Carbamazepine plasma levels in children and adults: Influence of age, dose, and associated therapy

D. Battino, L. Bossi, D. Croci, S. Franceschetti, C. Gomeni, A. Moise, A. Vitali

Research output: Contribution to journalArticle

Abstract

The effects of dose/kg, age, and associated therapy on car-bamazepine (CBZ) plasma concentrations and level/dose (L/D) ratios were evaluated retrospectively on 567 consecutive routine CBZ determinations from 326 chronically treated epileptic patients (207 children and adolescents less than 19 years old, and 119 adults between 19 and 45 years of age). In the pediat-ric group there was no correlation between the administered CBZ dose and the plasma levels. In the adults the correlation was significant, but the wide scat-tering of the plasma concentrations at each given dose was such that the re-lationship had no predictive value. The CBZ L/D ratio increased linearly with age in patients up to 19 years (p <0.001). Significant differences in mean CBZ L/D ratios were found between patients aged 0-3 years, 4-9 years, 10-15 years, and adults (19-45 years). The adolescents (16-18 years) had a mean CBZ L/D ratio very similar to the adults. Associated antiepileptic therapy af-fected the CBZ L/D ratio, which was significantly reduced in patients also re-ceiving phenytoin, primidone, and phenobarbital, as compared to those on CBZ monotherapy. The effects of age and associated therapy on the CBZ L/D ratio were also statistically significant in subgroups homogeneous for associated therapy and age. In subjects over 4 years of age, a significant negative correla-tion was observed between CBZ daily D/kg and L/D ratios, suggesting an im-paired absorption of CBZ at high doses. These data confirm the great interin-dividual variability in CBZ L/D ratios in chronically-treated epileptic patients, and clearly document important effects of age, associated therapy, and daily D/kg on CBZ disposition. Because it is impossible to predict the plasma con-centrations that will be attained in the individual patients after a given dose, routine monitoring of CBZ plasma levels is very useful, especially in pediatric patients and in patients on polytherapy.

Original languageEnglish
Pages (from-to)315-322
Number of pages8
JournalTherapeutic Drug Monitoring
Volume2
Issue number4
Publication statusPublished - 1980

Keywords

  • Adults
  • Anticonvulsants
  • Carbamazepine
  • Children
  • Drug interactions
  • Drug monitoring
  • Plasma concentrations

ASJC Scopus subject areas

  • Pharmacology (medical)
  • Pharmacology
  • Toxicology
  • Health, Toxicology and Mutagenesis
  • Biochemistry
  • Biochemistry, Genetics and Molecular Biology(all)
  • Public Health, Environmental and Occupational Health

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