Oda Kazutaka, Katanoda Tomomi, Arakaki Hitomi, Katsume Taiki, Matsuyama Kaho, Jono Hirofumi, Saito Hideyuki
Department of Pharmacy, Kumamoto University Hospital, 1-1-1Chuo-Ku, Kumamoto City, HonjoKumamoto, Japan.
Department of Clinical Pharmaceutical Sciences, Graduate School of Pharmaceutical Sciences, Kumamoto University, 1-1-1Chuo-Ku, Kumamoto City, HonjoKumamoto, Japan.
J Pharm Health Care Sci. 2024 Jul 12;10(1):39. doi: 10.1186/s40780-024-00362-w.
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.
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.
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.
治疗难治性癫痫持续状态（RSE）仍然是一项挑战。硫喷妥钠可作为二线或三线治疗药物；然而，其诱导细胞色素P450（CYP）活性的可能性可能会降低在使用硫喷妥钠之前所给予的抗癫痫药物（AEDs）的浓度。本报告详细介绍了一例接受硫喷妥钠治疗的RSE患者，监测了硫喷妥钠和其他AEDs的浓度。
一名72岁健康男性发生了RSE。尽管使用了各种AEDs，但他的癫痫发作仍未得到缓解。随后给予硫喷妥钠，初始推注剂量为2.1mg/kg，随后以4.2 - 5.2mg/kg/h的速度持续输注。观察到硫喷妥钠的初始浓度为7.8μg/mL，在剂量减少和停药前增加到35.2μg/mL，随后下降。同时，同时使用的卡马西平浓度从5.59μg/mL降至2.1μg/mL，并随着硫喷妥钠浓度的降低而恢复。其他AEDs受到的影响较小。
本病例报告强调了硫喷妥钠治疗RSE的疗效。然而，它也强调了临床医生在硫喷妥钠治疗期间密切监测同时使用的AEDs浓度的必要性，尤其是卡马西平。
