TY  - JOUR
T1  - Therapeutic drug monitoring of carbamazepine and valproic acid: interindividual variability in epilepsy patients
TT  - Karbamazepin ve valproik asitin terapötik ilaç izlemesi: epilepsi hastalarında bireyler arası değişkenlik
AU  - Uskur, Tuğçe
AU  - Güven, Oya
PY  - 2025
DA  - September
Y2  - 2025
DO  - 10.32322/jhsm.1751139
JF  - Journal of Health Sciences and Medicine
JO  - J Health Sci Med /JHSM /jhsm
PB  - MediHealth Academy Yayıncılık
WT  - DergiPark
SN  - 2636-8579
SP  - 884
EP  - 888
VL  - 8
IS  - 5
LA  - en
AB  - 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
KW  - Epilepsy
KW  - carbamazepine
KW  - valproic acid
KW  - blood-drug level
KW  - therapeutic drug monitoring
N2  - 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
CR  - Banerjee PN, Filippi D, Allen Hauser W. The descriptive epidemiology of epilepsy-a review. Epilepsy Res. 2009;85(1):31-45. doi:10.1016/j.eplepsyres. 2009.03.003
CR  - Turkish Neurological Society. In: Dervent A, Ayta S, Çokar Ö, Uludüz D. Approach Guide to Neurological Diseases in Children and Adolescents. 2015. https://noroloji.org.tr/TNDData/Uploads/files/%C3%87ED-2015 (1).pdf
CR  - Hanaya R, Arita K. The new antiepileptic drugs: their neuropharmacology and clinical indications. Neurol Med Chir (Tokyo). 2016;56(5):205-20. doi:10.2176/nmc.ra.2015-0344
CR  - Iorio ML, Moretti U, Colcera S, et al. Use and safety profile of antiepileptic drugs in Italy. Eur J Clin Pharmacol. 2007;63(4):409-415. doi:10.1007/s00228-006-0236-6
CR  - Elendu C, Jeswani BM, Madekwe CC, et al. Clinical and electroencephalographic correlates of carbamazepine-associated hiccups in epileptic patients. Ann Med Surg (Lond). 2024;86(7):4015-4034. doi:10.1097/MS9.0000000000002159
CR  - Rahman M, Awosika AO, Nguyen H. Valproic Acid. [Updated 2023 Aug 17]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK559112/
CR  - Maan JS, Duong TvH, Saadabadi A. Carbamazepine. [Updated 2023 Jul 10]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK 482455/
CR  - St Louis EK. Monitoring antiepileptic drugs: a level-headed approach. Curr Neuropharmacol. 2009;7(2):115-119. doi:10.2174/157015909788848938
CR  - Akdağ G, Algın Dİ, Erdinç OO. Epileps. Osmangazi J Med. 2016; 38(Special Issue 1):35-41. doi:10.20515/otd.88853
CR  - Giza E, Lefkopoulou M, Dimitrakopoulos D, Karachristianou S, Liasidis C. The impact of the COVID-19 pandemic on a Greek cohort of patients with epilepsy. Hippokratia. 2021;25(4):145-150.
CR  - Shared Health – SBGH Lab Manual. Carbamazepine. Available from: https://apps.sbgh.mb.ca/labmanual/test/view?seedId=1397. Accessed August 2025.
CR  - Tseng YJ, Huang SY, Kuo CH, Wang CY, Wang KC, Wu CC. Safety range of free valproic acid serum concentration in adult patients. PLoS One. 2020;15(9):e0238201. doi:10.1371/journal.pone.0238201
CR  - Zeng L, Yi Q, Huang L, et al. The guideline for therapeutic drug monitoring guidelines development. J Evid Based Med. 2022;15(3):272-283. doi: 10.1111/jebm.12486
CR  - Liu Y, Li J, Xiao S, et al. Revolutionizing precision medicine: exploring wearable sensors for therapeutic drug monitoring and personalized therapy. Biosensors (Basel). 2023;13(7):726. doi:10.3390/bios13070726
CR  - Irving PM, Gecse KB. Optimizing therapies using therapeutic drug monitoring: current strategies and future perspectives. Gastroenterology. 2022;162(5):1512-1524. doi:10.1053/j.gastro.2022.02.014
CR  - Sharma S, Joshi S, Mukherji S, Bala K, Tripathi CB. Therapeutic drug monitoring: appropriateness and clinical utility in neuropsychiatry practice. Am J Ther. 2009;16(1):11-16. doi:10.1097/MJT.0b013e31817fd85f
CR  - French JA, Perucca E. time to start calling things by their own names? The case for antiseizure medicines. Epilepsy Curr. 2020;20(2):69-72. doi: 10.1177/1535759720905516
CR  - Fratoni AJ, Colmerauer JL, Linder KE, Nicolau DP, Kuti JL. A retrospective case series of concomitant carbapenem and valproic acid use: are best practice advisories working? J Pharm Pract. 2023;36(3):537-541. doi:10.1177/08971900211063301
CR  - Al-Balawi RS, Alshehri MA, Alatawi AS, Al Shehri AM, Alshehry MA, Al-Gayyar MMH. Measuring the appropriateness of carbamazepine and valproic acid prescribing and utilization using a newly implemented online system in the Tabuk Region of Saudi Arabia. Saudi Pharm J. 2020;28(7):844-849. doi:10.1016/j.jsps.2020.06.008
CR  - Dalaklioglu S. Evaluating appropriateness of digoxin, carbamazepine, valproic acid, and phenytoin usage by therapeutic drug monitoring. Clin Lab. 2013;59(3-4):325-31. doi:10.7754/clin.lab.2012.120425
CR  - Bowden CL. Valproate. Bipolar Disord. 2003;5(3):189-202. doi:10.1034/j. 1399-5618.2003.00031.x
CR  - Marvanova M. Pharmacokinetic characteristics of antiepileptic drugs (AEDs). Ment Health Clin. 2016;6(1):8-20. doi:10.9740/mhc.2015.01.008
CR  - https://www.drugs.com/drug_interactions.html
UR  - https://doi.org/10.32322/jhsm.1751139
L1  - https://dergipark.org.tr/tr/download/article-file/5091462
ER  -