846: Effect of Therapeutic Plasma Exchange on Antiepileptic Drug Levels in a Patient With Seizures

Precision medicine has the potential to have a significant impact on both drug development and patient care. It is crucial to not only provide prompt effective antiseizure treatment for critically ill patients after seizures start but also have a proactive mindset and concentrate on epileptogenesis and the underlying cause of the seizures or seizure disorders. Critical illness presents different treatment issues compared with the ambulatory population, which makes it challenging to choose the best antiseizure medications and to administer them at the right time and at the right dose. Since there is a paucity of information available on antiseizure medication dosing in critically ill patients, therapeutic drug monitoring is a useful tool for defining each patient's personal therapeutic range and assisting clinicians in decision‐making. Use of pharmacogenomic information relating to pharmacokinetics, hepatic metabolism, and seizure etiology may improve safety and efficacy by individualizing therapy. Studies evaluating the clinical implementation of pharmacogenomic information at the point‐of‐care and identification of biomarkers are also needed. These studies may make it possible to avoid adverse drug reactions, maximize drug efficacy, reduce drug–drug interactions, and optimize medications for each individual patient. This review will discuss the available literature and provide future insights on precision medicine use with antiseizure therapy in critically ill adult patients.

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Personalized antiseizure medication therapy in critically ill adult patients

Almohaish

Cook

Brophy

et al. 2023

Pharmacotherapy

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The effect of plasma exchange on serum levels of lacosamide: A case report

Peters,

Brown,

Thornton

et al. 2023

American Journal of Health-System Pharmacy

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Disclaimer In an effort to expedite the publication of articles, AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. Purpose We describe the case of a 22-year-old male who developed thyroid storm necessitating therapeutic plasma exchange (TPE). The patient’s past medical history was complicated by epilepsy, for which he took lacosamide. Little evidence was available to guide lacosamide dosing while receiving TPE. Because of an exacerbation of the patient’s underlying epilepsy in the context of the thyroid storm, we conducted therapeutic medication monitoring of lacosamide concentrations to guide management. Summary We arranged for measurement of the lacosamide concentration immediately before TPE (5.1 μg/mL) and 2.5 hours after the initial measurement (3.4 μg/mL) to determine the amount of lacosamide removed by TPE. Utilizing population pharmacokinetic parameters, we calculated the expected concentration and compared this to the measured concentration. The difference between these values was used to determine the percentage removed via TPE compared to the expected post-TPE concentration. We found that one TPE session removed an additional 20% of serum lacosamide. Conclusion TPE appeared to remove an additional 20% of lacosamide when compared to the expected post-TPE concentration.

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846: Effect of Therapeutic Plasma Exchange on Antiepileptic Drug Levels in a Patient With Seizures

Cited by 2 publications

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Personalized antiseizure medication therapy in critically ill adult patients

Personalized antiseizure medication therapy in critically ill adult patients

The effect of plasma exchange on serum levels of lacosamide: A case report

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