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Salivary free concentrations of anti-epileptic drugs: an evaluation in a routine clinical setting
Mohammed al Za'abi1, Dirk Deleu, Chris Batchelor
1Department of Clinical Pharmacology & Therapeutics, Sultan Qaboos University Hospital, P.O. Box 35, Al-Khod, Muscat-123, Sultanate of Oman.
Objective:
This study was aimed at correlating the salivary and serum free concentrations of anti-epileptic drugs (carbamazepine, phenytoin and sodium valproate) in a population of neurological patients in a routine clinical setting.
Method:
Twenty-seven paired serum/saliva specimens from 22 patients: 10 for carbamazepine, 8 for phenytoin and 9 for sodium valproate were obtained to study these correlations. Salivary and serum free concentrations of anti-epileptic drugs, anti-epileptic drug dosing history, and associated information were collected prospectively. The salivary and serum free concentrations of the anti-epileptic drugs were simultaneously quantified using fluorescence polarization immunoassay (TDx analyzer).
Results:
For both carbamazepine and phenytoin there was a strong correlation between the salivary and serum free concentrations, 0.99 and 0.98, respectively. The mean ratio of salivary to serum free carbamazepine concentration was 1.02 +/- 0.11 and 0.82 +/- 0.15 for phenytoin. A poor correlation between salivary and serum free concentration was observed for sodium valproate (0.70) with a mean ratio of salivary to serum free concentration of 0.48 +/- 0.27.
Conclusion:
Monitoring of free salivary concentrations of anti-epileptic drugs, particularly phenytoin and carbamazepine proved to be a realistic alternative in this routine clinical setting.
