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Topiramate pharmacokinetics in infants
T A Glauser1, M V Miles, P Tang
1Children's Comprehensive Epilepsy Program, Department of Neurology, Children's Hospital Medical Center, Cincinnati, Ohio 45229-3039, USA.
Epilepsia
|June 15, 1999
Summary
Infants may need higher topiramate (TPM) doses than older individuals. Weight-based dosing and titration to effect are crucial for managing infantile spasms with TPM.
Area of Science:
- Pharmacology
- Pediatric Neurology
- Clinical Pharmacy
Background:
- Infantile spasms (IS) are a severe epilepsy syndrome in infants.
- Topiramate (TPM) is used for refractory IS, but its pharmacokinetics in infants are not well-established.
Purpose of the Study:
- To determine the pharmacokinetics of topiramate (TPM) in infants younger than 4 years with refractory infantile spasms.
- To provide preliminary data for optimizing TPM dosing in this population.
Main Methods:
- Assessed TPM pharmacokinetics in 5 infants receiving stable doses for over 7 days.
- Collected blood samples at multiple time points post-dose for TPM concentration analysis.
- Utilized noncompartmental analysis to calculate pharmacokinetic profiles.
Main Results:
- TPM pharmacokinetics in infants appeared linear.
- Mean TPM plasma clearance (CL/F) was higher in infants compared to children, adolescents, and adults.
- Concomitant enzyme-inducing antiepileptic drugs (AEDs) increased TPM CL/F and shortened its half-life.
Conclusions:
- Infants may require higher weight-based topiramate doses than older age groups.
- Therapeutic decisions for TPM in infants should prioritize titration to effect over absolute dose.
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