Article

Valproic acid (VPA) is a widely prescribed broad-spectrum antiepileptic
drug. However, the use of VPA is complicated in clinical practice by its
remarkably wide variability of pharmacokinetics.
The objective of this study was
to investigate the effects of demographic factors and associated therapies on
steady-state plasma VPA concentrations in patients with epilepsy. METHODS: This
retrospective cohort study was carried out using the routine therapeutic drug
monitoring (TDM) database. Stepwise logistic regression analysis was used to
compare serum VPA levels in 78 epilepsy patients treated with VPA in association
with at least one other drug that could have interacted with CYP2C9, CYP2C19 or
UGT enzymes. RESULTS: The frequency of subtherapeutic serum VPA levels was
significantly increased with younger age (P<0.02), the number of co-medications
(P<0.007) and use of enzyme-inducing co-medications (P<0.02). No significant
correlations between VPA dose and trough plasma concentrations were found, as the
latter did not increase in proportion to the dose. CONCLUSION: Routine monitoring
of VPA serum levels would be extremely useful in epilepsy patients in the
pediatric age group and in those who require associated enzyme-inducing
medications.
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Langue : ANGLAIS