Pharmacokinetics of sulthiame in epileptic patients

Sulthiame is an antiepileptic drug that was introduced approximately 30 years ago for the treatment of epilepsy. Currently it is rarely used, but recent studies show its efficacy, especially in the treatment of focal epilepsies in children. Because there are hardly any pharmacokinetic studies of sulthiame in humans, we studied the dose-level relationship, the elimination half-life, and the daily fluctuations in the concentration of sulthiame among children and adults with epilepsy. The evaluation of the sulthiame serum concentrations of 86 patients gave, considering age and comedication, a relatively high correlation (r = 0.82) between the sulthiame dose/body weight and the sulthiame serum concentration. Children on a comparable sulthiame dose per body weight have lower sulthiame concentrations than adults. In our study sulthiame was, with few exceptions, administered in combination with other antiepileptic drugs. The sulthiame serum concentrations were lower in comedication with carbamazepine than with valproic acid. The evaluation of the individual sulthiame dose-level relationship of 8 patients showed in most cases a close and linear relationship. After withdrawal of sulthiame in 11 patients, short elimination half-lives (8.65 +/- 3.10 h) were estimated. This was in accordance with the large daily fluctuations in the sulthiame concentrations (swing: 103.9 +/- 59.3%) of the nine patients examined. The shorter half-lives and higher daily fluctuations in children indicate a higher clearance of sulthiame among children.