s)
- Muhannad RM Salih
- Department of Clinical Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, 11800 Penang, Malaysia
| | - Mohd Baidi Bahari
- Department of Clinical Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, 11800 Penang, Malaysia
| | - Arwa Y Abd
- Department of Clinical Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, 11800 Penang, Malaysia
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