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RESULTS OF THERAPEUTIC DRUG MONITORING COMBINATION THERAPY OF ANTICONVULSANTS IN CLINICAL PRACTICS

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Abstract

Abstract: this paper presents the results of therapeutic drug monitoring (TDM) of anticonvulsants – valproats and carbamazepins. Analysis include 800 patients with epilepsy in clinical practices, who received monotherapy and drug combinations. We determine plasma concentrations in two points: Cmin – before use next dose and Cmax – after next dose; concentration range for valproats – 50-150 mg/l, for carbamazepin – 4-12 mg/l. Plasma concentrations of valproats was statistically low in combination with carbamazepins than in monotherapy: Cmin 44,1±1,4 versus 62.1±2.0 (р<0,001) и Cmax 57.6±1.9 versus 76.5±2.4, without differences in daily doses. The frequency of achievement the therapeutic concentrations of valproats on valproat/carbamazepin combination was 34% versus 67% in monotherapy as result of inducing metabolism valproate acid by carbamazepin. For carbamazepin there was tendency for high frequency of achievement the therapeutic concentrations on combination treatment than on monotherapy – 86% versus 75.9%, but the doses of carbamazepin were also higher in combination therapy. However, plasma concentrations of carbamazepin were statistically higher only in combinations with other anticonvulsants exclude valproats: Cmin 8.0±0.2 versus 6.1±0.16 и Cmax 9.4±0.2 versus 7.3±0.18 (р<0,001) in monotherapy. The frequency of achievement the therapeutic concentrations for valproats and carbamazepin simultaneously in combination therapy was only 28.5%. This demonstrate the level of drug interactions in combination therapy of epilepcy especially with valproats and carbamazepin.

About the Authors

M. V. Leonova
Pirogov Russian National Research Medical University, Moscow
Russian Federation


Yu. B. Belousov
Pirogov Russian National Research Medical University, Moscow
Russian Federation


I. F. Tischenkova
Pirogov Russian National Research Medical University, Moscow
Russian Federation


L. L. Shteinberg
Pirogov Russian National Research Medical University, Moscow
Russian Federation


A. V. Sokolov
Pirogov Russian National Research Medical University, Moscow
Russian Federation


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For citation:


Leonova M.V., Belousov Y.B., Tischenkova I.F., Shteinberg L.L., Sokolov A.V. RESULTS OF THERAPEUTIC DRUG MONITORING COMBINATION THERAPY OF ANTICONVULSANTS IN CLINICAL PRACTICS. Epilepsia and paroxysmal conditions. 2014;6(4):6-14. (In Russ.)

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ISSN 2077-8333 (Print)
ISSN 2311-4088 (Online)