Detection of Carbamazepine Level among Patients Visiting Psychiatric and Pediatric Services of a Tertiary Hospital in Eastern Nepal

Authors

  • Dipesh Raj Panday B. P. Koirala Institute of Health Sciences, Dharan, Nepal
  • Gajendra Prasad Rauniar B. P. Koirala Institute of Health Sciences, Dharan, Nepal
  • Dilli Sher Rai B. P. Koirala Institute of Health Sciences, Dharan, Nepal
  • Karishma Rajbhandari Panday B. P. Koirala Institute of Health Sciences, Dharan, Nepal
  • Madhur Basnet B. P. Koirala Institute of Health Sciences, Dharan, Nepal
  • Shyam Prasad Kafle B. P. Koirala Institute of Health Sciences, Dharan, Nepal

DOI:

https://doi.org/10.3126/jbpkihs.v4i1.36993

Keywords:

Carbamazepine, High performance liquid chromatography, Plasma level, Toxicity

Abstract

Background: Carbamazepine plasma level is directly related to dose, therapeutic effect, and toxicity. We aimed to observe its plasma level and relationship with dose among psychiatric and pediatric patients.

Methods: This observational study was performed in the Therapeutic Drug Monitoring Laboratory of a university hospital for a period of 1.5 years. Twenty-six consenting patients visiting either psychiatric or pediatric service and taking carbamazepine same dose for > 8 days (i.e. > 6 half-lives) were enrolled. The primary outcome was plasma carbamazepine level as determined by a High-Performance Liquid Chromatography machine. The secondary outcome included its correlation with dose assessed by the Spearman rho’s correlation coefficient.

Results: The mean dose received by the patients was 13.31 ± 5.39 mg/kg/day in pediatrics and 8.33 ± 2.29 mg/kg/day in psychiatry.  The plasma levels [median (IQR)] were 10.01 (6.27, 13.35) mg/L and 10.53 (5.17, 15.19) mg/L respectively in pediatric and psychiatric patients. Thirteen patients (50%) had therapeutic, 10 (36.46%) had above therapeutic, and 3 (11.54%) had subtherapeutic plasma level. Neurocysticercosis (23.1%) in pediatrics and partial seizure (69%) in psychiatry were the most common diagnosis. Symptom-control was achieved in 19 (73.1%) patients. The plasma carbamazepine level did not correlate with dose either in pediatric patients (p = 0.42) or in psychiatry patients (p = 0.63). 

Conclusion: The plasma carbamazepine levels [median (IQR)] in pediatric and psychiatric patients were 10.01 (6.27, 13.35) mg/L and 10.53 (5.17, 15.19) mg/L respectively. The plasma level was normal in half of the recruited patients and did not correlate with dose.

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Author Biographies

Dipesh Raj Panday, B. P. Koirala Institute of Health Sciences, Dharan, Nepal

Department of Clinical Pharmacology and Therapeutics

Gajendra Prasad Rauniar, B. P. Koirala Institute of Health Sciences, Dharan, Nepal

Department of Clinical Pharmacology and Therapeutics

Dilli Sher Rai, B. P. Koirala Institute of Health Sciences, Dharan, Nepal

Department of Clinical Pharmacology and Therapeutics

Karishma Rajbhandari Panday, B. P. Koirala Institute of Health Sciences, Dharan, Nepal

Department of Basic and Clinical Physiology

Madhur Basnet, B. P. Koirala Institute of Health Sciences, Dharan, Nepal

Departments of Psychiatry

Shyam Prasad Kafle, B. P. Koirala Institute of Health Sciences, Dharan, Nepal

Department of Pediatrics and Adolescent Medicine

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Published

2021-06-30

How to Cite

Panday, D. R., Rauniar, G. P., Rai, D. S., Panday, K. R., Basnet, M., & Kafle, S. P. (2021). Detection of Carbamazepine Level among Patients Visiting Psychiatric and Pediatric Services of a Tertiary Hospital in Eastern Nepal. Journal of BP Koirala Institute of Health Sciences, 4(1), 15–19. https://doi.org/10.3126/jbpkihs.v4i1.36993

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Original Articles