Karbamazepin ve valproik asitin terapötik ilaç izlemesi: epilepsi hastalarında bireyler arası değişkenlik

Year 2025, Volume: 8 Issue: 5, 884 - 888, 16.09.2025

Tuğçe Uskur , Oya Güven

https://doi.org/10.32322/jhsm.1751139

Abstract

Giriş: Epilepsi, dünya nüfusunun %1-3’ünü etkileyen, tekrarlayan nöbetlerle seyreden kronik bir nörolojik hastalıktır. Sık kullanılan antiepileptik ilaçlardan valproik asit ve karbamazepinin kan düzeylerinin izlenmesi, etkin nöbet kontrolü için büyük önem taşımaktadır. Bu çalışmada, valproik asit veya karbamazepin ile tedavi edilen hastaların serum ilaç konsantrasyonları, demografik özellikleri ve eş zamanlı ilaç kullanımları analiz edilmiştir.
Yöntem: Bu retrospektif çalışma, Kırklareli Eğitim ve Araştırma Hastanesi’nde yürütülmüş olup valproik asit veya karbamazepin ile tedavi edilen epilepsi hastalarının tıbbi kayıtları incelenmiştir. Toplam 440 epilepsi hastasına ait veriler retrospektif olarak analiz edilmiştir. Hastaların demografik verileri, eş zamanlı ilaç kullanımları ve kan ilaç düzeyleri kaydedilmiş, terapötik düzeye ulaşma oranları karşılaştırılmıştır.
Bulgular: Çalışmaya dahil edilen 440 hastadan 378’i valproik asit, 62’si karbamazepin ile tedavi edilmekteydi. Valproik asit grubunda hastaların %62,2’si terapötik düzeye ulaşırken, ortalama serum konsantrasyonu 68,15 µg/mL olarak saptandı. Karbamazepin grubunda ise yalnızca %27,4’ü terapötik düzeye ulaşmış olup, ortalama serum düzeyi 10,07 µg/mL idi. İki grup arasında istatistiksel olarak anlamlı fark bulundu. Karbamazepin grubunda ilaç etkileşimi sayısı ile terapötik düzeye ulaşamama arasında anlamlı bir ilişki saptandı (p<0.05).
Sonuç: Valproik asitin terapötik düzeye ulaşma açısından daha etkili olduğu gözlemlenmiştir. Karbamazepin ile tedavi edilen hastalarda terapötik düzeylerin düşük bulunması, bu hastalarda daha dikkatli izlem yapılması, doz ayarlamaları ve potansiyel ilaç etkileşimlerinin göz önünde bulundurulması gerekliliğini ortaya koymaktadır. Bu bulguların doğrulanması ve kişiselleştirilmiş tedavi yaklaşımlarının desteklenmesi için daha geniş örneklemli ileri çalışmalara ihtiyaç vardır.

Keywords

epilepsi , karbamazepin , valproik asit , ilaç kan düzeyi , terapötik ilaç düzeyi izlemi

Therapeutic drug monitoring of carbamazepine and valproic acid: interindividual variability in epilepsy patients

Abstract

Aims: Epilepsy is a chronic neurological disorder affecting 1-3% of the global population, characterized by recurrent seizures. Monitoring blood levels of valproic acid and carbamazepine, two commonly used antiepileptic drugs, is essential for effective seizure control. This study aims to analyze the serum concentrations, demographic characteristics and concomitant drug use of patients treated with valproic acid or carbamazepine.
Methods: This retrospective study was conducted at Kırklareli Training and Research Hospital, analyzing the medical records of epilepsy patients treated with valproic acid or carbamazepine. Medical records of 440 epilepsy patients were retrospectively analyzed. Demographic data, concurrent medication use and blood drug levels were recorded, and rates of achieving therapeutic levels were compared.
Results: Of the 440 patients, 378 were treated with valproic acid, and 62 with carbamazepine. In the valproic acid group, 62.2% reached therapeutic levels, with an average concentration of 68.15 µg/ml. In the carbamazepine group, only 27.4% reached therapeutic levels, with an average of 10.07 µg/ml. A statistically significant difference was found between the two groups. A significant association was found between drug interaction counts and non-therapeutic levels in the carbamazepine group (p<0.05).
Conclusion: Valproic acid was more likely to be within the therapeutic serum range. Lower therapeutic levels in carbamazepine-treated patients, indicate a need for careful monitoring, dose adjustments and consideration of potential drug interactions. Future studies with larger populations are needed to confirm these findings and support personalized treatment approaches.

Keywords

Epilepsy , carbamazepine , valproic acid , blood-drug level , therapeutic drug monitoring

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