The effect of hemodialysis and hemoperfusion on serum valproic acid concentration

Kandrotas, Robert J.; Love, James M.; Gál, Péter; Oles, Karen S.

doi:10.1212/wnl.40.9.1456

Cited by 24 publications

(12 citation statements)

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“…Hemodialysis does not significantly alter the level of serum VPA in patients with therapeutic drug levels undergoing chronic dialysis (13,14). However, recent reports suggest that the toxicokinetics of valproate vary considerably from the pharmacokinetics at therapeutic levels.…”

Section: Discussionmentioning

confidence: 99%

Extracorporeal Management of Valproic Acid Toxicity: A Case Report and Review of the Literature

Perazella

Al‐Aly

Yalamanchili

et al. 2005

Seminars in Dialysis

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The incidence of intentional or accidental valproic acid (VPA) overdose is increasing. Severe VPA toxicity may lead to coma and death. Traditionally the treatment of patients with VPA toxicity has been limited to supportive measures. VPA is highly protein bound and therefore it is considered not to be removable by extracorporeal means. However, studies of VPA toxicokinetics indicate that at blood levels that exceed therapeutic concentrations, VPA protein binding sites become saturated, leading to increased concentration of the free unbound drug. The free unbound drug has a small molecular weight and therefore it is theoretically amenable to removal by extracorporeal means. We present a patient with VPA toxicity who was successfully treated with "in-series" hemodialysis and hemoperfusion followed by continuous venovenous hemodiafiltration (CVVHDF) and review the literature on the management of VPA toxicity using extracorporeal therapies.

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Section: Discussionmentioning

confidence: 99%

Extracorporeal Management of Valproic Acid Toxicity: A Case Report and Review of the Literature

Perazella

Al‐Aly

Yalamanchili

et al. 2005

Seminars in Dialysis

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“…Die Proteinbindung wird unter Hämodialyse herabgesetzt [40]. Bei der Hämodialyse mit niedrig-effizienten Dialysatoren werden etwa 20 % der Serumkonzentration entzogen [transiente Plasmaspiegel-Erniedrigung für wenige Stunden], wobei an Dialyseund Nichtdialyse-Tagen ähnliche Halbwertszeiten vorliegen [41,42] und somit eine routinemäßige Zusatzgabe nach Dialyse nicht empfohlen ist. Der Effekt von hoch-effizienten Dialysatoren bei chronischer Hämodialyse jedoch ist unbekannt.…”

Section: Valproinsäure [Vpa]unclassified

Antiepileptika-Therapie bei Einschränkung der Nierenfunktion

Hintz

Schulze-Bonhage

2015

Akt Neurol

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Zusammenfassung Antiepileptika werden in unterschiedlichem Grade renal eliminiert. Zwischen AED der 1. und der 2. Generation bestehen wesentliche Unterschiede hinsichtlich ihrer Verstoffwechslung. Diese ?bersicht soll dazu dienen, pharmakokinetische Aspekte der Antiepileptikatherapie und ihre Relevanz zur Dosierungsanpassung bei Epilepsiepatienten mit Niereneinschr?nkungen zusammenzufassen. Insbesondere wird der Einfluss der H?modialyse auf die Plasmaspiegel der AED einschlie?lich der entsprechenden Therapieoptionen im Hinblick auf Medikamentenwahl und - ersatz dargestellt. Diese Informationen k?nnen hilfreich sein, um Fluktuationen innerhalb der Wirksamkeit der Anfallskontrolle bei Patienten mit Niereneinschr?nkungen zu vermeiden.

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“…Es metabolizado predominantemente en el hígado, siendo excretado menos del 3% por la orina sin modificar 69 . A nivel hepático destaca la glucuronización directa y la excreción biliar, con posible recirculación enterohepática 70 .…”

Section: Farmacocinética Y Farmacodinamiaunclassified

Intoxicaciones medicamentosas (II): Analgésicos y anticonvulsivantes

Munné

Banuelos

Izura

et al. 2003

Anales Sis San Navarra

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RESUMENEn este segundo capítulo sobre Intoxicaciones Medicamentosas Agudas abordamos dos grupos de sustancias de enorme trascendencia desde el punto de vista de su uso y morbimortalidad. Dentro del grupo de los anagésicos-antiinflamatorios desarrollamos el paracetamol y los salicilatos, de enorme disponibilidad para la población. En cuanto a los anticonvulsivantes, aunque están poco implicados en el conjunto de las intoxicaciones medicamentosas agudas, sus efectos pueden ser graves. Nos ceñimos a cuatro fármacos: ácido valproico, fenobarbital, carbamacepina, y fenitoína. Finalmente dedicamos un apartado a la isoniacida, fármaco que, con el rebrote de la tuberculosis, presenta interés toxicológico.Palabras clave. Intoxicación aguda. Paracetamol. Anticonvulsivantes. Fenitoína. Isoniacida. ABSTRACTIn this second chapter on Acute Drugs Poisoning we deal with two groups of substances of great transcendence from the point of view of their use and morbidity/mortality. Within the group of analgesic-antiinflammatory drugs we consider paracetamol and the salicylates, which are easily available to the population. With respect to the anticonvulsants, although they are barely involved in the ensemble of acute drug poisonings, their effects can be serious. We concentrate on four drugs: valproic acid, phenobarbitol, carbamacepine, and phenytoin. Finally, a section is dedicated to isoniazid, a drug that, with the renewed incidence of tuberculosis, is of toxicological interest.

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The effect of hemodialysis and hemoperfusion on serum valproic acid concentration

Cited by 24 publications

References 0 publications

Extracorporeal Management of Valproic Acid Toxicity: A Case Report and Review of the Literature

Extracorporeal Management of Valproic Acid Toxicity: A Case Report and Review of the Literature

Antiepileptika-Therapie bei Einschränkung der Nierenfunktion

Intoxicaciones medicamentosas (II): Analgésicos y anticonvulsivantes

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