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Monitoring salivary lamotrigine concentrations.

Stephen A Malone1, Mervyn J Eadie, Russell S Addison

  • 1Royal Children's Hospital, Brisbane, Queensland, Australia.

Journal of Clinical Neuroscience : Official Journal of the Neurosurgical Society of Australasia
|October 20, 2006
PubMed
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Saliva lamotrigine concentration measurements correlate closely with plasma levels after drug ingestion. This finding supports saliva analysis as a practical method for therapeutic drug monitoring, especially in children.

Area of Science:

  • Pharmacology
  • Clinical Chemistry
  • Analytical Chemistry

Background:

  • Therapeutic drug monitoring (TDM) is crucial for optimizing lamotrigine dosage.
  • Plasma concentration measurements are the standard for lamotrigine TDM.
  • Non-invasive methods for TDM are highly desirable.

Purpose of the Study:

  • To evaluate the correlation between lamotrigine concentrations in saliva and plasma.
  • To determine the feasibility of using saliva for lamotrigine therapeutic drug monitoring.
  • To investigate lamotrigine pharmacokinetics in pediatric populations via salivary analysis.

Main Methods:

  • Simultaneous measurement of lamotrigine in stimulated and unstimulated saliva and plasma.
  • Analysis of samples from adult volunteers and pediatric patients on antiepileptic therapy.

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  • Correlation analysis of drug concentrations over a 32-hour period.

    • Main Results:

    • A close correlation was observed between saliva and plasma lamotrigine concentrations (r > 0.78) at least 2 hours post-dose.
    • Stimulated and unstimulated saliva concentrations were similar, with minimal impact on secretion rate.
    • A linear relationship was found between saliva-to-plasma concentration ratio and plasma lamotrigine levels.

    Conclusions:

    • Salivary lamotrigine concentration measurement is a practicable approach for therapeutic drug monitoring.
    • This method offers significant implications for understanding lamotrigine pharmacokinetics, particularly in pediatric patients.
    • Precise timing of saliva collection and individual calibration are key for accurate salivary TDM.