Valproic acid and phenobarbital blood levels during the first month of treatment with the ketogenic diet

Coppola, Giangennaro; Verrotti, A.; D’Aniello, Alfredo; Arcieri, Salvatore; Operto, Francesca Felicia; Corte, Rita della; Ammendola, Eduardo; Pascotto, Antonio

doi:10.1111/j.1600-0404.2010.001359.x

Cited by 8 publications

(11 citation statements)

References 13 publications

(9 reference statements)

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“…This patient had an increase in seizures following MAD initiation by greater than 200% [68]. From the pediatric epilepsy literature, serum levels of the most commonly used AEDs, with the exception of valproic acid, do not appear to be significantly altered with concomitant KD use [154][155][156]. Valproic acid use in rare cases has also interfered with the development of ketosis and contributed to the worsening of secondary carnitine deficiency (which can occur with either KD or valproic acid use), so close monitoring of ketosis and carnitine level is advised and carnitine supplementation is recommended if a deficiency is observed [157,158].…”

Section: Ketogenic Diet Adverse Effects and Contraindications In Adultsmentioning

confidence: 87%

Ketogenic Diets for Adult Neurological Disorders

2018

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The current review highlights the evidence supporting the use of ketogenic diet therapies in the management of a growing number of neurological disorders in adults. An overview of the scientific literature supporting posited mechanisms of therapeutic efficacy is presented including effects on neurotransmission, oxidative stress, and neuro-inflammation. The clinical evidence supporting ketogenic diet use in the management of adult epilepsy, malignant glioma, Alzheimer's disease, migraine headache, motor neuron disease, and other neurologic disorders is highlighted and reviewed. Lastly, common adverse effects of ketogenic therapy in adults, including gastrointestinal symptoms, weight loss, and transient dyslipidemia are discussed.

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Section: Ketogenic Diet Adverse Effects and Contraindications In Adultsmentioning

confidence: 87%

Ketogenic Diets for Adult Neurological Disorders

2018

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“…Our strength is that all medications were kept unchanged throughout the study. Coppola et al found a nonsignificant reduction of serum concentration of VPA after 30 days on diet . Heo et al studied 139 children for at least 30 days on various ketogenic diets and observed a significant reduction in serum concentration of VPA .…”

Section: Discussionmentioning

confidence: 99%

Pharmacokinetic interaction between modified Atkins diet and antiepileptic drugs in adults with drug‐resistant epilepsy

et al. 2019

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Objective:The aim was to examine the influence of modified Atkins diet on serum concentration of antiepileptic drugs (AEDs). Methods: Prospective data from 63 adult patients with either focal or generalized drug-resistant epilepsy recruited to 12-week dietary treatment as add-on to AEDs are analyzed. AED serum concentrations, ketones, glucose, and hemoglobin A1cwere measured before and after the dietary intervention. Paired t test was used and Spearman correlation coefficient, r, was estimated. Results: Mean age was 37 years (range 16-65 years). Mean serum concentrations of carbamazepine, clobazam, and valproate were significantly reduced after 4 and 12 weeks of the diet period (<.001 ≤ P ≤ .02). Levels of lacosamide, lamotrigine, and topiramate were less reduced (.02 ≤ P ≤ .08), whereas the serum concentrations of oxcarbazepine, zonisamide, and levetiracetam were unchanged (.06 ≤ P ≤ .90).The largest reduction in serum concentration was found for clobazam: mean reduction after 12 weeks was 1.5 μmol/L (34%). Percent change in serum concentration after 4 and 12 weeks of all drugs analyzed was −10.5% (95% confidence interval[CI] −14.1 to −6.8; n = 60; P < .001) and −13.5% (95% CI −18.8 to −8.3; n = 56; P < .001), respectively. Percent change in serum concentration of AEDs was not significantly correlated to percent change in seizure frequency after 12 weeks of dietary treatment (r = .14, P = .33, n = 53) but negatively correlated to urine ketosis (r = −.43; P = .003; n = 46). Significance: A reduction in AED serum concentrations may counteract a seizurereducing effect of the diet, and in patients without such an effect, it may cause seizure aggravation. Thus, we recommend that clinicians who are treating patients with ketogenic diets monitor serum concentrations of the concomitant AEDs. K E Y W O R D Sadults, antiepileptic drugs, epilepsy, ketogenic diet, ketosis, serum concentration | Carbohydrate, E% 3 (3-3) 3 (3-3)Ketogenic ratio 1.7 (1.6-1.9) 1.7 (1.5-1.9) Abbreviation: AEDs, antiepileptic drugs. a Data are mean (range) or frequency (%). b Values presented as mean (95% confidence interval).

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“…In addition, this study included a higher number of patients receiving valproic acid than the other studies did. 4,12 T A B L E 2 Demographics of study patients There are several possible reasons why the serum concentrations of valproic acid decreased with the KD and other dietary therapies.…”

Section: Discussionmentioning

confidence: 99%