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THERAPEUTIC DRUG MONITORING OF VALPROIC ACID IN PEDIATRIC EPILEPTIC PATIENTS

Therapeutic drug monitoring (TDM) or the measurement of drug concentrations in plasma, serum or blood, aims to improve clinical activity, avoid toxicity, and reduce the costs of drug treatment. Specific conditions for TDM to be reasonably applied include the availability of a validated assay, a considerable inter-individual pharmacokinetic variability, a high correlation between drug concentration and toxicity, and a narrow therapeutic index. Our aim of study is to investigate that, therapeutic drug monitoring of valproic acid in pediatric epileptic patients at tertiary care government hospital. The study was carried out prospectively during course of research activity in MGMH between March 2009 – October 2010. The study was approved by hospital ethical committee, Warangal. The patient group was selected from epileptic pediatrics patients who visited tertiary care hospital. All of the patients fulfilled the inclusion criteria and exclusion criteria. Informed consent was taken from the patients and guardian. Blood samples were collected from patients after morning dose at peak level. In our study total 30 pediatric epileptic patients are included in which 17 were males and 13 were females with mean age in years (7.93±3.38), mean BMI kg/m2 (12.14±4.61) & mean total VPA serum concentration of 53.39±4.18 μg/ml . Serum levels within the therapeutic range were found in 46. 33% of epileptic patient. Serum levels were below the therapeutic range in 56.66% of study population achieved partial control . Our article suggests that there was Poor correlation between daily dose and therapeutic level. There was a need for individual monitoring of liver function tests and blood urea nitrogen. In addition to that, a clinician has to check the therapeutic level or and despite daily dose being prescribed as per the guidelines. In future, clinician should step forward in the effort to ensure a more optimal and individual valproic acid therapy.