title: Free drug levels monitoring as a detector of false metabolic refractory epilepsy.
abstract: Unbound and total plasma levels of carbamazepine (CBZ) and phenobarbital (PB) were evaluated in a group of 12 refractory patients out of 397 subjects, with normal values of total drug concentration and unbound levels below the expected ones. We established a minimal acceptable 'subtherapeutic' free drug level, i.e. less than 9.62 micrograms/ml for PB and 1.36 micrograms/ml for CBZ. PB and CBZ dosages were increased during a 3-month period. We observed a normalization of free levels, unaccompanied by a significant decrease in seizure frequency. Free drug level monitoring may prove to be an unchallenged detector of false metabolic refractory epilepsy.
authors.affiliation: Neurological Clinic, University of Turin, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Gianelli
authors.forename: S
authors.initials: S
authors.lastname: Gentile
authors.forename: L
authors.initials: L
authors.lastname: Verzè
authors.forename: U
authors.initials: U
authors.lastname: Dimanico
authors.forename: M
authors.initials: M
authors.lastname: Baruchello
authors.forename: F
authors.initials: F
authors.lastname: Monaco
authors.forename: R
authors.initials: R
authors.lastname: Mutani
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000927:Anticonvulsants / Q000493:pharmacokinetics* / Q000627:therapeutic use; D002220:Carbamazepine / Q000493:pharmacokinetics* / Q000627:therapeutic use; D004827:Epilepsy / Q000188:drug therapy* / Q000378:metabolism; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010634:Phenobarbital / Q000493:pharmacokinetics* / Q000627:therapeutic use
chemical_list: D000927:Anticonvulsants; D002220:Carbamazepine; D010634:Phenobarbital