Sixty-eight patients with convulsive status epilepticus (SE) were randomly assigned to two groups to study the efficacy of sodium valproate (VPA) and phenytoin (PHT). Seizures were aborted in 66% in the VPA group and 42% in the PHT group. As a second choice in refractory patients, VPA was effective in 79% and PHT was effective in 25%. The side effects in the two groups did not differ. Sodium valproate may be preferred in convulsive SE because of its higher efficacy.

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The clinical impact of coadministration of the oral SARS-CoV-2 protease inhibitor nirmatrelvir and the pharmacokinetic booster ritonavir among vaccinated populations is uncertain. This study emulated a clinical trial to assess whether nirmatrelvir plus ritonavir reduces risk for hospitalization or death among outpatients with early COVID-19 in the setting of prevalent SARS-CoV-2 immunity and immune-evasive SARS-CoV-2 lineages.

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Essentials The optimal dosing strategy of rivaroxaban for patients at the extremes of body weight is not known.A pharmacokinetic study was conducted based in real‐world patients in a London teaching hospital.In the cohort of patients studied, weight on its own did not impact significantly on rivaroxaban pharmacokinetics.A larger study with patients in the weight categories of interest from the real‐world population is required to further clarify the situation. BackgroundThere is concern amongst clinicians that the fixed dosing strategy of rivaroxaban for the treatment of venous thromboembolism (VTE) might not be optimal in those patients under or overweight.ObjectiveTo develop a pharmacokinetic model for rivaroxaban, based on real‐world patients, specifically focusing on the impact of patients’ body weight on rivaroxaban pharmacokinetics.Patients/methodsOne hundred and one patients prescribed rivaroxaban prophylactic or treatment doses for the prevention or treatment of VTE were recruited at a London teaching hospital. Subjects had up to 3 rivaroxaban concentrations measured during a single dosing period (trough, 1 and 3 hours post dose). Population pharmacokinetic analyses was conducted to develop a rivaroxaban model, which was subsequently evaluated.ResultsA one‐compartment model with between‐subject variability on rivaroxaban clearance and volume of distribution, with a combined (additive and proportional) error model, best fitted the data. Following a full covariate analysis, creatinine clearance on rivaroxaban clearance was found to be the significant covariate impacting on the pharmacokinetic profile of rivaroxaban in the dataset.ConclusionsOur results suggest that the most important covariate impacting on rivaroxaban pharmacokinetics is creatinine clearance and the weight alone has little effect. These findings are in line with previous studies for rivaroxaban. Larger datasets, from real‐world patients who are followed longitudinally, should be conducted to provide front‐line clinicians with further reassurance when prescribing rivaroxaban for the acute management of VTE.