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Remedial dosing recommendations for valproic acid in nonadherence patients with epilepsy

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Objective: 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 nonadherence patients. Methods: The Monte Carlo simulations based on all previous population pharmacokinetic models for pediatric, adult and elder patients with epilepsy receiving valproic acid, which is the most commonly used first-line AED. The following three remedial approaches were investigated for each delayed dose: A) A partial dose was administered immediately, and the regular dose was administered 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 and partial doses were coadministered immediately, the next scheduled dose was skipped, and the regular dosing was resumed at the subsequent scheduled time. Results: The most appropriate remedial regimen was that with the shortest deviation time from the therapeutic window. The effect of nonadherence on PK was dependent on the delay duration and daily dose, and the recommended remedial dose was related to the delay duration and concomitant antiepileptic drugs. Remedial dosing strategies A and B were almost equivalent, whereas C showed a larger PK deviation time. If one dose was missed, double doses were not recommended for the next scheduled time. Significance: Simulations provide quantitative insight into the remedial regimens for nonadherence patients and clinicians should select the optimal regimen based on the status of patients
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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:10.12074/201907.00014
Recommended references: Chenyu,Wang,Jun-jie Ding,Zheng Jiao,Er-qian Yu,Guo-xing Zhu.(2019).Remedial dosing recommendations for valproic acid in nonadherence patients with epilepsy.[ChinaXiv:201907.00014] (Click&Copy)
Version History
[V2] 2019-07-21 17:05:05 chinaXiv:201907.00014V2 Download
[V1] 2019-07-18 13:06:01 chinaXiv:201907.00014v1(View This Version) Download
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