Anticonvulsant Drug Blood Levels

Livingston, Samuel; Berman, Wulfred; Pauli, Lydia L.

doi:10.1001/jama.1975.03250010042028

Cited by 24 publications

(2 citation statements)

References 10 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…2). A considerably higher risk for adverse effects is expected using PB concentrations above 30–50 mg/L (Livingston et al., 1975; Patsalos et al., 2008). Two studies reported no adverse effects on heart rate, respiratory rate, blood pressure, or arterial blood gas values with a loading PB dose of 30 (Donn et al., 1985) or 40 mg/kg (Hall et al., 1998).…”

Section: Discussionmentioning

confidence: 99%

Phenobarbital for neonatal seizures in hypoxic ischemic encephalopathy: A pharmacokinetic study during whole body hypothermia

et al. 2011

View full text Add to dashboard Cite

SUMMARYPurpose: Therapeutic hypothermia has recently been introduced to treat term newborns with hypoxic-ischemic encephalopathy, of whom more than half have seizures. Phenobarbital is widely used to treat neonatal seizures, but it is unknown whether its pharmacokinetics is affected by hypothermia. We evaluated the influence of hypothermia on phenobarbital pharmacokinetics in asphyxiated newborns. Methods: Nineteen term asphyxiated newborns treated with mild whole body hypothermia, started within 6 h after birth and protracted for 72 h, received phenobarbital for clinical seizures. Treatment schedule consisted of a loading dose of 20 mg/kg, titrated to response, up to a maximum dose of 40 mg/kg, followed by a maintenance dose of 2.5 or 1.5 mg/kg every 12 h. Phenobarbital concentrations were measured on 28 dried blood spots in each newborn. Key Findings: Eighteen newborns showed plasma concentrations within the reference range after receiving a loading dose of 20 mg/kg. In the remaining newborn, who had received a loading dose of 35 mg/kg, phenobarbital concentrations exceeded the upper reference limit. Phenobarbital concentrations reached a virtual steady state in all newborns. Pharmacokinetic parameters were then calculated. Minimum and maximum concentration (24.7 ± 8.8 and 30.63 ± 10.3 mg/L), average plasma concentration (27.37 ± 9.4 mg/L), and half-life (173.9 ± 62.5 h) were considerably higher than reported in literature for normothermic newborns. Pharmacokinetic parameters did not differ significantly between infants receiving different maintenance doses. Significance: Phenobarbital administered to newborns under whole body hypothermia results in higher plasma concentrations and longer half-lives than expected in normothermic newborns.

show abstract

Section: Discussionmentioning

confidence: 99%

Phenobarbital for neonatal seizures in hypoxic ischemic encephalopathy: A pharmacokinetic study during whole body hypothermia

et al. 2011

View full text Add to dashboard Cite

show abstract

“…One study reported that serum phenobarbital concentrations required to prevent simple and complex partial seizures (with or without secondary generalization) were higher than those necessary to prevent generalized tonic–clonic seizures only (38 ± 6 mg/L vs. 18 ± 10 mg/L, respectively; Schmidt et al, 1986). Adverse effects, such as drowsiness become more frequent as serum phenobarbital concentrations increase from 30 to 50 mg/L (Livingstone et al, 1975).…”

Section: Relevance Of Tdm For Individual Aedsmentioning

confidence: 99%

Antiepileptic drugs—best practice guidelines for therapeutic drug monitoring: A position paper by the subcommission on therapeutic drug monitoring, ILAE Commission on Therapeutic Strategies

et al. 2008

View full text Add to dashboard Cite

SUMMARYAlthough no randomized studies have demonstrated a positive impact of therapeutic drug monitoring (TDM) on clinical outcome in epilepsy, evidence from nonrandomized studies and everyday clinical experience does indicate that measuring serum concentrations of old and new generation antiepileptic drugs (AEDs) can have a valuable role in guiding patient management provided that concentrations are measured with a clear indication and are interpreted critically, taking into account the whole clinical context. Situations in which AED measurements are most likely to be of benefit include (1) when a person has attained the desired clinical outcome, to establish an individual therapeutic concentration which can be used at subsequent times to assess potential causes for a change in drug response; (2) as an aid in the diagnosis of clinical toxicity; (3) to assess compliance, particularly in patients with uncontrolled seizures or breakthrough seizures; (4) to guide dosage adjustment in situations associated with increased pharmacokinetic variability (e.g., children, the elderly, patients with associated diseases, drug formulation changes); (5) when a potentially important pharmacokinetic change is anticipated (e.g., in pregnancy, or when an interacting drug is added or removed); (6) to guide dose adjustments for AEDs with dose-dependent pharmacokinetics, particularly phenytoin.

show abstract

Discrepancies in Recommended Dosage Regimens of Drugs

Chiou¹

1976

The Journal of Clinical Pharma

View full text Add to dashboard Cite

Anticonvulsant Drug Blood Levels

Cited by 24 publications

References 10 publications

Phenobarbital for neonatal seizures in hypoxic ischemic encephalopathy: A pharmacokinetic study during whole body hypothermia

Phenobarbital for neonatal seizures in hypoxic ischemic encephalopathy: A pharmacokinetic study during whole body hypothermia

Antiepileptic drugs—best practice guidelines for therapeutic drug monitoring: A position paper by the subcommission on therapeutic drug monitoring, ILAE Commission on Therapeutic Strategies

Discrepancies in Recommended Dosage Regimens of Drugs

Contact Info

Product

Resources

About