RESUMO
BACKGROUND: Treating refractory status epilepticus (RSE) remains a challenge. Thiamylal can be used as a second- or third-line treatment; however, its potential to induce cytochrome P450 (CYP) activity may reduce the concentration of antiepileptic drugs (AEDs) administered prior to thiamylal. This report details a case of RSE patient treated with thiamylal, with monitored concentrations of thiamylal and other AEDs. CASE PRESENTATION: A 72-year-old healthy man developed RSE. Despite the administration of various AEDs, his seizures were not resolved. Thiamylal was then administered at an initial bolus dose of 2.1 mg/kg, followed by a continuous infusion of 4.2-5.2 mg/kg/h. The initial thiamylal concentration was observed at 7.8 µg/mL, increasing to 35.2 µg/mL before decreasing after dose reduction and cessation. Concurrently, the concentration of concomitant carbamazepine decreased from 5.59 µg/mL to 2.1 µg/mL and recovered as thiamylal concentration decreased. Lesser impacts were noted for other AEDs. CONCLUSIONS: This case report underscored the efficacy of thiamylal in treating RSE. However, it also highlighted the need for clinicians to closely monitor the concentrations of concurrent AEDs, especially carbamazepine, during thiamylal therapy.
RESUMO
BACKGROUND: Therapeutic drug monitoring for voriconazole is recommended for its optimum pharmacotherapy. Although the feedback of the measurement result of serum voriconazole concentration by outsourcing needs a certain time (days within a 1 week), there was no medical equipment for the measurement available in clinical practice. Recently, a medical equipment based on high performance liquid chromatography, named LM1010, has been developed and authorized for clinical use. In this study, to validate the clinical performance of LM1010, we compared the measured serum voriconazole concentrations by LM1010 with those by outsourcing measurement using liquid chromatography-tandem mass spectrometry. METHODS: We conducted the observational study approved by the institutional review board of Kumamoto University Hospital (No. 1786). Residual serum samples harvested for therapeutic drug monitoring were separated. Measured concentrations by LM1010 by the standard filter method (needs serum volume of > 400 µL) or the dilute method (needs serum volume of 150 µL) were compared with those by outsourcing, respectively. Acceptable measurement error range of 0.72-1.33 was considered. There were 69 serum samples, where the 35 or 34 samples were employed for evaluation of the standard filter method or the dilute method, respectively. RESULTS: The measured concentration using the standard filter method/outsourcing was 2.22/2.10 µg/mL as the median, 1.57-3.40/1.53-3.62 as the interquartile range, < 0.2-10.76/< 0.2-11.46 µg/mL as the range, while those using the dilute method/outsourcing was 2.36/2.29 µg/mL as the median, 1.08-2.94/1.03-3.06 as the interquartile range, 0.24-10.00/< 0.2-10.85 µg/mL as the range. The regression line for the standard filter method or the dilute method were y = 0.935x + 0.154 or y = 0.933x + 0.162, respectively. The standard filter method or the dilute method showed 11.4% samples (4/35, 95%CI 3.2-26.7%) or 8.8% samples (3/34, 95%CI 1.9-23.7%) out of the acceptable measurement error range, respectively. CONCLUSION: Measurement of serum voriconazole concentration by LM1010 can be acceptable in clinical TDM practice.