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Interactions between hormonal contraception and antiepileptic drugs : Clinical and mechanistic considerations

Antiepileptic drugs (AEDs) and hormonal contraceptives may affect each other's metabolism and clinical efficacy. Loss of seizure control and unplanned pregnancy may occur when these compounds are used concomitantly. Although a large number of available preparations yield a plethora of possible drug combinations, most of these drug interactions are predictable and, thus, avoidable. Unfortunately, t

New antiepileptic drugs and women

Since 1990, sixteen new antiepileptic drugs (AEDs) have been introduced. Most of these new AEDs have only been insufficiently studied with respect to women-specific aspects such as endogenous sex hormones, hormonal contraception, pregnancy, breastfeeding, or menopause. This is of concern because it has been shown for some of the new AEDs that these factors may have a clinically significant impact

Is dietary caffeine involved in seizure precipitation?

Caffeine acts as a central nervous stimulant by blocking A1 and A2A adenosine receptors. Its effect on seizures is complex. Animal studies and case reports indicate that acute caffeine exposure may induce seizures, whereas chronic exposure might have an opposite effect. Patients acutely hospitalized for seizures (n=174) were asked for their consumption of caffeinated beverages 24. h prior to admis

Relating fatty acid composition in human fingertip blood to age, gender, nationality and n-3 supplementation in the Scandinavian population

This study investigated data obtained from whole blood fatty acid (FA) composition of 3476 Norwegian and Swedish individuals, which provided background information including age, gender, nationality and self-motivated n-3 supplement consumption. The aim of this paper was to statistically relate this background information on the subjects to their whole blood FA profile, focusing mainly on the n-3

Second-generation antiepileptic drugs and pregnancy : A guide for clinicians

When treating pregnant women with antiepileptic drugs (AEDs), clinicians have to balance potential fetal adverse effects against the risks of uncontrolled maternal disease. Only recently have emerging scientic data provided a rational basis for treatment decisions considering both aspects. The focus of research is currently moving from the first to the second AED generation. Lamotrigine is relativ

Benzoylated uronic acid building blocks and synthesis of n-uronate conjugates of lamotrigine

A chemoenzymatic approach towards benzoylated uronic acid building blocks has been investigated starting with benzoylated hexapyranosides using regioselective C-6 enzymatic hydrolysis as the key step. Two of the building blocks were reacted with the antiepileptic drug lamotrigine. Glucuronidation of lamotrigine using methyl (2,3,4-tri-O-benzoyl-a-D-glycopyranosyl bromide)uronate proceeded to give

Lamotrigine and its N2-glucuronide during pregnancy : The significance of renal clearance and estradiol

Purpose: To investigate the physiological mechanisms behind the pronounced decline of lamotrigine (LTG) serum concentrations during pregnancy. Methods: Serum and urine concentrations of LTG and its main metabolite, LTG-N2-glucuronide (LTG-GLUC), were measured monthly in 21 pregnancies of 19 women using LTG. Simultaneously, a panel of biochemical variables was monitored to evaluate liver and kidney

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Bakgrunn.I 2007 kom det anbefalinger om at serumkonsentrasjonen av digitoksin bør ligge i området 8 – 15 nmol/l, noe som er ca. halvparten av det som tidligere var ansett som optimalt, og forslag til nye doseringsrutiner.Materiale og metode.Utviklingen for angitt dosering og serumkonsentrasjoner av digitoksin er undersøkt med utgangspunkt i 13 054 prøver sendt til Avdeling for klinisk farmakologi

Trends and changes in the clinical use of lamotrigine

Purpose: To investigate long-term trends and changes in the pattern of use of lamotrigine (LTG). Methods: Retrospective survey of a large, routine therapeutic drug monitoring database. Results: Twelve thousand one hundred and seven samples from 4123 subjects were analysed from October 1999 to May 2007. Within this period, the mean daily dose rose from 183 to 253 mg, whereas the median dose remaine

Expression of UDP-glucuronosyltransferase 1A4 in human placenta at term

The placenta contains a large variety of metabolizing enzymes, among them UDP-glucuronosyltransferase (UGT). Several UGT2B isozymes have so far been detected in human placenta, but little is known on placental expression of UGT1A isozymes. The antiepileptic drug lamotrigine (LTG) is a UGT1A4-substrate, and its serum concentration falls by over 50% during pregnancy, leading to impaired seizure cont

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Bakgrunn.I Norge blir det hvert år analysert hundretusener av urinprøver for å påvise inntak av rusmidler og legemidler med ruspotensial. Ved Avdeling for klinisk farmakologi ved St. Olavs hospital analyseres årlig rundt 60 000 urinprøver for rusmidler og legemidler med ruspotensial. Vi ønsket å finne ut om vårt standard analysepanel avdekker de fleste.Materiale og metode.Alle urinprøver mottatt i

Drug interactions between lamotrigine and psychoactive drugs : Evidence from a therapeutic drug monitoring service

We present a systematic study on the interaction potential of lamotrigine, with focus on psychoactive drugs. A review of routine serum concentration measurements of lamotrigine performed in our laboratory yielded a total of 1733 serum samples from 829 patients (530 women, 299 men) suitable for statistical analysis. Main results for the whole study population were (median; interquartile range in pa

Ethinyl estradiol, not progestogens, reduces lamotrigine serum concentrations

Purpose: To study the interaction between lamotrigine (LTG) and hormonal contraception. Methods: LTG serum concentrations of female patients using either no hormonal contraception (n = 18), an ethinyl estradiol (EE)-containing (n = 11), or a progestogen (PG)-only-containing compound (n = 16) were analyzed. Patients were recruited prospectively, and blood samples were drawn during drug fasting and

Lamotrigine in children and adolescents : The impact of age on its serum concentrations and on the extent of drug interactions

Objective: To investigate the impact of age and co-treatment with other drugs on the serum concentrations of lamotrigine in children and adolescents. Methods: A review of routine serum concentration measurements of lamotrigine performed in our laboratory yielded a total of 744 serum samples from 296 subjects (110 males, 186 females, age: 2-19 years) suitable for statistical analysis. The primary o