Richards Noni, Reith David, Stitely Michael, Smith Alesha
School of Pharmacy University of Otago Dunedin New Zealand.
Department of Women's and Children's Health Dunedin School of Medicine University of Otago Dunedin New Zealand.
Epilepsia Open. 2017 Nov 27;3(1):86-90. doi: 10.1002/epi4.12086. eCollection 2018 Mar.
Subtherapeutic levels of lamotrigine and levetiracetam are more likely to occur during pregnancy owing to the effect of pregnancy on their pharmacokinetics. This can lead to suboptimal control of epilepsy, and guidelines recommend proactive dose adjustment in the second and third trimesters alongside therapeutic drug monitoring (TDM). This retrospective cohort study using administrative databases aimed to investigate whether prescribers adjust the dose of lamotrigine or levetiracetam during and after pregnancy and whether TDM is used to manage dose adjustment. In 460 individual pregnancies, 232 women (61.4%) had their lamotrigine dose increased in the second and third trimesters and 44 women (53.7%) had their levetiracetam dose increased. Only 57 women (12.4%) had any TDM. The dose was not always decreased postpartum, and 157 women (56.9% of those who had escalated doses during pregnancy) had dose reduced following birth. Between 2012 and 2015, 29 women had an epilepsy-coded hospital discharge during pregnancy and were more likely to have had their dose of lamotrigine or levetiracetam increased. Overall, doses of lamotrigine and levetiracetam were not increased during pregnancy in 40% of the study population, dose changes were not often guided by TDM, and doses were not always reduced postpartum.
由于妊娠对拉莫三嗪和左乙拉西坦药代动力学的影响，孕期更易出现低于治疗水平的药物浓度。这可能导致癫痫控制不佳，指南建议在孕中期和孕晚期进行积极的剂量调整并同时进行治疗药物监测（TDM）。这项利用管理数据库进行的回顾性队列研究旨在调查处方医生在孕期及产后是否调整拉莫三嗪或左乙拉西坦的剂量，以及是否使用TDM来管理剂量调整。在460例单胎妊娠中，232名女性（61.4%）在孕中期和孕晚期增加了拉莫三嗪剂量，44名女性（53.7%）增加了左乙拉西坦剂量。只有57名女性（12.4%）进行了任何TDM。产后剂量并非总是降低，157名女性（占孕期剂量增加者的56.9%）在分娩后剂量降低。在2012年至2015年期间，29名女性在孕期有癫痫编码的出院记录，且更有可能增加了拉莫三嗪或左乙拉西坦的剂量。总体而言，40%的研究人群在孕期未增加拉莫三嗪和左乙拉西坦的剂量，剂量变化并不常由TDM指导，且产后剂量并非总是降低。
