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[Blood level profile of valproate administration under therapeutic conditions in children]
F P Meyer1, I Sauer, U Staemmler
1Institut für Klinische Pharmakologie, Medizinischen Akademie Magdeburg.
Insights
This study found that children treated with valproic acid often had excessively high and fluctuating blood levels. Valproic acid was also frequently combined with other antiepileptic drugs, contrary to recommendations.
Area of Science:
- Pediatric Neurology
- Pharmacology
- Clinical Pharmacy
Context:
- Valproic acid is a widely used antiepileptic drug in children.
- Therapeutic drug monitoring is crucial for optimizing treatment and minimizing adverse effects.
- Combined antiepileptic drug therapy is common but requires careful management.
Purpose:
- To evaluate the clinical practice of valproic acid administration in pediatric patients.
- To assess valproate blood levels and identify potential therapeutic drug monitoring issues.
- To determine the frequency of combined antiepileptic drug therapy with valproic acid.
Summary:
- Thirty-two children received valproic acid, with various combinations of other antiepileptic drugs.
- Valproate blood levels were monitored, revealing significantly high plasma concentrations.
- Unnecessary fluctuations in valproate levels and frequent polytherapy were observed, deviating from international guidelines.
Impact:
- Highlights potential challenges in pediatric epilepsy management regarding valproic acid dosing.
- Suggests a need for improved adherence to international therapeutic drug monitoring recommendations.
- Underscores the importance of individualized treatment strategies in pediatric epilepsy to optimize efficacy and safety.
Abstract:
The antiepileptic drug, valproic acid, was administered to 32 children (valproate calcium 8; valproate plus ethosuximide 10; valproate plus phenobarbitone 2; valproate plus primidone 8; valproate plus DPH, primidone and/or carbamazepine 4). They received valproic acid three times daily (8.00 a.m., at noon, 6.00 p.m.). Valproate blood levels were determined. The study revealed that, in contrast to international recommendations, (i) plasma levels were very high, (ii) unnecessary fluctuations occurred, and (iii) obviously valproic acid was too often administered in combined therapy with other antiepileptics.