Levetiracetam circulating concentrations and response in status epilepticus.

Détails

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Etat: Public
Version: de l'auteur
Licence: Non spécifiée
ID Serval
serval:BIB_4F4192BBC5DD
Type
Article: article d'un périodique ou d'un magazine.
Collection
Publications
Institution
Titre
Levetiracetam circulating concentrations and response in status epilepticus.
Périodique
Epilepsy & behavior
Auteur(s)
Perrenoud M., André P., Buclin T., Decosterd L.A., Rossetti A.O., Novy J.
ISSN
1525-5069 (Electronic)
ISSN-L
1525-5050
Statut éditorial
Publié
Date de publication
11/2018
Peer-reviewed
Oui
Volume
88
Pages
61-65
Langue
anglais
Notes
Publication types: Journal Article ; Research Support, Non-U.S. Gov't
Publication Status: ppublish
Résumé
Intravenous levetiracetam (LEV) is broadly used in the treatment of status epilepticus (SE). A loading dose is usually infused, aiming to reach quickly the range of plasma concentrations considered as therapeutic (12-46 mg/l). The aim of the study was to evaluate the response to LEV in SE, correlated exposure assessed by plasma concentration monitoring, as well as calculated exposure parameters.
We retrospectively analyzed a SE registry, including patients since 2015 with at least one available LEV plasma level measured less than 36 h after loading. A Bayesian maximum likelihood approach based on a population pharmacokinetic model was used to estimate LEV exposure parameters. We compared plasma levels and pharmacokinetics parameter estimates between responders and nonresponders. Therapeutic response was defined as SE cessation within 24 h following LEV introduction without a need for additional antiepileptic drug (AED).
We included 29 patients (45 plasma levels). Variability was salient in LEV loading doses (ranging between 17 and 38 mg/kg) and monitoring practice. There was no difference in median plasma concentrations (19.5 versus 21.5 mg/l; p = 0.71), median estimated LEV exposure (25.8 versus 37.0 mg/l; p = 0.61), peak (30.4 versus 41.5 mg/l; p = 0.36), or residual levels after loading dose (14.4 versus 20.5 mg/l; p = 0.07) between responders and nonresponders.
Levetiracetam exposure does not seem to differ significantly between responders and nonresponders; greater exposure was not associated with better outcome. Loading doses of 30 mg/kg seem, however, appropriate to quickly reach the target exposure level. The short LEV half-life makes standardized sampling measurement necessary to obtain directly interpretable LEV levels.
Mots-clé
Administration, Intravenous, Aged, Aged, 80 and over, Anticonvulsants/pharmacokinetics, Bayes Theorem, Dose-Response Relationship, Drug, Female, Humans, Levetiracetam/pharmacokinetics, Likelihood Functions, Male, Middle Aged, Retrospective Studies, Status Epilepticus/blood, Status Epilepticus/drug therapy, Critical care, Pharmacokinetic analysis, Therapeutic drug monitoring
Pubmed
Web of science
Création de la notice
17/10/2018 13:28
Dernière modification de la notice
13/09/2019 7:08
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