Therapeutic monitoring of levetiracetam concentration in epileptic children and influencing factors
Objective To determine the effect of daily dose,weight,age,gender,combined use of antiepileptic drugs(AEDs)and creatinine dearance rate(Ccr)on the steady-state plasma concentration of levetiracetam(LEV)in epileptic children.Methods Totally 345 epileptic children aged 0 to 18 years old who regularly took LEV were collected from January 2022 to November 2022.The plasma concentration was determined by high performance liquid chromatography-tandem mass spectrometry(HPLC-MS/MS).The correlation between daily dose,weight and plasma concentration was analyzed.The effect of age,gender,combined use of AEDs and Ccr on the plasma concentration of LEV were measured.Results LEV concentration was positively correlated with daily dose and weight.The concentration dose ratio(CDR)in infants was significantly lower than that in children and adolescents(P＜0.05).There was no significantly difference in CDR of LEV between males and females(U=14 335.00,P=0.562).The plasma concentration in combined enzyme inhibited AEDs group was significantly higher than that in LEV monotherapy group(U=6003.00,P=0.011).The CDR of LEV was positively correlated with Ccr(r=0.168,P=0.002).At the same time,the CDR of Ccr＞120 mL·min-1 group was significantly higher than that of 80～120 mL·min-1 group(P=0.010).Conclusion The influence factors of LEV concentration are complex,with much variation in pharmacokinetics between individuals.Daily dose,weight,age,combined enzyme inhibited AEDs and Ccr were important factors for LEV concentration.It is important to monitor the plasma concentration of LEV in antiepileptic treatment and provide individualized regimen.
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