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Rapid loading of critically ill patients with carbamazepine suspension

M V Miles1, S T Lawless, M B Tennison

  • 1Division of Pharmacy Practice, School of Pharmacy, University of North Carolina, Chapel Hill 27599.

Pediatrics
|August 1, 1990
PubMed

Insights

Carbamazepine suspension effectively manages seizures in critically ill children. Factors like ileus, delayed gastric emptying, and enteral feedings can impact its absorption rate.

Area of Science:

  • Pediatric Critical Care Medicine
  • Clinical Pharmacology
  • Neuropharmacology

Background:

  • Frequent seizures in critically ill pediatric patients require prompt and effective management.
  • Carbamazepine is an established antiepileptic drug, but its absorption characteristics in this population are not well-defined.

Purpose of the Study:

  • To evaluate the absorption rate of carbamazepine suspension in pediatric intensive care unit (PICU) patients.
  • To identify factors influencing carbamazepine absorption in critically ill children.

Main Methods:

  • Six PICU patients received carbamazepine suspension loading doses (7.4-10.4 mg/kg) via nasogastric or nasoduodenal tubes.
  • Carbamazepine serum concentrations were measured at multiple time points (15, 30, 60, 120, 480 minutes) using fluorescence polarization immunoassay.

Main Results:

  • One patient with an ileus did not reach therapeutic carbamazepine concentrations (>4.0 mg/L).
  • Five patients with normal gastrointestinal function achieved mean serum concentrations of 4.3 mg/L at 1 hour and 7.3 mg/L at 2 hours.
  • Delayed gastric emptying and concurrent enteral feedings were associated with slower carbamazepine absorption.

Conclusions:

  • Rapid loading with carbamazepine suspension is a viable option for managing frequent seizures in critically ill pediatric patients.
  • Gastrointestinal function, specifically gastric emptying and the presence of enteral feedings, significantly influences carbamazepine absorption kinetics.

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