Indian Write- Ups
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| Epilepsy treatment with a sustained release formulation of valproate Dr. P. N. Renjen, Senior Consultant Neurologist, Indraprastha Apollo Hospitals, New Delhi. |
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The compliance was judged to be varying from good-to-very-good by a large majority of responsible physicians. This is probably due to easier handling for the patients, on account of the possibility to take the sustained-release VPA preparation only once or twice daily, as well as, to the good tolerability. The acceptance and compliance of the patients in this investigation were markedly improved by the once or twice daily administration with equally good seizure control.
Controlled release formulations offer increased convenience in school children and ensures their compliance In a study undertaken with a newly developed controlled release formulation of valproate in children with epilepsy, the investigators studied plasma levels and behavioural effects in these children. Valproate plasma levels and performances in attention and vigilance tasks were monitored during a 12-h period (daytime), both during monotherapy of conventional valproate and 4 weeks after switching to a similar dosage of controlled-release preparations taken once daily. Neuropsychological assessment showed no significant difference between the two formulations of valproate and no correlation was found between cognitive performance and valproate plasma levels. The authors concluded that the advantage of the controlled-release valproate is that the once daily regimen may increase compliance and is more convenient for school children. Controlled-release valproate formulations facilitate easy switchover The question that arises now is that can the patients, on conventional three time a day valproate be switched over to sustained-release (chrono) preparation given as a single dose? In a retrospective study 113 patients were treated with a sustained-released formulation of valproate known as the "chrono" formulation in most European countries. It was observed that patients treated with the old formulation of valproate could immediately receive the same daily dosage of the chrono-formulation without loss of seizure control when administrated as a single evening dose. The tolerability of the chrono-formulation was good and twice or single daily dosing was preferred by the patients. Besides, the results of this study also showed that the efficacy of the chrono-formulation of valproate was comparable to that of other major anti-epileptic drugs such as carbamazepine. Sodium valproate is a broad spectrum anti epileptic which covers a large range of seizure disorders but was limited in use due to the pharmacokinetics of the drug. With the introduction of the controlled release formulation, its clinical efficacy undoubtedly makes it a drug of singular importance either as monotherapy or in combination with other anti-epileptic drugs. |
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