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Titolo:
Harnessing the clinical potential of antiepileptic drug therapy - Dosage optimisation
Autore:
Perucca, E; Dulac, O; Shorvon, S; Tomson, T;
Indirizzi:
Univ Pavia, Clin Pharmacol Unit, I-27100 Pavia, Italy Univ Pavia Pavia Italy I-27100 Clin Pharmacol Unit, I-27100 Pavia, Italy Hop St Vincent de Paul, Dept Pediat, F-75674 Paris, France Hop St Vincent de Paul Paris France F-75674 ediat, F-75674 Paris, France Univ Coll London, Neurol Inst, London, England Univ Coll London London England ll London, Neurol Inst, London, England Karolinska Hosp, Karolinska Inst, Dept Clin Neurosci, Div Neurol, S-10401 Stockholm, Sweden Karolinska Hosp Stockholm Sweden S-10401 urol, S-10401 Stockholm, Sweden
Titolo Testata:
CNS DRUGS
fascicolo: 8, volume: 15, anno: 2001,
pagine: 609 - 621
SICI:
1172-7047(2001)15:8<609:HTCPOA>2.0.ZU;2-N
Fonte:
ISI
Lingua:
ENG
Soggetto:
MULTICENTER COMPARATIVE TRIAL; NEWLY-DIAGNOSED EPILEPSY; SODIUM VALPROATE; PLASMA-LEVELS; CARBAMAZEPINE; LAMOTRIGINE; SEIZURES; PHENYTOIN; PHARMACOKINETICS; HYDROXYLATION;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Clinical Medicine
Life Sciences
Citazioni:
43
Recensione:
Indirizzi per estratti:
Indirizzo: Perucca, E Univ Pavia, Clin Pharmacol Unit, Piazza Botta 10, I-27100 Pavia, Italy Univ Pavia Piazza Botta 10 Pavia Italy I-27100 00 Pavia, Italy
Citazione:
E. Perucca et al., "Harnessing the clinical potential of antiepileptic drug therapy - Dosage optimisation", CNS DRUGS, 15(8), 2001, pp. 609-621

Abstract

For patients with epilepsy, effective seizure control is the most important determinant of good quality of life. To achieve this, antiepileptic drug (AED) dosages should be individualised to maximise therapeutic benefit and to avoid most - if not all - adverse effects. Several studies suggest that,in routine clinical practice, dosage individualisation is often suboptimal. This may lead to patients receiving unnecessarily large dosages. Conversely, it may lead to patients switching to an alternative therapy (when clinical response is deemed insufficient), without exploration of the full dosage range. Indeed, dosage optimisation - which should involve consideration of the treatment setting and individual patient characteristics - can be a complicated process requiring skill and patience. In general neurological practice, most AEDs should be started at a low dosage and gradually titrated upwards. Starting dosages are similar in most types of epilepsy; however. if a rapid onset of therapeutic action is required, phenytoin, phenobarbital (phenobarbitone). levetiracetam and gabapentin are probably the best tolerated AEDs for starting at full dosage. The initial target maintenance dosage of an AED should be based on the dose-response profile of the drug, and on specific patient characteristics. Usually, the lowest effective daily dose expected to provide seizure control should be used. although various factors (e.g. stage and severity of epilepsy, pharmacokinetic and pharmacodynamic considerations. attitude of the patient) will markedly influence dosage selection. If seizures are not controlled on the initial target dose. the dosage should be increased gradually until complete seizure control is achieved or intolerable adverse effects occur. In most patients who fail to respond to the initially prescribed drug, switching to another AED (monotherapy) is the best option. Combination therapy may be appropriate for patients unresponsive to 2 or more sequential monotherapies. Therapeutic drug monitoring (measurement of serum drug concentrations) is useful in various settings, such as when drug interactions are expected. toxicity is Suspected, or when AEDs with nonlinear pharmacokinetics (e.g. phenytoin, carbamazepine) are used. No indications currently exist for routinetherapeutic drug monitoring of the newer AEDs. In summary. dosage regimens of AEDs should be assessed regularly, and adjusted if necessary. so that patients can derive optimal therapeutic benefit. For patients considered 'difficult to treat' (i.e. those in whom seizures remain incompletely controlled after several attempts at treatment), referral to a specialist is recommended.

ASDD Area Sistemi Dipartimentali e Documentali, Università di Bologna, Catalogo delle riviste ed altri periodici
Documento generato il 04/04/20 alle ore 08:41:05