Influence of Ramadan on the pharmacokinetics of a single oral dose
of valproic acid administered at two different times

Aadil, Nadia; Fassi-Fihri, A; Houti, I; Benaji, Brahim; Ouhakki, M; Kotbi, S; Diquet, Bertrand; Hakkou, F.

doi:10.1358/mf.2000.22.2.796073

Cited by 32 publications

(5 citation statements)

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“…Also, they have concluded that decrease in the plasma elimination half-life could be the result of the reversal of the feeding rhythm and the alteration in the rest/ activity cycle could modify the circadian evolution of physiological parameters that are required for hepatic metabolism such as hepatic enzymatic activity and hepatic blood flow; thus changes in the hepatic metabolism of drugs were seen. 10 We believe that these pharmacokinetic changes are very important in the increase of the seizure frequency of our patients who received a single evening dose valproic acid treatment.…”

Section: Discussionmentioning

confidence: 82%

Does the seizure frequency increase in Ramadan?

Gömceli

Kutlu

Cavdar

et al. 2008

Seizure

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During Ramadan, the ninth month of the Islamic lunar calendar, adult Muslims are required to refrain from taking any food, beverages, or oral drugs, as well as from sexual intercourse between dawn and sunset. In this study, we aimed at discovering alterations in drug regimens and the seizure frequency of epileptic patients during Ramadan (15 October 2004-13 November 2004). In the 3 months following Ramadan in the year 2004, 114 patients with epilepsy who were fasting during Ramadan were examined at our Epilepsy Department. Of the 114 patients who were included in the study, 38 patients had seizures and one of these patients developed status epilepticus during Ramadan. When the seizure frequency of these patients during Ramadan was compared to that in the last 1 year and last 3 months period just prior to Ramadan, a statistically significant increase was observed (p<0.001). Moreover, there was an important increase in the risk of having seizures in the patients who changed their drug regimens compared with those who did not (p<0.05). In the patients who received monotherapy or polytherapy, no difference in the frequency of seizures during Ramadan was seen (p>0.05). During Ramadan, an increase in the seizure frequency of patients with epilepsy was observed. The most important reason for this situation was the alteration in the pharmacokinetics and pharmacodynamics of drugs, and consequently, in their efficacy. We believe that in the patients who received monotherapy and who did not change their drug regimes, the increase in seizure frequency may have been related to the changes in their daily rhythms, emotional stress, tiredness and their day-long fasting.

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Section: Discussionmentioning

confidence: 82%

Does the seizure frequency increase in Ramadan?

Gömceli

Kutlu

Cavdar

et al. 2008

Seizure

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“…Also, changes in circadian rhythms sleep disturbances, emotional stress and physical stress can influence drug pharmacokinetics. In one study, even changing the timing of a single dose of valproate (800 mg) during Ramadan increased the frequency of seizures significantly [36]. The problem becomes more notable in patients on polytherapy.…”

Section: Discussionmentioning

confidence: 99%

Islamic fasting and multiple sclerosis

et al. 2014

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BackgroundMonth-long daytime Ramadan fasting pose s major challenges to multiple sclerosis (MS) patients in Muslim countries. Physicians should have practical knowledge on the implications of fasting on MS. We present a summary of database searches (Cochrane Database of Systematic Reviews, PubMed) and a mini-symposium on Ramadan fasting and MS. In this symposium, we aimed to review the effect of fasting on MS and suggest practical guidelines on management.DiscussionIn general, fasting is possible for most stable patients. Appropriate amendment of drug regimens, careful monitoring of symptoms, as well as providing patients with available evidence on fasting and MS are important parts of management. Evidence from experimental studies suggests that calorie restriction before disease induction reduces inflammation and subsequent demyelination and attenuates disease severity. Fasting does not appear to have unfavorable effects on disease course in patients with mild disability (Expanded Disability Status Scale (EDSS) score ≤3). Most experts believed that during fasting (especially in summer), some MS symptoms (fatigue, fatigue perception, dizziness, spasticity, cognitive problems, weakness, vision, balance, gait) might worsen but return to normal levels during feasting. There was a general consensus that fasting is not safe for patients: on high doses of anti-convulsants, anti-spastics, and corticosteroids; with coagulopathy or active disease; during attacks; with EDSS score ≥7.SummaryThese data suggest that MS patients should have tailored care. Fasting in MS patients is a challenge that is directly associated with the spiritual belief of the patient.

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“…These alterations could affect the drug's plasma concentration profileand,therefore,itsefficacyandtolerance.Inaddition, drug-food interactions may result in reduced, delayed or increasedsystemicavailabilityofadrug.Circadianrhythm hastobeconsideredasanimportantfactorthatinfluences drug pharmacokinetics. In nine patients (23.7%) with a monotherapy of valproic acid (taken as single evening dose),seizurefrequencyincreasedeventhoughnochange wasmadetotheirdrugregimen.Inanotherstudy,Adilet al (42) assessed the pharmacokinetics of valproic acid in 12 healthy volunteers during fasting. A single oral dose of800mgwasadministeredtothefirstgroupofsubjects (n=7) in the evening and to the second group (n=5) in the early morning.…”

Section: Epilepsy and Fastingmentioning

confidence: 99%

Mini-symposium: Ramadan fasting and the medical patient: An overview for clinicians

Beshyah

Fathalla

Saleh

et al. 2010

Ibnosina Journal of Medicine and Biomedical Sciences

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ThedaytimefastingofRamadanisobservedannuallyby millions of adult Muslims all over the world. Some may have mild, moderate or severe medical conditions. They may seek advice on feasibility and safety of fasting and/ ortheirmanagement.Physiciansoughttohaveaworking knowledgeaboutthereligiousrulesofRamadanfastand theirmedicalimplications.Inthisarticlewepresentaconcise summaryoftheproceedingsofaseriesofsymposia.Their objectivesweretoreviewtheeffectsofRamadanfastingon thehealthofMuslimpatientswithvariouschronicmedical conditionsandtoproposepracticalmanagementstrategies. An initial introductory Islamic perspective on fasting to setthesceneforthefollowingpresentations.Thereligious rulingsexcludingpatientswithacuteandchronicmedical conditionsfromfastingwerehighlighted.Therolesofthe medicalprofessionalinguidingpatientsonbestwaystomake

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Influence of Ramadan on the pharmacokinetics of a single oral dose of valproic acid administered at two different times

Cited by 32 publications

References 0 publications

Does the seizure frequency increase in Ramadan?

Does the seizure frequency increase in Ramadan?

Islamic fasting and multiple sclerosis

Mini-symposium: Ramadan fasting and the medical patient: An overview for clinicians

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