Selected pharmacokinetic issues of the use of antiepileptic drugs and parenteral nutrition in critically ill patients

Abstract

ObjectivesTo conduct a systematic review for the evidence supporting or disproving the reality of parenteral nutrition- antiepileptic drugs interaction, especially with respect to the plasma protein-binding of the drug.MethodsThe articles related to the topic were identified through Medline and PubMed search (1968-Feburary 2010) for English language on the interaction between parenteral nutrition and antiepileptic drugs; the search terms used were anti-epileptic drugs, parenteral nutrition, and/or interaction, and/or in vitro. The search looked for prospective randomized and nonrandomized controlled studies; prospective nonrandomized uncontrolled studies; retrospective studies; case reports; and in vitro studies. Full text of the articles were then traced from the Universiti Sains Malaysia (USM) library subscribed databases, including Wiley-Blackwell Library, Cochrane Library, EBSCOHost, OVID, ScienceDirect, SAGE Premier, Scopus, SpringerLINK, and Wiley InterScience. The articles from journals not listed by USM library were traced through inter library loan.ResultsThere were interactions between parenteral nutrition and drugs, including antiepileptics. Several guidelines were designed for the management of illnesses such as traumatic brain injuries or cancer patients, involving the use of parenteral nutrition and antiepileptics. Moreover, many studies demonstrated the in vitro and in vivo parenteral nutrition -drugs interactions, especially with antiepileptics.ConclusionsThere was no evidence supporting the existence of parenteral nutrition-antiepileptic drugs interaction. The issue has not been studied in formal researches, but several case reports and anecdotes demonstrate this drug-nutrition interaction. However, alteration in the drug-free fraction result from parenteral nutrition-drug (i.e. antiepileptics) interactions may necessitate scrupulous reassessment of drug dosages in patients receiving these therapies. This reassessment may be particularly imperative in certain clinical situations characterized by hypoalbuminemia (e.g., burn patients).

O Estresse Vivenciado Pela Equipe De Enfermagem No Atendimento Às Urgências: Revisão Integrativa

“…É importante o conhecimento da posição da sonda no TGI quando são prescritos medicamentos por essa via. O conhecimento da localização da sonda é importante para que sejam antecipadas possíveis alterações na absorção e na farmacodinâmica da substância utilizada, mantendo a função da região do TGI em que será administrado determinado medicamento (MOURA, 2002;SALIH, 2010). A posição pré ou pós-pilórica da sonda de alimentação, usada em pacientes críticos e com pancreatite grave, não traz evidente benefício para a terapia nutricional e nem proteção para pneumonia de aspiração (MCCLAVE, 2009).…”

Physicochemical stability and compatibility testing of levetiracetam in all-in-one parenteral nutrition admixtures in daily practice

“…Therefore, it represents a very hydrophilic (logP of -0.6), neutral not dissociated drug compound used therapeutically in molar doses (1000 mg ~ 6 moles) [13,18]. A review showed that anticonvulsants are often used together with PN in traumatic brain injuries and in cancer patients [19]. Stability and compatibility data with PN are scare, although it is a relevant and frequently used drug for critically ill patients or neonates.…”

Drug-nutrient interactions in the intensive care unit: literature review and current recommendations

“…( 30 ) However, depending on the region of the GI tract in which a particular drug is administered, knowledge about the location of the tube is important so that possible changes in the absorption and pharmacokinetics of the administered substance may be anticipated. ( 1 , 16 , 21 )…”

“…Researchers have demonstrated increased serum concentrations of free fatty acids, which cause an increase in the free fraction of valproic acid. ( 16 ) The plasma-protein binding of valproic acid ranges from 90 to 95% and occurs mostly with albumin. The phenytoin protein binding has been observed to be significantly decreased.…”

“…Therefore, the free fatty acids from the fat emulsions in the PN may displace drugs, such as phenytoin, from the albumin-binding sites. ( 16 ) An in vitro study that assessed the interaction between anticonvulsants (carbamazepine, phenytoin, phenobarbital, procainamide, quinidine, and valproic acid) and theophylline in human serum with five types of PN fluids revealed that five drugs (phenobarbital, phenytoin, procainamide, quinidine, and valproic acid) exhibited greater binding to human serum than to the PN components. Carbamazepine exhibited greater binding to the PN components, whereas for theophylline, the binding to the PN and to the serum was similar.…”