Titre du document / Document title

Serum concentrations of Topiramate in patients with epilepsy: Influence of dose, age, and comedication

Auteur(s) / Author(s)

MAY Theodor W. ⁽¹⁾ ; RAMBECK Bernhard ⁽¹⁾ ; JÜRGENS Uwe ⁽¹⁾ ;

Affiliation(s) du ou des auteurs / Author(s) Affiliation(s)

⁽¹⁾ Department of Biochemistry, Gesellschaft für Epilepsieforschung, Bielefeld, ALLEMAGNE

Résumé / Abstract

Topiramate is a new antiepileptic drug (AED) approved as add-on therapy. Previous studies have shown that topiramate has only a limited effect on other AEDs, but its own metabolism can be induced by enzyme-inducing drugs. The aim of this study was to investigate the influence of topiramate dose, age, and comedication, especially of carbamazepine, phenytoin, phenobarbital, oxcarbazepine, lamotrigine, and valproic acid (VPA) on topiramate serum concentrations in patients with epilepsy. In total 480 samples of 344 inpatients who fulfilled the inclusion criteria (e.g., trough concentration, body weight available) were investigated. The topiramate serum concentration in relation to topiramate dose per body weight (level-to-dose ratio) was calculated and compared for patients receiving topiramate monotherapy and for patients receiving topiramate plus one other AED. Analysis of covariance (using age as covariate) showed that comedication had a highly significant influence on the topiramate serum concentrations. Regression analysis including all 480 samples confirmed that in combinations with phenytoin, carbamazepine, phenobarbital, and oxcarbazepine, the topiramate concentrations were significantly lower compared with topiramate monotherapy, whereas VPA and lamotrigine had no significant influence. Moreover, regression analysis indicated that primidone and methsuximide lowered topiramate concentrations, whereas gabapentin, bromide, and sulthiame did not. In addition to comedication, the patient's age was significantly correlated with topiramate clearance. In accordance with the results of previous studies, these results indicated that infants and children had lower topiramate concentrations than adults receiving the same topiramate dose per body weight. Comedication and age should be considered in adjusting topiramate dosage. Determination of topiramate serum concentrations may be useful, especially when enzyme-inducing drugs are withdrawn or added.

Revue / Journal Title

Therapeutic drug monitoring   ISSN 0163-4356   CODEN TDMODV 

Source / Source

2002, vol. 24, n^o3, pp. 366-374 (33 ref.)

Langue / Language

Anglais

Editeur / Publisher

Lippincott Williams & Wilkins, Hagerstown, MD, ETATS-UNIS  (1979) (Revue)

Mots-clés anglais / English Keywords

Cerebral disorder ; Central nervous system disease ; Nervous system diseases ; Human ; Oral administration ; Multiple dose ; Biological monitoring ; Drug interaction ; Drug combination ; Age ; Dose activity relation ; Chemotherapy ; Treatment ; Sex ; Interindividual comparison ; Adult ; Child ; Blood ; Blood plasma ; Pharmacokinetics ; Anticonvulsant ; Epilepsy ; Topiramate ;

Mots-clés français / French Keywords

Encéphale pathologie ; Système nerveux central pathologie ; Système nerveux pathologie ; Homme ; Voie orale ; Dose répétée ; Surveillance biologique ; Interaction médicamenteuse ; Association médicamenteuse ; Age ; Relation dose réponse ; Chimiothérapie ; Traitement ; Sexe ; Comparaison interindividuelle ; Adulte ; Enfant ; Sang ; Plasma sanguin ; Pharmacocinétique ; Anticonvulsivant ; Epilepsie ; Topiramate ;

Mots-clés espagnols / Spanish Keywords

Encéfalo patología ; Sistema nervosio central patología ; Sistema nervioso patología ; Hombre ; Vía oral ; Dosis múltiple ; Vigilancia biológica ; Interacción medicamentosa ; Asociación medicamentosa ; Edad ; Relación dosis respuesta ; Quimioterapia ; Tratamiento ; Sexo ; Comparación interindividual ; Adulto ; Niño ; Sangre ; Plasma sanguíneo ; Farmacocinética ; Anticonvulsivante ; Epilepsia ; Topiramato ;

Localisation / Location

INIST-CNRS, Cote INIST : 18087, 35400010820406.0070