A prospective study between carbamazepine, phenytoin and sodium valproate as monotherapy in previously untreated and recently diagnosed patients with epilepsy.

Callaghan, N.; Kenny, Rose Anne; O’Neill, Billy Lane; Crowley, Michael J.; Goggin, T.

doi:10.1136/jnnp.48.7.639

Cited by 173 publications

(73 citation statements)

References 16 publications

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“…Sodium valproate (VPA), the sodium salt of 1982), which is now recognised as a first line valproic acid, is a broad spectrum anticonvulsant agent for the management of partial and generaldrug (Richens & Ahmed, 1975; al., ized seizures (Callaghan et al, 1985;Turnbull et 1979;Covanis et al, 1982;Callaghan et al, al., 1985). Its branched chain fatty acid structure Correspondence: Dr M. J.…”

Section: Introductionmentioning

confidence: 99%

Effect of sodium valproate on carbamazepine disposition and psychomotor profile in man.

Macphee

Mitchell

Wiseman

et al. 1988

Brit J Clinical Pharma

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1 The effect of sodium valproate (VPA; 500 mg thrice daily for 7 days) and matched placebo on the disposition and psychomotor profile of a single dose of carbamazepine (CBZ; 10 mg kg-1) was studied in eight healthy male subjects using a randomised balanced crossover design.2 VPA alone had no effect on antipyrine clearance, urinary 6p-hydroxycortisol excretion and a battery of psychomotor function tests after 3 days' treatment despite achieving a mean steady-state concentration (90 ± 6 mg 1-1) well within the target range (50-100 mg I-1) for the drug.3 VPA pre-treatment did not alter total CBZ area under the concentration-time curve (AUC 0-59 h) but did prolong CBZ elimination half life by 12% (P < 0.01). AUC 0-59 h for free plasma CBZ was 13% higher (P < 0.02) and half-life of unbound CBZ 16% longer (P < 0.02) during VPA treatment. CBZ-10, 11 epoxide (CBZ-E) levels (52%) and CBZ-E/ CBZ ratios (45%) were both elevated by concurrent VPA (P < 0.05) and free CBZ fraction was increased by 7% (P < 0.02). 4 The sole effect of VPA on the psychomotor profile of CBZ was prolongation of card sorting time (P < 0.05), although CBZ-related side effects were reported as more severe when VPA was also taken (P < 0.01). 5 These data suggest that VPA displaces CBZ from plasma protein binding sites and inhibits the metabolism of both the parent drug and its epoxide. The effect of VPA on the psychomotor profile of a large single dose of CBZ was minimal. 6 Further studies in epileptic patients receiving both these anticonvulsant drugs are warranted to appraise the extent and clinical relevance of their interaction.

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Section: Introductionmentioning

confidence: 99%

Effect of sodium valproate on carbamazepine disposition and psychomotor profile in man.

Macphee

Mitchell

Wiseman

et al. 1988

Brit J Clinical Pharma

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“…It is known that 75% of the patients will have at least half of their seizures controlled, while approximately 25% of them will not show significant improvement 1,7,16, ". The number of seizure free patients tends to decline after 1 year, as seizures reccur after being controlled for a period 2,17 .…”

Section: Discussionmentioning

confidence: 99%

High doses of carbamazepine for refractory partial epilepsy

Pereira

Heise

Cukiert

1996

Arq. Neuro-Psiquiatr.

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Forty-eight patients with partial seizures were analysed during treatment with 1200 mg/d or more of carbamazepine (CBZ). Thirty-three were on monotherapy and fifteen on polytherapy. The other drugs were kept unchanged in the patients on polytherapy. The dose of CBZ was increased if no control was observed and the patient had no side effects. The doses used ranged between 1200 and 1900 mg/day (1200 mg/day, n=18; 1300mg/day, n=1; 1400 mg/day, n=7; 1600 mg/day, n=9; 1700 mg/day, n=4; 1800 mg/day, n=8; 1900 mg/day, n=1). Anticonvulsant plasma levels were taken to confirm patient compliance. The average plasma level was 9.6 ug/mL. The period of follow up varied from 3 to 96 months (M=25.6). Seizure's control was observed in 7 (14.48%) patients taking 1200 mg/day and in 2 (4.16%) patients taking 1400 mg/day of CBZ. Thirty-nine patients did not show any control (81.21%). Ten patients (20.81%) had signs of intoxication. When patients have no improvement with 1400 mg/day, it is difficult to obtain any control despite the use of higher doses of CBZ, which frequently expose the patient to significant side effects.

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“…По данным многочисленных исследований, при монотерапии препаратами вальпроевой кислоты стойкую многолет-нюю ремиссию удается достигнуть более чем у 50 % пациентов. Этот показатель значительно выше при ле-чении вальпроатами, чем препаратами других групп, также используемыми в виде монотерапии, и состав-ляет 52 % в общей группе больных эпилепсией [21], 59 % -у больных с генерализованными формами эпи-лепсии и 44,5 % -у пациентов с парциальными фор-мами [10,12,20]. При ИГЭ у 85 %, а при отдельных формах ИГЭ (детская абсансная эпилепсия, эпилеп-сия с изолированными генерализованными судорож-ными приступами, юношеская миоклоническая эпи-лепсия) -у 90 % и более пациентов может быть достигнута ремиссия на монотерапии вальпроатами [6].…”

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Comparative Efficаcy and Tolerability of Monotherapy With Depakine Chronosphere, Drugs of Carbamazepine Group With Extended Release and Oxcarbazepine in Symptomatic and Cryptogenic Focal Epilepsy (Svt. Luka’s Institute of Child Neurology and Epilepsy)

Мухин¹,

Пылаева²,

Бородин³

et al. 2015

Rus. ž. det. nevrol.

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A prospective study between carbamazepine, phenytoin and sodium valproate as monotherapy in previously untreated and recently diagnosed patients with epilepsy.

Cited by 173 publications

References 16 publications

Effect of sodium valproate on carbamazepine disposition and psychomotor profile in man.

Effect of sodium valproate on carbamazepine disposition and psychomotor profile in man.

High doses of carbamazepine for refractory partial epilepsy

Comparative Efficаcy and Tolerability of Monotherapy With Depakine Chronosphere, Drugs of Carbamazepine Group With Extended Release and Oxcarbazepine in Symptomatic and Cryptogenic Focal Epilepsy (Svt. Luka’s Institute of Child Neurology and Epilepsy)

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