Use of antiepileptic drugs in hepatic and renal disease

Handbook of Clinical Neurology
Jorge J Asconapé

Abstract

The use of antiepileptic drugs in patients with renal or hepatic disease is common in clinical practice. Since the liver and kidney are the main organs involved in the elimination of most drugs, their dysfunction can have important effects on the disposition of antiepileptic drugs. Renal or hepatic disease can prolong the elimination of the parent drug or an active metabolite leading to accumulation and clinical toxicity. It can also affect the protein binding, distribution, and metabolism of a drug. The protein binding of anionic acidic drugs, such as phenytoin and valproate, can be reduced significantly by renal failure, causing difficulties in the interpretation of total serum concentrations commonly used in clinical practice. Dialysis can further modify the pharmacokinetic parameters or result in significant removal of the antiepileptic drugs. Antiepileptic drugs that are eliminated unchanged by the kidneys or undergo minimal metabolism include gabapentin, pregabalin, vigabatrin, and topiramate when used as monotherapy. Drugs eliminated predominantly by biotransformation include phenytoin, valproate, carbamazepine, tiagabine, and rufinamide. Drugs eliminated by a combination of renal excretion and biotransformation include ...Continue Reading

Citations

May 5, 2017·The Annals of Pharmacotherapy·Vincent V SorianoSean P Kane
Feb 7, 2017·American Journal of Therapeutics·Dalvir GillFatme Allam
Jul 3, 2018·Therapeutic Drug Monitoring·Natalia AlzuetaAzucena Aldaz
Sep 3, 2016·Pharmaceutical Research·Nilay ThakkarDaniel Gonzalez
Sep 3, 2016·Clinical Drug Investigation·Sherif Hanafy Mahmoud
Oct 19, 2019·Expert Review of Neurotherapeutics·Alessandra MoranoCarlo Di Bonaventura
Sep 8, 2020·Expert Opinion on Drug Safety·Laura OrsoliniUmberto Volpe
Jun 9, 2018·Critical Care : the Official Journal of the Critical Care Forum·Salia FarrokhMarek A Mirski
Jun 18, 2016·Current Treatment Options in Neurology·José M FerroPatrícia Santos
Mar 12, 2019·Current Treatment Options in Neurology·Samer Dahdaleh, Paresh Malhotra
Dec 11, 2020·Expert Review of Neurotherapeutics·Giovanni MastroianniEdoardo Ferlazzo
Feb 15, 2021·Journal of Stroke and Cerebrovascular Diseases : the Official Journal of National Stroke Association·Mona Sazgar
Jul 16, 2021·Epilepsy Research·Hyun Kyung KimDong Wook Kim

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