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Related Concept Videos

Antiepileptic Drugs: Modulators of Neurotransmitter Release Mediated by SV2A Protein01:20

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Antiepileptic drugs, such as levetiracetam (Keppra) and brivaracetam (Briviact), have emerged as crucial tools in managing epilepsy. These medications exert their therapeutic effects by targeting the synaptic vesicle protein SV2A, a transmembrane glycoprotein primarily found in the brain.
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In cases of acute poisoning, the primary objective is to prevent further absorption of the toxic substance into the body. Immediate interventions using various decontamination techniques targeting the gastrointestinal (GI) tract can achieve this. Decontamination is crucial to prevent poison from entering the systemic circulation, which involves washing affected areas with water and mild soap and removing contaminated clothing. Once external decontamination is done, attention must be turned to...
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L-carnitine for valproic acid-induced toxicity.

Tomasz Gziut1, Ruben Thanacoody1,2

  • 1National Poisons Information Service (Newcastle unit), Newcastle-upon-Tyne Hospitals NHS Foundation Trust, UK.

British Journal of Clinical Pharmacology
|September 11, 2024
PubMed
Summary

L-carnitine may treat valproic acid toxicity, including liver damage and high ammonia levels. An intravenous loading dose followed by continuous infusion is suggested over oral or bolus methods for better outcomes.

Keywords:
L‐carnitinehyperammonaemiaoverdosevalproic acid

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Area of Science:

  • Pharmacology
  • Biochemistry
  • Clinical Toxicology

Background:

  • Valproic acid (VPA) is widely used for epilepsy and bipolar disorder.
  • VPA metabolism can lead to hepatotoxicity and hyperammonemia.
  • L-carnitine is crucial for mitochondrial fatty acid metabolism.

Purpose of the Study:

  • To review L-carnitine's effectiveness for VPA-induced toxicity.
  • To determine optimal dosing and administration routes for L-carnitine in VPA toxicity.

Main Methods:

  • Literature review of L-carnitine pharmacokinetics and clinical applications.
  • Analysis of studies on VPA-induced adverse effects.

Main Results:

  • VPA toxicity includes hepatotoxicity and hyperammonemia.
  • L-carnitine bioavailability varies by administration route (oral 14-18%).
  • Renal clearance of L-carnitine is dose-dependent.

Conclusions:

  • Evidence supports L-carnitine for VPA-induced hyperammonemia and hepatotoxicity.
  • Optimal L-carnitine dosing and route remain unclear.
  • Advocating for intravenous loading dose (5 mg/kg) followed by continuous infusion.