Diurnal fluctuations in free and total steady-state plasma levels of carbamazepine and correlation with intermittent side effects.

Abstract:

:The relationship between diurnal fluctuations in free (unbound) and total plasma carbamazepine levels and the appearance of intermittent side effects was investigated in nine epileptic patients receiving chronic therapy with carbamazepine, alone or in combination with phenobarbital. On a three-times-daily or four-times-daily dosing schedule, both total and free carbamazepine levels fluctuated considerably (on an average, 41 and 45%, respectively, around the mean). Side effects (particularly diplopia and nystagmus) were observed in five patients and showed an intermittent pattern in four. Side effects were never found at total carbamazepine levels less than 34 mumol/L but invariably appeared at levels greater than 38 mumol/L. At levels between 34 and 38 mumol/L adverse effects were inconsistently observed. The correlation between plasma carbamazepine levels and manifestations of toxicity was slightly stronger when free rather than total levels were considered. Side effects were always apparent at free levels greater than 7.2 mumol/L. These data underline the limitations of relying on a single drug level determination during the monitoring of carbamazepine therapy and emphasize the necessity of carefully adjusting the dosing schedule, to minimize the appearance of intermittent adverse effects.

journal_name

Epilepsia

journal_title

Epilepsia

authors

Riva R,Albani F,Ambrosetto G,Contin M,Cortelli P,Perucca E,Baruzzi A

doi

10.1111/j.1528-1157.1984.tb03446.x

subject

Has Abstract

pub_date

1984-08-01 00:00:00

pages

476-81

issue

4

eissn

0013-9580

issn

1528-1167

journal_volume

25

pub_type

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