+ Site Statistics
+ Search Articles
+ Subscribe to Site Feeds
Most Shared
PDF Full Text
+ PDF Full Text
Request PDF Full Text
+ Follow Us
Follow on Facebook
Follow on Twitter
Follow on LinkedIn
+ Translate
+ Recently Requested

Evaluating appropriateness of digoxin, carbamazepine, valproic acid, and phenytoin usage by therapeutic drug monitoring

Evaluating appropriateness of digoxin, carbamazepine, valproic acid, and phenytoin usage by therapeutic drug monitoring

Clinical Laboratory 59(3-4): 325-331

Therapeutic drug monitoring (TDM) is a useful tool for the optimization of drug therapy. The aim of this retrospective study was to evaluate the appropriateness of carbamazepine, phenytoin, valproic acid, and digoxin therapy by using TDM data. We evaluated the appropriateness of drug usage in 325 patients who received carbamazepine, valproic acid, phenytoin, or digoxin in a large teaching hospital during the period from March 2010 to January 2011. The serum drug levels were measured by cloned enzyme donor immunoassay (CEDIA). A total of 325 TDM tests were performed in this period. In our TDM unit, valproic acid was the most evaluated test among the samples obtained. In 100 valproic acid-treated patients, serum levels in 58 patients (58%) were within the therapeutic range. While 11 patients (11%) had serum levels in the above-therapeutic range, 31 patients (31%) had sub-therapeutic levels of valproic acid: The results of TDM were mostly found in the therapeutic range for carbamazepine. A total of 91 request forms were collected. The overall data show that 64 patients (70.3%) had serum carbamazepine levels within the therapeutic range. In the phenytoin assays, the mean plasma concentrations generally did not reach the therapeutic range. Among the total of 49 blood samples, the highest number of sub-therapeutic levels (65.3%) were detected for phenytoin. Similarly, inappropriate levels of digoxin were established in about half of all cases. This study gives information about the inappropriate usage of digoxin and phenytoin in respect to the results of our TDM practice. Our results suggest that there is a need for interventions to improve the appropriate use of digoxin and phenytoin in patients treated with these drugs.

(PDF emailed within 1 workday: $29.90)

Accession: 053055486

Download citation: RISBibTeXText

PMID: 23724621

Related references

A LC-MS/MS method for therapeutic drug monitoring of carbamazepine, lamotrigine and valproic acid in DBS. Bioanalysis 7(16): 2031-2039, 2016

Drug interactions of phenobarbital phenytoin valproic acid and carbamazepine. Medical Journal of Kagoshima University 42(2): 159-175, 1990

Fluorescence polarization immunoassay for the monitoring of phenytoin pheno barbital carbamazepine and valproic acid. American Journal of Clinical Pathology 77(2): 238, 1982

An early determination of drug-drug interaction between valproic acid, phenytoin, carbamazepine, or topiramate and retigabine in epilepsy patients. Epilepsia 42(Suppl. 7): 298-299, 2001

An early determination of drug-drug interaction between valproic acid, phenytoin, carbamazepine or topiramate, and retigabine in epileptic patients. Neurology 56(8 Suppl. 3): A331-A332, April 24, 2001

Binding of fosphenytoin, phosphate ester pro drug of phenytoin, to human serum proteins and competitive binding with carbamazepine, diazepam, phenobarbital, phenylbutazone, phenytoin, valproic acid or warfarin. Research Communications in Molecular Pathology and Pharmacology 88(1): 51-62, 1995

Three new assays for monitoring serum carbamazepine, phenytoin and valproic acid on the IMMULITE automated immunoassay analyzer. Clinical Chemistry 45(6 PART 2): A121, 1999

Estimation vs determination of fraction of free drug of phenytoin , valproic acid and carbamazepine in patients on monotherapy. Clinical Chemistry & Laboratory Medicine 37(SPEC SUPPL ): S317, 1999

Liquid chromatographic assay based on microextraction by packed sorbent for therapeutic drug monitoring of carbamazepine, lamotrigine, oxcarbazepine, phenobarbital, phenytoin and the active metabolites carbamazepine-10,11-epoxide and licarbazepine. Journal of Chromatography. B, Analytical Technologies in the Biomedical and Life Sciences 971: 20-29, 2015

Therapeutic drug monitoring of digoxin, phenytoin and ganciclovir: Evaluation of three softwares. Journal de Pharmacie Clinique 15(3): 192-195, 1996

Prediction of the free serum concentrations of phenytoin phenobarbital carbamazepine and carbamazepine 10 11 epoxide in patients on valproic acid co medication. Sunshine, I (Ed ) Recent Developments in Therapeutic Drug Monitoring And Clinical Toxicology; Second International Conference on Tdm (Therapeutic Drug Monitoring)-Toxicology, Barcelona, Spain Xii+791p Marcel Dekker, Inc : New York, New York, Usa; Basel, Switzerland Illus 401-407, 1992

Therapeutic carbamazepine (Cbz) and valproic acid (Vpa) monitoring in children using saliva as a biologic fluid. Journal of Epilepsy and Clinical Neurophysiology 14(2): 55-58, 2008

Evaluation of therapeutic drug level monitoring of phenobarbital, phenytoin and carbamazepine in Iranian epileptic patients. International Journal of Clinical Pharmacology and Therapeutics 45(2): 121-125, 2007

Filtration for free drug level monitoring: carbamazepine and valproic acid. Therapeutic Drug Monitoring 6(1): 67-76, 1984

Serial free and plasma valproic acid and phenytoin monitoring and drug interactions. Therapeutic Drug Monitoring 3(3): 303-307, 1981