Pharmacokinetic variability of eslicarbazepine in real clinical practice.

INTRODUCTION: Eslicarbazepine acetate (ESL) is a sodium channel blocker indicated for partial-onset seizures with or without secondary generalization, at a single daily dose. There are very few publications on the levels of ESL metabolites in real clinical practice. OBJECTIVE: To describe the serum levels of licarbazepine (main metabolite of ESL) in patients with refractory epilepsy in real clinical practice. To evaluate the influence of age, sex, and polytherapy on levels and adverse effects. METHODS: This study involved a retrospective analysis of patients diagnosed with epilepsy treated with ESL for whom plasma levels of licarbazepine were available, measured by spectrophotometry. RESULTS: Sixty-four patients were included. One patient had licarbazepine levels of 0 (admitted not taking the drug) was not analyzed. Mean licarbazepine levels of 7.66 µg/mL (400 mg/day dose), 16.56 µg/mL (800-mg dose), and 20.80 µg/mL (1200 mg) were significantly different. There was a significant correlation between daily dose and serum levels (p < 0.05) and between the concentration/dose ratio and lower to higher doses (p < 0.05). Pharmacokinetic variability (coefficient of variation for the concentration/dose ratio) was 33.2%. We found a decrease in the concentration/dose ratio in the 1200 mg/day dose, compared to lower doses. We did not find differences by sex or intake of other antiepileptic inducers or metabolic inhibitors. Fifteen patients (23.8%) had mild nonsymptomatic hyponatremia. CONCLUSION: These results suggest that it is not necessary to routinely determine licarbazepine levels. In specific cases, licarbazepine levels can be useful to assess adherence to treatment and for personalized dose adjustment.

Lateral macrobicyclic architectures: toward new lead(II) sequestering agents.

The macrobicyclic receptor L,(5) derived from 4,13-diaza-18-crown-6 incorporating a pyridinyl Schiff-base spacer, forms stable complexes with lead(II) in the presence of different counterions. The coordination environment of the guest lead(II) ion may be modulated by external factors thanks to the optimal cavity size of L(5) as well as the nature and distribution of its donor atoms. Both in solution and in solid state, the guest lead(II) is nearly centered into the macrobicyclic cavity of L(5) when poorly coordinating groups such as perchlorate are present. The long Pb-donor atom distances found in the X-ray crystal structure of [Pb(L(5))](ClO(4))(2).0.5H(2)O (1) reveal that weak interactions between the lead(II) ion and the donor atoms of the receptor exist. (1)H and (207)Pb NMR spectroscopy studies demonstrate that monoprotonation of the receptor L(5) moves the lead(II) ion to one end of the cavity, whereas its diprotonation causes the demetalation of the complex without receptor destruction. This demetalation process is reversible and very fast. All of this, together with the inertia of the receptor toward hydrolysis, opens very interesting perspectives for the use of receptor L(5) as a new lead(II) extracting agent. The X-ray crystal structure of compound [Pb(HL(5))(NO(3))][Pb(NO(3))(4)] (3) appears to be a good model for the monoprotonated intermediate of the demetalation process. In 3 the lead(II) ion is six-coordinate and clearly placed at one end of the macrobicyclic cavity, which results in a substantial shortening of the bond distances of the lead(II) coordination sphere.