Appropriateness of Antiepileptic Drug-Level Monitoring at A Childrens’ Hospital in Mexico.
Maribel Márquez Cruz1, Mirna Elizabeth Ruiz2, Anaya Alejandro Chehue Romero1 and Ana Luisa Robles-Piedras11Universidad Autónoma del Estado de Hidalgo Instituto de Ciencias de la Salud Área Académica de Farmacia Circuito Ex-Hacienda La Concepción, Km. 1.5 San Agustín Tlaxiaca, Hidalgo. México c.p. 42160.
2Hospital del Niño DIF Hidalgo Blvd. Felipe Ángeles Km 84.5, Venta Prieta, Pachuca de Soto, Hidalgo. México c.p. 42083.Corresponding Author E-mail: mary_mc17@hotmail.com
Abstract: In Mexico, plasma drug monitoring is being used to check toxicity, compliance, and dose titration in treatment with antipileptic drugs (AEDs), but without taking into account the principles of pharmacokinetics due to the absence of a clinical pharmacokinetic service with specialized pharmacists. The present retrospective study was performed to assess the proportion of AED serum level determinations for phenytoin, carbamazepine, phenobarbital and valproic acid fulfilling criteria for appropriate drug level monitoring in hospitalized patients, as well as the potential pharmacokinetic interactions between medications received. Only 40% of requests to measuring concentration levels of phenytoin in the patient were done having reached steady state, followed for 75% for phenobarbital, 79% for valproic acid and 91% for carbamazepine. Therapeutic levels were achieved in a much higher proportion of patients (60%) on phenobarbital treatment as compared to only 26% patients on phenytoin therapy. A total of 117 potential pharmacokinetic interactions were found. We recommend that the better clinical outcome can be evaluated only by monitoring the pharmacokinetic parameters for the variations appearing on individual patients, so that the overutilization or under-utilization or optimum TDM utilization service given to the patients can be analyzed and better patient outcomes can be maximized.
Keywords: Antiepileptic; Drug; Timing; Evaluation Back to TOC