Iniciación de un programa de monitorización de lamotrigina en pacientes epilépticos

Abstract

The monitoring of lamotrigine's (LTG) plasmatic concentrations (TDM-Therapeutic Drug Monitoring) constitutes a strategy designed to individualize the posology and to optimize the therapeutic response. It has been initiated an LTG TDM program by using as an analytical technique the high-performance liquid chromatography (HPLC). The LTG dose was individualized in 41 epileptic patients, estimating its pharmacokinetic parameters by means of a Bayesian method (PKS program), in which bibliographic pharmacokinetic parameters were included as a previous information. The utilized analytical technique showed linearity in a concentration margin between 0.5 and 20 µg/mL (r 2 = 0.990). The evaluation of the predictive capacity of the LTG pharmacokinetic parameters estimated in each patient by the Bayesian method, with respect to the use of average populational pharmacokinetic parameters («a priori method»), revealed that the mean error and the absolute mean error of prediction for plasmatic concentrations are significantly reduced (p < 0.05) when a Bayesian algorithm is used (-0.14 ± 1.69 µg/mL vs. 1.64 ± 3.82 µg/mL) and (0.94 ± 1.41 µg/mL vs. 3.26 ± 2.55 µg/mL), respectively. The wide interindividual variability observed in LTG's kinetic behavior, close to 150%, would justify its TDM. Bayesian techniques have proved to be good strategies for the adequate posologic individualization of LTG