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Topiramate and Lamotrigine Pharmacokinetics during Repetitive Monotherapy and Combination Therapy in Epilepsy Patients
Author(s) -
Doose Dennis R.,
Brodie Martin J.,
Wilson Elaine A.,
Chadwick David,
Oxbury John,
Berry David J.,
Schwabe Stefan,
Bialer Meir
Publication year - 2003
Publication title -
epilepsia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.687
H-Index - 191
eISSN - 1528-1167
pISSN - 0013-9580
DOI - 10.1046/j.1528-1157.2003.64402.x
Subject(s) - pharmacokinetics , medicine , topiramate , cmin , cmax , dosing , concomitant , anticonvulsant , lamotrigine , pharmacology , combination therapy , area under the curve , trough level , epilepsy , urology , anesthesia , transplantation , psychiatry , tacrolimus
Summary: Purpose: To determine at steady state (in the same group of patients): (a) the pharmacokinetics (PK) of lamotrigine (LTG) with LTG monotherapy, (b) the PK of LTG concomitantly administered with topiramate (TPM) at three escalating TPM doses (100, 200, and 400 mg/day), (c) the PK of TPM at three escalating TPM doses while receiving fixed‐dose LTG therapy, and (d) the PK of TPM with TPM monotherapy. Methods: This was an open‐label, sequential, single‐group, dose‐escalating PK study in which 13 patients with epilepsy not optimally controlled with LTG received stable‐dose LTG monotherapy for 2 weeks, followed by stable‐dose LTG therapy combined with escalating doses of TPM for ≤16 weeks, stable‐dose TPM therapy combined with tapered‐dose LTG therapy for 4 weeks, and stable‐dose TPM monotherapy for 2 weeks. Serial blood and urine samples were collected before and during TPM dosing, and safety data were collected throughout the study. Results: The exposure, or area under the plasma LTG concentration–time curve within a dosing interval at steady state (AUC ss ), did not change in the presence of TPM, with mean AUC ss values ranging at each TPM dose level between 66 and 81 mg×h/L with concomitant LTG/TPM therapy compared with 77 mg×h/L with LTG monotherapy. No significant change was found in the steady‐state peak (C max ) and trough (C min ) plasma levels of LTG in the presence and absence of TPM. The mean (±SD) oral clearance (CL/F) of TPM (400 mg/day) was 2.6 ± 1.1 L/h when given alone and 2.7 ± 0.7 L/h when given with LTG. The similarity of CL/F values also was reflected by the similar exposure (AUC ss ), C max , and C min values of TPM in the absence, and presence of LTG. Conclusions: The results of this study show that no PK interaction between TPM and LTGwas observed at the doses used in this study.