Use of Antiepileptic Drugs in Patients with Chronic Kidney Disease and End Stage Renal Disease

Bansal, Amar D.; Hill, Chloé E.; Berns, Jeffrey S.

doi:10.1111/sdi.12385

Cited by 27 publications

(26 citation statements)

References 102 publications

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“…Dose adjustments in renal failure may be reasonable, but specific recommendations are not available. Doses should be administered after hemodialysis, and supplemental doses may be necessary based on clinical response …”

Section: Phenobarbitalmentioning

confidence: 99%

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Repurposing Valproate, Enteral Clonidine, and Phenobarbital for Comfort in Adult ICU Patients: A Literature Review with Practical Considerations

et al. 2017

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Provision of adequate sedation is a fundamental part of caring for critically ill patients. Propofol, dexmedetomidine, and benzodiazepines are the most commonly administered sedative medications for adult patients in the intensive care unit (ICU). These agents are limited by adverse effects, need for a monitored environment for safe administration, and lack of universal effectiveness. Increased interest has recently been expressed about repurposing older pharmacologic agents for patient comfort in the ICU. Valproate, enteral clonidine, and phenobarbital are three agents with increasing evidence supporting their use. Potential benefits associated with their utilization are cost minimization and safe administration after transition out of the ICU. This literature review describes the historical context, pharmacologic characteristics, supportive data, and practical considerations associated with the administration of these agents for comfort in critically ill adult patients.

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Section: Phenobarbitalmentioning

confidence: 99%

“…Doses should be administered after hemodialysis, and supplemental doses may be necessary based on clinical response. 55 Supportive ICU Data Table 4 outlines data describing the use of phenobarbital for behavioral control in the ICU. Two publications reported administration in adult ICU patients.…”

Section: Pharmacologic Characteristicsmentioning

confidence: 99%

Repurposing Valproate, Enteral Clonidine, and Phenobarbital for Comfort in Adult ICU Patients: A Literature Review with Practical Considerations

et al. 2017

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“…Correspondingly, the area under plasma concentration (AUC) can be doubled in subjects with mild‐to‐moderately impaired renal function compared to those with normal function . In these patients, dose adjustment is required, and in patients on chronic haemodialysis (HD), reduced maintenance doses with a supplemental dose after dialysis have been suggested . However, information about levetiracetam concentrations in this group of patients is scarce.…”

Section: What Is Known and Objectivementioning

confidence: 99%

“…The dose of levetiracetam after HD was increased to 500 mg. Furthermore, to reduce dialysis efficiency, FX80 dialyzer (helixone, 1.8 m, Fresenius Medical Care , Bad Homburg, Germany) was switched to a smaller FX60 dialyzer (helixone, 1.4 m, Fresenius Medical Care). Intravenous levetiracetam concentrations before and after three consecutive HD sessions after the seizure episode are listed in Table .…”

Section: Case Descriptionmentioning

confidence: 99%

Haemodialysis significantly reduces serum levetiracetam levels inducing epileptic seizures: Case report

et al. 2017

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“…Considering that the frequency of epilepsy is also increasing (Palmer, 2002), it is likely that patients undergoing HD will also need treatment for epilepsy. Therapeutic drug monitoring (TDM) is particularly important during HD (Neels et al, 2004) because CKD and HD can alter the pharmacokinetic profile of some antiepileptic drugs (AEDs) (Asconape and Penry, 1982;Lacerda et al, 2006;Bansal et al, 2015). However, there are few reports on the influence of HD using high-efficiency dialyzers on AEDs in epileptic patients.…”

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confidence: 99%

Pharmacological monitoring of antiepileptic drugs in epilepsy patients on haemodialysis

Araki

Nakamura

Takeuchi

et al. 2020

Epileptic Disorders

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Aims : To retrospectively evaluate the pharmacological profiles of antiepileptic drugs (AEDs) in epilepsy patients during haemodialysis using therapeutic drug monitoring data. Methods : The serum concentration of AEDs was collected before and after haemodialysis, and the clearance rate and concentration‐to‐dose ratio were calculated as pharmacological parameters. Results : Thirty‐six patients were enrolled in the study (25 males, 11 females; age: 65.3 ± 14.8 years). In 24 of the 36 patients, epilepsy was associated with cerebrovascular disorders, and diabetes was the most common reason for haemodialysis in 16 patients. With regards to seizure type, focal aware seizures were less frequent than focal impaired awareness seizures and focal‐to‐bilateral tonic‐clonic seizures. Interictal EEG showed intermittent rhythmic slow waves and intermittent slow waves more often than spikes or sharp waves. Levetiracetam was the most commonly used AED and led to the highest percentage of responders (80%; 16/20 patients). However, the clearance rate of levetiracetam during dialysis was highest among the antiepileptic drugs used, requiring supplementary doses after haemodialysis in all 20 patients. Valproic acid was not effective for focal epilepsy for patients on haemodialysis, and non‐responders to phenytoin had low serum concentration of phenytoin both before and after haemodialysis. The pre‐haemodialysis concentration of levetiracetam tended to be higher than the reference range, suggesting a potential risk of overdosing before haemodialysis. The pre‐ and post‐haemodialysis concentrations of valproic acid tended to be lower than the reference range, suggesting a potential risk of underdosing. The concentration‐to‐dose ratios for levetiracetam, valproic acid, phenytoin, and carbamazepine were significantly lower after than before haemodialysis. Conclusions : The majority of patients with epilepsy on haemodialysis had cerebrovascular diseases, and therapeutic drug monitoring for levetiracetam, valproic acid, and phenytoin, before and after haemodialysis, is needed to ensure proper dosing.

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Use of Antiepileptic Drugs in Patients with Chronic Kidney Disease and End Stage Renal Disease

Cited by 27 publications

References 102 publications

Repurposing Valproate, Enteral Clonidine, and Phenobarbital for Comfort in Adult ICU Patients: A Literature Review with Practical Considerations

Repurposing Valproate, Enteral Clonidine, and Phenobarbital for Comfort in Adult ICU Patients: A Literature Review with Practical Considerations

Haemodialysis significantly reduces serum levetiracetam levels inducing epileptic seizures: Case report

Pharmacological monitoring of antiepileptic drugs in epilepsy patients on haemodialysis

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