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Remedial dosing recommendations for delayed or missed doses of valproic acid in patients with epilepsy based on Monte Carlo simulations

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Objective: Delayed or missed doses are unavoidable in the pharmacotherapy of epilepsy and significantly compromise the efficacy of antiepileptic drug treatment. An inappropriate remedial regimen can cause seizure relapse or serious adverse events. This study investigated the effect of delayed or missed doses on the pharmacokinetics (PK) of valproic acid (VPA) in patients with epilepsy and established remedial dosing recommendations for nonadherent patients. Methods: Monte Carlo simulations are based on all previous population pharmacokinetic models for pediatric, adult and elderly patients with epilepsy. The following four remedial strategies were investigated for each delayed dose: A) A partial dose or a regular dose is taken immediately; a regular dose is taken at the next scheduled time. B) The delayed dose was administered immediately, followed by a partial dose at the next scheduled time. C) The delayed dose and a partial dose are taken; the next scheduled time is skipped, and the regular regimen is resumed. D) Double doses are taken when missed one dose or two doses, and the regular regimen at the subsequent scheduled time is resumed. Results: The recommended remedial dose was related to the delay duration and daily dose. Remedial dosing strategies A and B were almost equivalent, whereas Strategy C was recommended when the delayed dose was close to the next scheduled dose. Strategy D was only suggested for delayed two doses. Conclusion: Simulations provide quantitative insight into the remedial regimens for nonadherent patients, and clinicians should select the optimal regimen for each patient based on the individual's status.
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1 希望能看到更多的评论啊! 中国农村癫痫防治管理项目先期已经覆盖200多个县,中央有专项财政补助支持。苯巴比妥和丙戊酸钠是最基础有效价廉的抗癫痫药物。因为癫痫疾病的治疗需要长期的临床用药,平时不发作时和正常人一样,因此,坚持每天的按时、按量服药(依存性)很重要。此文对临床病人漏服和延迟服用药物的情况进行药代学方面的深入研究,对临床用药具有一定的指导借鉴意义。 (Comment time:2019-07-22 20:11:19,From: 123.116.55.6 ,0 )
From: 王琛瑀
DOI:10.1016/j.yebeh.2020.107265.
Journal:Epilepsy Behav .
Recommended references: Chenyu,Wang,Jun-jie Ding,Zheng Jiao,Er-qian Yu,Guo-xing Zhu.(2020).Remedial dosing recommendations for delayed or missed doses of valproic acid in patients with epilepsy based on Monte Carlo simulations.Epilepsy Behav . .doi:10.1016/j.yebeh.2020.107265. (Click&Copy)
Version History
[V5] 2020-09-07 11:36:58 chinaXiv:201907.00014V5 Download
[V4] 2020-09-05 20:26:32 chinaXiv:201907.00014v4(View This Version) Download
[V3] 2020-08-31 15:40:42 chinaXiv:201907.00014v3(View This Version) Download
[V2] 2019-07-21 17:05:05 chinaXiv:201907.00014v2(View This Version) Download
[V1] 2019-07-18 13:06:01 chinaXiv:201907.00014v1(View This Version) Download
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