Therapeutic monitoring of antiepileptic drugs in comatose patients

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Published Aug 17, 2018
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Vol. 96 No. 2 (2018): Issue Feb 2018

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Rim Charfi
Ramla Mizouri
Mouna Ben Sassi
Hanene Eljebari
Nadia Jebabli
Fatma Ben Salem
Sarra Zerei
Ali Mrabet
Riadh Daghfous
Anis Klouz
Issam Salouage
Emna Gaies
Sameh Trabelsi

Abstract

Objective: In this study, we aimed to analyze the trough plasmatic levels (C0) of the antiepileptic drugs (AED) administered by nasogastric tubes (NGT) in comatose patients and to draw up recommendations for therapeutic drug monitoring (TDM) and for the modalities of AED administration by NGT.
Materials and methods: We conducted a retrospective study on comatose patients addressed over six years and 10 months in Clinical Pharmacology for C0 measurement of AED administered by NGT.
Results: In this study, the sex-ratio was 2.38 (44 patients). The patients’ median age was 24 years. There was 14.5% of children (≤16 years). Among the 103 samples, C0 measurement concerned valproic acid in 57%, phenobarbital in 28 % and carbamazepine in 15%. Two AED or more were associated in 42% of patients. AED were associated to other drugs in 85% of cases. The AED C0 were subtherapeutic in 71% of cases. C0/Dp lower than recommanded in 65 %. In these samples, 55% presented at least one drug association with the concerned AED. In 45% of the cases, there was no drug association but a non-respect of modalities of AED administration by NGT in patients.
Conclusion:  The drug monitoring is a useful tool to assess drug-drug interactions and to control modalities of AED administration in comatose patients.

Keywords:

Antiepileptic drugs - Coma - Therapeutic drug monitoring - Nasogastric intubation - Adverse effects - Drug interaction - Drug safety.

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References

  1. Marquet P. Suivi thérapeutique pharmacologique : pour l'adaptation de posologie des médicaments. Paris: Elsevier, 2004.
  2. Junius-Walker U, Theile G, Hummers-Pradier E. Prevalence and predictors of polypharmacy among older primary care patients in Germany. Fam Pract 2007; 24(1):14-9.
  3. Vidal 2014 le dictionnaire. 90ème édition. Issy-les-Moulineaux: Vidal, 2014.
  4. ÅšwiÄ…der MJ, Czuczwar SJ. Interaction of famotidine, an H2 histamine receptor antagonist, with conventional antiepileptic drugs in mice. Pharmacol Rep 2014;66(3):485-91.
  5. Zaccara G, Perucca E. Interactions between antiepileptic drugs, and between antiepileptic drugs and other drugs. Epileptic Disord Int Epilepsy J Videotape 2014;16(4):409-31.
  6. Mori H, Takahashi K, Mizutani T. Interaction between valproic acid and carbapenem antibiotics. Drug Metab Rev. 2007;39(4):647-57.
  7. Levy RH. Cytochrome P450 isozymes and antiepileptic drug interactions. Epilepsia 1995;36 Suppl 5:S8-13.
  8. http://www.hugge.ch/sites/interhug/files/structures/pharmacologie_et_toxicologie_cliniques/documents/inter actions_medicamenteuses_et_cyp450.pdf. [cited 2017 Feb 22]
  9. Talavera S, Grasset L, Verdier E, Brunel P. Administration des médicaments par sonde de nutrition entérale : de l'audit de pratiques à l'élaboration d'outils pour aider le personnel soignant. /data/revues/09850562/v26i3/S0985056212000313/ [Internet]. 2012 Sep 13 [cited 2017 Feb 22]; Available from: http://www.em-consulte.com/en/article/751906.
  10. Haute Autorité de Santé - Soins et surveillance des abords digestifs pour l'alimentation entérale chez l'adulte en hospitalisation et à domicile [Internet]. [cited 2017 Feb 22]. Available from: http://www.has-sante.fr/portail/jcms/c_272139/en/care-and-monitoring-ofenteral-access-for-enteral-nutrition-in-adults-in-hospital-and-at-home.
  11. Engle KK, Hannawa TE. Techniques for administering oral medications to critical care patients receiving continuous enteral nutrition. Am J Health-Syst Pharm AJHP Off J Am Soc Health-Syst Pharm 1999;56(14):1441-4.
  12. Varella L, Jones E, Meguid MM. Drug-nutrient interactions in enteral feeding: a primary care focus. Nurse Pract 1997;22(6):98-104.
  13. Miyagawa CI. Drug-nutrient interactions in critically ill patients. Crit Care Nurse 1993;13(5):69-72, 77-82, 84-90.
  14. Lorent S, Liévin V, Ballarin A, Gossum AV, Preiser J-C. L'administration des médicaments par sonde d'alimentation entérale. Réanimation 2011;20(4):354-7.
  15. Gilbar PJ. A guide to enternal drug administration in palliative care. J Pain Symptom Manage 1999;17(3):197-207.
  16. Stegemann S. Drug administration via enteral tubing: an unresolved but increasing challenge. Expert Opin Drug Deliv 2015;12(2):159-61.