The influence of polytherapy on the relationships between serum carbamazepine and its metabolites in epileptic children

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Abstract

The influence of polytherapy on the relationships between the age, weight, carbamazepine (CBZ) dose, total clearance and intrinsic clearance, with concentrations, concentration ratios and level/dose ratios of CBZ, carbamazepine-10,11-epoxide (CBZ-E) and trans-10,1 l-dihydroxy-10,11-dihydro-carbamazepine (CBZ-H) are investigated. Three groups of patients with CBZ monotherapy, or receiving CBZ polytherapy by taking CBZ and valproic acid (VPA) or CBZ plus other antiepileptic drugs (AEDs) were studied. The significant correlations between serum CBZ concentrations and CBZ dose in patients taking CBZ alone were no longer significant in patients with polytherapy and the positive associations between serum CBZ-E concentrations and CBZ dose were lost in patients with CBZ + VPA. Only the concentrations of CBZ-H had significant correlations with CBZ dose in all three groups of patients. Results from this relationship study indicate a heteroinduction effect of other AEDs on CBZ metabolism and a relatively weak influence on CBZ-E elimination. Data also suggest that there is a block in the biotransformation from CBZ-E to CBZ-H in patients taking CBZ + VPA, presumably caused by the inhibition effect of VPA on epoxide hydrolase. Therapeutic drug monitoring of CBZ will benefit from the knowledge obtained from the relationship study.

Original languageEnglish (US)
Pages (from-to)257-269
Number of pages13
JournalEpilepsy Research
Volume17
Issue number3
DOIs
StatePublished - 1994

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Carbamazepine
Serum
Valproic Acid
Anticonvulsants
Epoxide Hydrolases

Keywords

  • Antiepileptic drugs
  • Carbamazepine
  • Carbamazepine diol
  • Carbamazepine epoxide
  • Epileptic children
  • Valproic acid

ASJC Scopus subject areas

  • Clinical Neurology
  • Pediatrics, Perinatology, and Child Health
  • Neurology

Cite this

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title = "The influence of polytherapy on the relationships between serum carbamazepine and its metabolites in epileptic children",
abstract = "The influence of polytherapy on the relationships between the age, weight, carbamazepine (CBZ) dose, total clearance and intrinsic clearance, with concentrations, concentration ratios and level/dose ratios of CBZ, carbamazepine-10,11-epoxide (CBZ-E) and trans-10,1 l-dihydroxy-10,11-dihydro-carbamazepine (CBZ-H) are investigated. Three groups of patients with CBZ monotherapy, or receiving CBZ polytherapy by taking CBZ and valproic acid (VPA) or CBZ plus other antiepileptic drugs (AEDs) were studied. The significant correlations between serum CBZ concentrations and CBZ dose in patients taking CBZ alone were no longer significant in patients with polytherapy and the positive associations between serum CBZ-E concentrations and CBZ dose were lost in patients with CBZ + VPA. Only the concentrations of CBZ-H had significant correlations with CBZ dose in all three groups of patients. Results from this relationship study indicate a heteroinduction effect of other AEDs on CBZ metabolism and a relatively weak influence on CBZ-E elimination. Data also suggest that there is a block in the biotransformation from CBZ-E to CBZ-H in patients taking CBZ + VPA, presumably caused by the inhibition effect of VPA on epoxide hydrolase. Therapeutic drug monitoring of CBZ will benefit from the knowledge obtained from the relationship study.",
keywords = "Antiepileptic drugs, Carbamazepine, Carbamazepine diol, Carbamazepine epoxide, Epileptic children, Valproic acid",
author = "Liu Hua and Delgado, {Mauricio R.}",
year = "1994",
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T1 - The influence of polytherapy on the relationships between serum carbamazepine and its metabolites in epileptic children

AU - Hua, Liu

AU - Delgado, Mauricio R.

PY - 1994

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N2 - The influence of polytherapy on the relationships between the age, weight, carbamazepine (CBZ) dose, total clearance and intrinsic clearance, with concentrations, concentration ratios and level/dose ratios of CBZ, carbamazepine-10,11-epoxide (CBZ-E) and trans-10,1 l-dihydroxy-10,11-dihydro-carbamazepine (CBZ-H) are investigated. Three groups of patients with CBZ monotherapy, or receiving CBZ polytherapy by taking CBZ and valproic acid (VPA) or CBZ plus other antiepileptic drugs (AEDs) were studied. The significant correlations between serum CBZ concentrations and CBZ dose in patients taking CBZ alone were no longer significant in patients with polytherapy and the positive associations between serum CBZ-E concentrations and CBZ dose were lost in patients with CBZ + VPA. Only the concentrations of CBZ-H had significant correlations with CBZ dose in all three groups of patients. Results from this relationship study indicate a heteroinduction effect of other AEDs on CBZ metabolism and a relatively weak influence on CBZ-E elimination. Data also suggest that there is a block in the biotransformation from CBZ-E to CBZ-H in patients taking CBZ + VPA, presumably caused by the inhibition effect of VPA on epoxide hydrolase. Therapeutic drug monitoring of CBZ will benefit from the knowledge obtained from the relationship study.

AB - The influence of polytherapy on the relationships between the age, weight, carbamazepine (CBZ) dose, total clearance and intrinsic clearance, with concentrations, concentration ratios and level/dose ratios of CBZ, carbamazepine-10,11-epoxide (CBZ-E) and trans-10,1 l-dihydroxy-10,11-dihydro-carbamazepine (CBZ-H) are investigated. Three groups of patients with CBZ monotherapy, or receiving CBZ polytherapy by taking CBZ and valproic acid (VPA) or CBZ plus other antiepileptic drugs (AEDs) were studied. The significant correlations between serum CBZ concentrations and CBZ dose in patients taking CBZ alone were no longer significant in patients with polytherapy and the positive associations between serum CBZ-E concentrations and CBZ dose were lost in patients with CBZ + VPA. Only the concentrations of CBZ-H had significant correlations with CBZ dose in all three groups of patients. Results from this relationship study indicate a heteroinduction effect of other AEDs on CBZ metabolism and a relatively weak influence on CBZ-E elimination. Data also suggest that there is a block in the biotransformation from CBZ-E to CBZ-H in patients taking CBZ + VPA, presumably caused by the inhibition effect of VPA on epoxide hydrolase. Therapeutic drug monitoring of CBZ will benefit from the knowledge obtained from the relationship study.

KW - Antiepileptic drugs

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KW - Carbamazepine epoxide

KW - Epileptic children

KW - Valproic acid

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