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Clinical Utility of a Continuous Intravenous Infusion of Valproic Acid in Pediatric Patients
Author(s) -
Taylor Lisa M.,
Farzam Farjam,
Cook Aaron M.,
Lewis Daniel A.,
Baumann Robert J.,
Kuhn Robert J.
Publication year - 2007
Publication title -
pharmacotherapy: the journal of human pharmacology and drug therapy
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.227
H-Index - 109
eISSN - 1875-9114
pISSN - 0277-0008
DOI - 10.1592/phco.27.4.519
Subject(s) - medicine , dosing , valproic acid , adverse effect , loading dose , anesthesia , medical record , continuous infusion , pediatrics , surgery , epilepsy , psychiatry
Study Objective . To describe the dose‐concentration relationship of a continuous intravenous infusion of valproic acid (VPA) in pediatric patients when a dosing protocol is used. Design . Retrospective and concurrent chart review. Setting . Tertiary care, 473‐bed, academic medical center with a 120‐bed, dedicated children's hospital. Patients . Twenty‐six pediatric patients (< 18 yrs old) who received VPA according to the protocol for continuous intravenous infusions between January 1, 2004, and March 31, 2006, identified by using a pharmacy order‐entry system. Measurements and Main Results . Patient demographics, VPA treatment regimens, clinical responses, and safety data were recorded and analyzed. Median patient age was 8.5 years (range 1.4–16 yrs). Approximately two thirds received VPA for seizures, and one third for migraines. Patients were given a mean ± SD VPA loading dose of 28.5 ± 5.2 mg/kg followed by a continuous infusion rate of 1 ± 0.2 mg/kg/hour. Mean ± SD serum concentration measured 4.5 ± 1.6 hours after the loading dose was 83.3 ± 22.8 μg/ml. Steady‐state concentration at 23.3 ± 3.0 hours after the start of the continuous infusion was 80.0 ± 26.0 μg/ml. Postload and steady‐state serum concentrations were within the target concentration of 50–100 μg/ml in 77% and 69% of patients, respectively. On further analysis, when the target range was expanded to 50–125 μg/ml (125 μg/ml was deemed acceptable if no adverse effects were noted), 89% and 92% of patients, respectively, had postload and steady‐state VPA serum concentrations within this range. The response rate was excellent, with nearly 85% of patients achieving a complete or partial response to therapy. Adverse effects were generally mild and uncommon. Conclusions . The continuous‐infusion protocol permitted rapid intravenous loading of VPA in pediatric patients while minimizing adverse events and achieving concentrations in the upper region of the therapeutic range.