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    Journal of Pharmacology and PharmacotherapeuticsNOW IN
    Article

    Correlation between Breakthrough Seizures and Serum Level of Phenytoin and Valproate in Indian Patients

    Neena Katoch1, Ankit Bhardwaj1, Kapil Suchal1, Sangeeta Sharma1★★ Corresponding author

    1. 1Department of Neuropsychopharmacology, Institute of Human Behavior and Allied Sciences, Delhi, India.

    CORRESPONDENCE

    Sangeeta Sharma

    Department of Neuropsychopharmacology, Institute of Human Behavior and Allied Sciences, Delhi ‑ 110 095, India.

    sharmasangeeta2003@gmail.com

    Received: 15-01-2021; Revised: 06-04-2021; Accepted: 24-06-2021.

    Volume 12, Issue 2 · pp. 73–78 · PUBLISHED 2021 · DOI: 10.4103/jpp.jpp_3_21

    View on J Pharmacol. Pharmacother. original site ↗

    ABSTRACT

    Objectives: To determine the optimum range of phenytoin (PHT) and valproate (VAP) levels and find out the critical drug levels below which chances of breakthrough seizures increase in North Indian population. Methodology: A cross‑sectional, case‑controlled, record‑based study was conducted in a quaternary care hospital from September 2018–2019. The case group comprised epilepsy patients on monotherapy with PHT/VAP presenting with breakthrough seizures after at least 6 months of seizure control. Noncompliant, overdose, toxicity, no or partial response, any other psychiatric or neurological disorder, adverse effects, and patients taking two or more antiepileptic drugs were excluded. Results: Data of 100 patients in each group were analyzed. Significantly lower mean levels in cases were observed in PHT (5.74 ± 3.68 mg/L vs. 13.75 ± 4.27 mg/L control) and VAP (24.13 ± 27.39 mg/L vs. 76.37 ± 17.71 mg/L control). A negative correlation of drug levels was observed with age and weight in both the groups. The level/dose ratio in controls (0.05 ± 0.03; 0.09 ± 0.06) was significantly (P < 0.0001) higher than cases (0.02 ± 0.01; 0.02 ± 0.03) in PHT and VAP, respectively. Conclusions: This study identifies the critical levels and level/dose ratio at which the risk of breakthrough seizures increases. A wide level/dose ratio was found in controls, more so in the VAP group. A prospective study with larger group size along with genetic studies should be done to evaluate further.

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      Katoch, N., Bhardwaj, A., Suchal, K., & Sharma, S. (2021). Correlation between Breakthrough Seizures and Serum Level of Phenytoin and Valproate in Indian Patients. Journal of Pharmacology and Pharmacotherapeutics, 12(2), 73–78. https://doi.org/10.4103/jpp.jpp_3_21