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The pharmacology of chewable versus regular carbamazepine in chronically treated children with epilepsy
P Camfield1, P Hwang, C Camfield
1IWK Children's Hospital, Department of Pediatrics, Dalhousie University, Halifax, Nova Scotia, Canada.
Insights
This study compared chewable and regular carbamazepine (CBZ) for epilepsy in children. Results showed similar seizure control and side effects, but unpredictable peak levels suggest switching forms may help manage side effects.
Area of Science:
- Pharmacology
- Pediatric Neurology
- Epilepsy Treatment
Background:
- Carbamazepine (CBZ) is a common antiepileptic drug.
- Different formulations of CBZ, such as chewable and regular tablets, exist.
- Understanding pharmacokinetic differences between formulations is crucial for pediatric epilepsy management.
Purpose of the Study:
- To compare serum levels of carbamazepine (CBZ) and its epoxide metabolite between chewable and regular CBZ tablets in children with epilepsy.
- To assess if formulation differences impact seizure control and side effect profiles.
- To investigate potential variability in peak and trough serum concentrations.
Main Methods:
- A crossover study involving 44 children with epilepsy on chronic CBZ monotherapy.
- Children received regular CBZ for one month, followed by chewable CBZ for one month (or vice versa).
- Fasting predose serum CBZ and CBZ epoxide levels were measured weekly; intensive 12-hour sampling was done in a subset.
Main Results:
- No consistent differences in weekly trough serum levels of CBZ or CBZ epoxide were observed between formulations.
- Seizure control and reported side effects were similar for both chewable and regular CBZ.
- Individual patient data revealed unpredictable differences in peak CBZ levels, with five patients showing higher peaks on chewable and five on regular CBZ.
Conclusions:
- Regular and chewable CBZ formulations can exhibit unpredictable differences in peak serum levels, though trough levels are generally consistent.
- Switching between regular and chewable CBZ formulations may offer a strategy to manage or alleviate peak-level-related side effects in pediatric epilepsy patients.
Abstract:
We report the first comparison of Chewable and Regular Carbamazepine (CBZ) tablets in children with epilepsy. Forty-four children receiving chronic monotherapy CBZ participated. In month 1 children received regular CBZ; in month 2, the same dose of Chewable CBZ. Once per week fasting predose CBZ and CBZ epoxide serum levels were determined. In a subset of 15 children, at the end of each month serum levels were obtained every 2 hours for 12 hours beginning pre-dose. Standards for CBZ and CBZ epoxide were tested in each centre. Overall, weekly levels showed no consistent differences between the month on chewable CBZ and regular CBZ. Seizure control and rates of reported side effects were similar. In five patients chewable CBZ produced higher peak CBZ levels while five had higher peaks with regular CBZ. In conclusion, regular and chewable CBZ often have unpredictable differences in peak but not trough levels of CBZ suggesting that peak level side effects with one form of CBZ might be alleviated by changing to the other.