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>A seven-day study of the pharmacokinetics of intravenous levetiracetam in neonates: marked changes in pharmacokinetics occur during the first week of life
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A seven-day study of the pharmacokinetics of intravenous levetiracetam in neonates: marked changes in pharmacokinetics occur during the first week of life
Introduction:Levetiracetam (LEV) is increasingly used in the treatment of neonatal seizures. The aim of this study was to determine pharmacokinetics in neonates with seizures and to obtain preliminary safety and efficacy data.Methods:Eighteen term neonates with seizures persisting after 20mg/kg of phenobarbital received intravenous LEV for 1?wk. LEV was administered as a 20 or 40?mg/kg bolus followed by 5–10?mg/kg/d. Pharmacokinetic data were analyzed using a nonlinear mixed-effects population approach. Continuous electroencephalogram monitoring allowed preliminary assessment of the efficacy of LEV in this population.Results:LEV clearance (CL) increased from a mean of 0.7?ml/min/kg (SD 0.27?ml/min/kg) on day 1 to 1.33?ml/min/kg (SD 0.35?ml/min/kg) by day 7. Mean half-life was 18.5?h (SD 7.1?h) on day 1 of the study and decreased to 9.1?h (SD 2.0?h) by day 7. The mean volume of distribution was 1.01 l/kg (SD 0.13 l/kg). No study-related serious adverse events were observed.Discussion:CL of LEV in neonates was higher than expected on the basis of immature renal function in term infants and increased significantly during the first week of life. More frequent dosing of LEV is needed in term infants to maintain serum concentrations in the range seen in children and adults.
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机译:简介:左乙拉西坦(LEV)被越来越多地用于治疗新生儿癫痫发作。这项研究的目的是确定癫痫发作的新生儿的药代动力学,并获得初步的安全性和有效性数据。方法:苯巴比妥20mg / kg静脉接受LEV 1周后持续发作的18个足月新生儿。 LEV以20或40?mg / kg推注给药,然后以5-10?mg / kg / d给药。使用非线性混合效应总体方法分析药代动力学数据。连续的脑电图监测可以初步评估该人群LEV的疗效。结果:LEV清除率(CL)从第1天的平均0.7µml / min / kg(SD 0.27µml / min / kg)增加到1.33?到第7天时达到ml / min / kg(SD 0.35?ml / min / kg),研究的第一天的平均半衰期为18.5?h(SD 7.1?h),降至9.1?h(SD 2.0?h) ),直到第7天。平均分配量为1.01 l / kg(标准差0.13 l / kg)。没有观察到与研究相关的严重不良事件。讨论:新生儿LEV的CL值高于足月婴儿未成熟肾功能的预期值,并在出生后第一周显着增加。足月婴儿需要更频繁地服用LEV,以将血清浓度维持在儿童和成人所见的范围内。
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