| Autor: |
J Sala Padró, R. Jódar Masanes, M Falip Centellas, C Mariño Fernández, R Rigo Bonnin, C. Esteban Sanchez, R Juvany Roig |
| Rok vydání: |
2018 |
| Předmět: |
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| Zdroj: |
Eur J Hosp Pharm |
| Popis: |
BACKGROUND: Levetiracetam (LEV) is a second-generation antiepileptic drug used as a unique or adjunctive therapy for treating partial or generalised epilepsy. Its maximum dose according to the summary product is 3000 mg/day. In patients with resistant epilepsy sometimes it is used at doses higher than recommended. A recent report suggests that high doses may still be possible without toxicity.(1) PURPOSE: To describe the importance of therapeutic drug monitoring (TDM) of LEV for minimising toxicity when it is used at doses higher than recommended. MATERIAL AND METHODS: Case report of 57-years-old male diagnosed with symptomatic focal epilepsy and human immunodeficiency virus (HIV). Antiepileptic treatment consists of LEV 4000 mg/day, topiramate 300 mg/day and clonazepam 4 mg/day since 2010 plus lacosamide 200 mg/day added in 2015. In September 2016 he had a new neurological crisis and dosage was increased to 4500 mg/day. Antiretroviral medication (AM) was changed in 2013 from tenofovir/efavirenz/emtricitabine to abacavir/lamivudine plus efavirenz. In January 2017 AM medication was simplified to dolutegravir/abacavir/lamivudine. RESULTS: LEV trough plasma levels (LEVTPL) were 35.9 µg/mL (therapeutic range is 10–40 µg/mL) at the beginning of 2016, 6 years after treatment with LVT 4000 mg/day, glomerular filtration (GFR) calculated by CKD-EPI was >60 ml/min/1.73 m(2) and the patient did not have clinical signs of toxicity. Three months after increasing LEV dose to 4500 mg/day the patient presented symptoms of intoxication, felt tired and sleepy. TDM confirmed supratherapeutic LEVTPL of 67.1 µg/mL accompanied by a slight deterioration of renal function (GFR: 50 ml/min/1.73 m(2)). Concomitant medication seemed not to interact with LEV. LEV dose was reduced to 3500 mg/day. Three months’ later, LEVTPL values returned to normal (36.3 µg/mL) and clinical signs of toxicity disappeared. CONCLUSION: LEV at doses higher than recommended could be used safely if there is a close TDM programme to ensure treatment effectiveness and minimise adverse effects. REFERENCES AND/OR ACKNOWLEDGEMENTS: 1. Stepanova D, Beran R. Measurement of levetiracetam drug levels to assit with seizure control and monitoring of drug interactions with other Anti-Epileptic Medication (AEMs). Seizure2014;23:371–376. No conflict of interest |
| Databáze: |
OpenAIRE |
| Externí odkaz: |
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