You have raised a relevant issue, relating to valproate. While our
work-load is very small for valproate, it is requested in children for (a)
compliance (b)
drug efficacy if there is seizure recurrence (c) dose-related drug toxicity
( i.e.hepatic dysfunction and tremor) (d) cases where combination therapy
is used.As you know, sensitivity and hence toxicity to valproate in
children is of major concern and when the drug is used, plasma levels are
monitored sometimes, but rarely, for the above reasons at our institution.
At 10:52 PM 10/13/98 +0100, Michael Colley wrote:
>In message <[log in to unmask]>, Zul Verjee
><[log in to unmask]> writes
>>We Studied the correlation between plasma and salivary anticonvulsants
>>levels including valproate in children some years ago. REF. Therapeutic
>>Drug Monitoring, vol. 19 No.6, 1997, 637-642. Valproate levels did not
>>correlate. It is a weak acid and changes in pH gradient between plasma and
>>saliva may play a role in the interindividual variability of its
>>saliva/plasma concentration ratios. Saliva valproate level therefore is not
>>useful for TDM.
>>
>>
>>
>>
>>
>>At 11:11 AM 10/1/98 +0100, JP Begley wrote:
>>> I've been asked whether it's possible to measure Sodium Valproate in
>>>saliva from a young lady with muscular dystrophy and epilepsy who is
>>>impossible to bleed. I have no experience of this approach and would have
>>>concerns re sample quality and interpretation. Can anyone offer any
>>>advice? Joe Begley Clinical Biochemistry Poole Hospital
>>
>But of course the BNF states that serum valproate is not useful for
>routine monitoring of valproate therapy, so why are you measuring it at
>all?
>
>
>--
>Michael Colley
>
>Dr. C. M. Colley
>Dept. Chemical Pathology,
>Princess Margaret Hospital
>Swindon SN1 4 JU
>
>
%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%
|