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Factors influencing valproic acid trough levels in epileptic children

Khouloud Ferchichi1,2, Rim Charfi1,2,3, Syrine Ben Hammamia1,2,3

  • 1University of Tunis El Manar, Faculty of de Medicine of Tunis.

La Tunisie Medicale
|October 23, 2024
PubMed

Insights

Older children with epilepsy on Valproic Acid (V.Acid) are more likely to reach therapeutic drug levels (C0) with increased monitoring. Close follow-up is essential for achieving and maintaining optimal V.Acid C0 in pediatric patients undergoing TDM.

Area of Science:

  • Pharmacology
  • Pediatric Neurology
  • Clinical Pharmacy

Background:

  • Epilepsy management in children requires precise dosing of antiepileptic drugs like Valproic Acid (V.Acid).
  • Therapeutic Drug Monitoring (TDM) is crucial for optimizing V.Acid plasma trough levels (C0) to ensure efficacy and minimize toxicity.
  • Factors influencing V.Acid C0 achievement in pediatric epilepsy patients are not fully elucidated.

Purpose of the Study:

  • To identify key factors affecting Valproic Acid (V.Acid) plasma trough levels (C0) in children with epilepsy.
  • To quantify the influence of these factors on achieving therapeutic V.Acid C0 levels during TDM.

Main Methods:

  • An observational study involving 805 pediatric epilepsy patients (2-18 years) with at least two V.Acid C0 determinations.
  • Assessment of daily V.Acid dose optimization by practitioners.
  • Comparison of patients achieving therapeutic range (TR) versus those outside TR to identify influencing factors.

Main Results:

  • A total of 2537 V.Acid C0 measurements were analyzed.
  • 59.4% of children initially achieved V.Acid C0 within the TR; 72.3% had dose optimization.
  • Increased age (3.79%) and number of V.Acid C0 determinations (7.39%) significantly improved the likelihood of reaching the TR.

Conclusions:

  • Older age and more frequent V.Acid C0 monitoring are associated with a higher probability of achieving therapeutic levels in pediatric epilepsy.
  • Continuous patient follow-up and TDM are critical for successfully reaching and maintaining target V.Acid C0 levels.
Abstract

Keywords:
childrenepilepsyplasma concentrationtherapeutic drug monitoringvalproic acid

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