Monitoring salivary lamotrigine concentrations

Malone, S.; Eadie, Mervyn J.; Addison, R. S.; Wright, Andrew; Dickinson, R. G.

doi:10.1016/j.jocn.2005.12.037

Cited by 29 publications

(16 citation statements)

References 14 publications

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“…64 In specimens collected $2 hours after ingestion, there was a close correlation in each individual between the concentrations in stimulated and unstimulated saliva, which were similar. 64 In specimens collected $2 hours after ingestion, there was a close correlation in each individual between the concentrations in stimulated and unstimulated saliva, which were similar.…”

Section: Saliva Tdm For Lamotriginementioning

confidence: 63%

Therapeutic Drug Monitoring of Antiepileptic Drugs by Use of Saliva

Patsalos¹,

Berry²

2013

Therapeutic Drug Monitoring

170

126

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Blood (serum/plasma) antiepileptic drug (AED) therapeutic drug monitoring (TDM) has proven to be an invaluable surrogate marker for individualizing and optimizing the drug management of patients with epilepsy. Since 1989, there has been an exponential increase in AEDs with 23 currently licensed for clinical use, and recently, there has been renewed and extensive interest in the use of saliva as an alternative matrix for AED TDM. The advantages of saliva include the fact that for many AEDs it reflects the free (pharmacologically active) concentration in serum; it is readily sampled, can be sampled repetitively, and sampling is noninvasive; does not require the expertise of a phlebotomist; and is preferred by many patients, particularly children and the elderly. For each AED, this review summarizes the key pharmacokinetic characteristics relevant to the practice of TDM, discusses the use of other biological matrices with particular emphasis on saliva and the evidence that saliva concentration reflects those in serum. Also discussed are the indications for salivary AED TDM, the key factors to consider when saliva sampling is to be undertaken, and finally, a practical protocol is described so as to enable AED TDM to be applied optimally and effectively in the clinical setting. Overall, there is compelling evidence that salivary TDM can be usefully applied so as to optimize the treatment of epilepsy with carbamazepine, clobazam, ethosuximide, gabapentin, lacosamide, lamotrigine, levetiracetam, oxcarbazepine, phenobarbital, phenytoin, primidone, topiramate, and zonisamide. Salivary TDM of valproic acid is probably not helpful, whereas for clonazepam, eslicarbazepine acetate, felbamate, pregabalin, retigabine, rufinamide, stiripentol, tiagabine, and vigabatrin, the data are sparse or nonexistent.

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Section: Saliva Tdm For Lamotriginementioning

confidence: 63%

Therapeutic Drug Monitoring of Antiepileptic Drugs by Use of Saliva

Patsalos¹,

Berry²

2013

Therapeutic Drug Monitoring

170

126

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“…Lamotrigine distributes into saliva, with salivary lamotrigine concentrations being on average approximately 0.4–0.5 that of serum concentrations in patients receiving chronic lamotrigine therapy. Salivary lamotrigine concentrations correlate well with those in serum, which makes saliva an alternative sample to perform TDM [83,84]. The parent drug is extensively metabolized, mainly by glucuronidation to an inactive metabolite [85].…”

Section: Lamotriginementioning

confidence: 99%

Therapeutic Drug Monitoring of the Newer Anti-Epilepsy Medications

Krasowski

2010

Pharmaceuticals

103

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Abstract:In the past twenty years, 14 new antiepileptic drugs have been approved for use in the United States and/or Europe. These drugs are eslicarbazepine acetate, felbamate, gabapentin, lacosamide, lamotrigine, levetiracetam, oxcarbazepine, pregabalin, rufinamide, stiripentol, tiagabine, topiramate, vigabatrin and zonisamide. In general, the clinical utility of therapeutic drug monitoring has not been established in clinical trials for these new anticonvulsants, and clear guidelines for drug monitoring have yet to be defined. The antiepileptic drugs with the strongest justifications for drug monitoring are lamotrigine, oxcarbazepine, stiripentol, and zonisamide. Stiripentol and tiagabine are strongly protein bound and are candidates for free drug monitoring. Therapeutic drug monitoring has lower utility for gabapentin, pregabalin, and vigabatrin. Measurement of salivary drug concentrations has potential utility for therapeutic drug monitoring of lamotrigine, levetiracetam, and topiramate. Therapeutic drug monitoring of the new antiepileptic drugs will be discussed in managing patients with epilepsy.

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“…However, pill count may not be accurate in estimating adherence; it tends to overestimate medication adherence and yield an imprecise metric of the total dose taken (Farmer, 1999; Haynes, Ackloo, Sahota, McDonald, & Yao, 2008; McDonald, Garg, & Haynes, 2002; Pullar, Kumar, Tindall, & Feely, 1989). A biological measure, derived from blood, saliva, or urine concentrations of medication, is generally considered to be the most accurate measure of adherence and is commonly used in other research fields such as epilepsy (Dutta & Reed, 2006; Herkes & Eadie, 1990; Landmark, Rytter, & Johannessen, 2007; Malone, Eadie, Addison, Wright, & Dickinson, 2006; Mitchell, Scheier, & Baker, 2000; Specht, Elsner, May, Schimichowski, & Thorbecke, 2003; Vermeire, Hearnshaw, Van Royen, & Denekens, 2001; Williams et al, 2001). Given varenicline’s pharmacokinetic attributes such as minimal metabolism and long half-life (approximately 24 hours) (Faessel et al, 2010), assessment of varenicline is a valid method for biologically assessing varenicline adherence.…”

Section: Introductionmentioning

confidence: 99%

Measures and predictors of varenicline adherence in the treatment of nicotine dependence

Peng

Morales

Wileyto

et al. 2017

Addictive Behaviors

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Introduction While adherence to medication in smoking cessation clinical trials is strongly associated with clinical outcome, very few studies have evaluated the validity of pill count as a measure of adherence relative to a biological assay, and evaluated a broad range of correlates of adherence. Methods In a smoking cessation clinical trial of varenicline, we compared pill counts collected over 4 different time periods to varenicline salivary levels taken after 2 weeks of treatment, as well as evaluated predictors of adherence to varenicline. Results Using a binary measure of adherence based on salivary varenicline levels, adherence was higher among older, white, and more educated participants. Relative to 3, 7, and 14-day pill count, 12-week pill count was the only significant measure able to discriminate adherence as defined by salivary varenicline levels (assessed by area under the receiver operating characteristic curve; AUC = .59, p =.004). Seventy-two percent of participants who indicated adherence on 12-week pill count were classified as adherent based on varenicline saliva levels (sensitivity=.80; specificity=.40). There was modest variability in the relationship between 12-week pill count and varenicline levels across race and rate of nicotine metabolism. Lastly, General Estimating Equation models demonstrated that longitudinal changes in withdrawal, craving, negative and positive affect, and side effect count and severity were not related to adherence based on salivary varenicline levels. Conclusions These results indicate that 12-week pill count was the best, albeit a relatively weak, measure of varenicline adherence; additional factors associated with treatment adherence need to be identified.

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Monitoring salivary lamotrigine concentrations

Cited by 29 publications

References 14 publications

Therapeutic Drug Monitoring of Antiepileptic Drugs by Use of Saliva

Therapeutic Drug Monitoring of Antiepileptic Drugs by Use of Saliva

Therapeutic Drug Monitoring of the Newer Anti-Epilepsy Medications

Measures and predictors of varenicline adherence in the treatment of nicotine dependence

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