Lamotrigine and valproate: efficacy of co-administration in a pediatric population

Thomé‐Souza, Sigride; Freitas, Alessandra; Fiore, Lia Arno; Valente, Kette D.

doi:10.1016/s0887-8994(03)00014-6

Cited by 22 publications

(23 citation statements)

References 16 publications

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“…Out of 142 patients on AED therapy, 138 (97.2%) patients were on montherapy and 4 (2.8%) patients were on polytherapy. VPA was the most commonly prescribed drug (58), followed by PHT (24), PB (21) and CBZ (16). Lorazepam was the least prescribed drug with one patient.…”

Section: Resultsmentioning

confidence: 99%

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Study of adverse drug effects of antiepileptic drugs used in pediatric patients in a tertiary care rural hospital – a Pharmacovigilance study

Suman¹,

Gosavi²

2017

JYP

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Objective: To assess the prescription pattern & Adverse Drug Reaction (ADR)) profile of Antiepileptic drug (AEDs) therapy in children of rural population. Materials and Methods: This prospective open label, observational study was carried out over one and half year duration on 142 newly diagnosed epileptic children below 12 yrs age receiving AEDs in pediatric department in a tertiary care rural hospital. Follow up was done every month for 6 months duration. Prescription pattern and incidence, causality and severity of ADRs due to AEDs were assessed at each visit. Results: Out of 142 patients on AEDs, 97.2% patients were on mono-therapy and 2.8% patients were on poly-therapy. Valproic acid was the most commonly prescribed drug (58) and Lorazepam was the least prescribed drug (1). Central nervous system related ADRs (50%) were most common followed by gastrointestinal system (14.7%). Sedation and gastrointestinal distress were among the most frequently reported ADRs and29.4% of probable category while 70.5% ADR's were possible category. 72% ADRs were mild, 22% were moderate and 5.8% of ADRs were severe. Conclusions: Children receiving AEDs should be closely monitored for the development of any ADRs, especially related to their behavior and cognition. as it can influence their learning and memory, Active surveillance can help in knowing the exact incidence of ADRs. This study emphasizes on the role of patient / parent education and importance of health care professionals in pharmacovigilance studies.

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Section: Resultsmentioning

confidence: 99%

“…Dooley and Thoma Souza have reported overall incidence of rash due to antiepileptic 7-12% in their studies. 23,24 Out of 4 cases which reported with rash, 2 cases were on combination of AEDs (PB + PHT and PB+ CBZ). Other 2 cases were due to PHT and CBZ monotherapy.…”

Section: Discussionmentioning

confidence: 99%

Study of adverse drug effects of antiepileptic drugs used in pediatric patients in a tertiary care rural hospital – a Pharmacovigilance study

Suman¹,

Gosavi²

2017

JYP

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“…Adverse events ocurred in 4 (11%) patients: two of them (5.5%) presented with tremors, 1 (3%) had irritability and 1 (3%) had gastrointestinal symptoms (Table 3). None of the subjects developed a skin rash during the course of treatment and the adverse effects were not considered severe to the patient health, so that they did not warrant interruption of the medication DISCUSSION recent studies have shown that the concomitant administration of LMT and VPA might be a reasonable option in order to obtain a better seizure control in refractory epilepsy 4,8,9 . Thomé et al 4 reported the results of the first exclusive pediatric group.…”

Section: Resultsmentioning

confidence: 99%

“…when patients keep on having seizures despite adequate treatment with at least two first-line antiepileptic drugs, diagnoses of refractory epilepsy should be considered 3 . As a result, most patients with refractory epilepsy are treated with politherapy, which in turn has risen the concerning for the use of new drugs in an add on association that might be beneficial in such cases 4 , thus avoiding the direct toxic effects of combining multiple drugs or the adverse effects resulting from their interaction 1 . Lamotrigine (LMT) is considered to be an effective drug in the control of partial seizures with or without secondary generalization, as well as in generalized epilepsies with multiple seizure types 5 .…”

Section: Dr Isac Bruck -Rua Floriano Essenfelder 81 -80060-270 Curitmentioning

confidence: 99%

“…The mechanism of action behind this association seems to be due to an inhibitory effect of VPA in the hepatic metabolization of LMT, thus reducing its clearance and elevating its serum levels 4,7,8 . There are some reports on higher incidence of skin rash when LMT is associated with VPA, though it still is not clear whether this side-effect is due to a rapid elevation of serum levels of LMT or if there is a sort of "immunological" synergism between the two drugs 6 .…”

Section: Dr Isac Bruck -Rua Floriano Essenfelder 81 -80060-270 Curitmentioning

confidence: 99%

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Association of lamotrigine and valproate in refractory epilepsies of children and adolescents

Karen

Bruck

Antoniuk

et al. 2008

Arq. Neuro-Psiquiatr.

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-Objective: To evaluate the efficacy or eventual side-effects of the association of lamotrigine and sodium valproate in the control of refractory epilepsies. Method: A retrospective analysis of 37 children with a mean age of 12 years taking exclusivelly lamotrigine and sodium valproate. Efficacy of seizure control was considered satisfactory if there was a reduction in seizures ≥50% or total control. Results: The association of lamotrigine and sodium valproate was considered satisfactory in 65% of the studied children, independent of seizure type. Total seizure control was obtained in 33% and 35% had an unsatisfactory response or remained unchanged. Primary generalized tonic clonic seizures were the most common type with 84% of day-time seizures having a good response to treatment. Side-effects were seen in 11% of patients and the most common was tremor. Conclusion: Total or satisfactory control of seizures was seen in the majority of patients and sideeffects were uncommon.KEy wordS: epilepsy, refractory, valproate, lamotrigine, childhood. Associação de lamotrigina e valproato de sódio no tratamento de epilepsia refratária em crianças e adolescentesResumo -Objetivo: Avaliar a eficácia ou eventuais efeitos colaterais da associação de lamotrigina e valproato de sódio no controle de epilepsia refrataria. Método: Análise retrospectiva de 37 crianças e adolescentes com idade média de 12 anos tratadas exclusivamente com lamotrigina e valproato de sódio. A eficácia do controle de crises foi considerada satisfatória se o controle das crises foi ≥50% ou total. Resultados: A associação de lamotrigina e valproato de sódio foi considerada satisfatória em 65%, independente do tipo de crise. o controle total de crises foi obtido em 33% e em 35% a resposta foi insatisfatória ou permaneceu inalterada. Crise generalizada primaria tônico clonica foi o mais comum, com 84% das crises ocorrendo durante o dia, com boa resposta ao tratamento. Efeitos colaterais foram vistos em 11% dos pacientes, sendo tremor o mais freqüente. Conclusão: Controle total ou satisfatório das crises ocorreu na maioria dos pacientes, sendo pouco freqüente os efeitos colaterais.

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Variation of the prevalence of pediatric polypharmacy: A scoping review

Baker

Feinstein

et al. 2019

Pharmacoepidemiology and Drug

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Purpose To examine the range of prevalence of pediatric polypharmacy in literature through a scoping review, focusing on factors that contribute to its heterogeneity in order to improve the design and reporting of quality improvement, pharmacovigilance, and research studies. Methods We searched Ovid Medline, PubMed, EMBASE, CINAHL, Ovid PsycINFO, Cochrane CENTRAL, and Web of Science Core Collection databases for studies with concepts of children and polypharmacy, along with a hand search of the bibliographies of six reviews and 30 included studies. We extracted information regarding study design, disease conditions, and prevalence of polypharmacy. Results Two hundred eighty‐four studies reported prevalence of polypharmacy. They were more likely to be conducted in North America (37.7%), published after 2010 (44.4%), cross‐sectional (67.3%), in outpatient settings (59.5%). Prevalence ranged from 0.9% to 98.4%, median 39.7% (interquartile range [IQR] 22.0%‐54.0%). Studies from Asia reported the highest median prevalence of 45.4% (IQR 27.3%‐61.0%) while studies from North America reported the lowest median prevalence of 30.4% (IQR 14.7%‐50.2%). Prevalence decreased over time: median 45.6% before 2001, 38.1% during 2001 to 2010, and 34% during 2011 to 2017. Studies involving children under 12 years had a higher median prevalence (46.9%) than adolescent studies (33.7%). Inpatient setting studies had a higher median prevalence (50.3%) than studies in outpatient settings (38.8%). Community level samples, higher number and duration of medications defining polypharmacy, and psychotropic medications were associated with lower prevalence. Conclusions The prevalence of pediatric polypharmacy is high and variable. Studies reporting pediatric polypharmacy should account for context, design, polypharmacy definition, and medications evaluated.

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Lamotrigine and valproate: efficacy of co-administration in a pediatric population

Cited by 22 publications

References 16 publications

Study of adverse drug effects of antiepileptic drugs used in pediatric patients in a tertiary care rural hospital – a Pharmacovigilance study

Study of adverse drug effects of antiepileptic drugs used in pediatric patients in a tertiary care rural hospital – a Pharmacovigilance study

Association of lamotrigine and valproate in refractory epilepsies of children and adolescents

Variation of the prevalence of pediatric polypharmacy: A scoping review

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