Antiepileptic dosing for critically ill adult patients receiving renal replacement therapy

J Crit Care. 2016 Dec:36:116-124. doi: 10.1016/j.jcrc.2016.06.023. Epub 2016 Jul 5.

Abstract

Objectives: The aim of this review was to evaluate current literature for dosing recommendations for the use of antiepileptic medications in patients receiving renal replacement therapy (RRT).

Data sources: With the assistance of an experienced medical librarian specialized in pharmacy and toxicology, we searched MEDLINE, EMBASE, CINAHL, Web of Science, WorldCat, and Scopus through May 2016.

Study selection and data extraction: Four hundred three articles were screened for inclusion, of which 130 were identified as potentially relevant. Micromedex® DRUGDEX as well as package inserts were used to obtain known pharmacokinetic properties and dosage adjustment recommendations in RRT if known.

Data synthesis: Data regarding antiepileptic drug use in RRT are limited and mostly consist of case reports limiting our proposed dosing recommendations. Known pharmacokinetic parameters should guide dosing, and recommendations are provided where possible.

Conclusion: Additional studies are necessary before specific dosing recommendations can be made for most antiepileptic drugs in critically ill patients receiving RRT, specifically with newer agents.

Keywords: Anticonvulsants; Continuous renal replacement therapy; Hemodialysis; Intensive care.

Publication types

  • Review

MeSH terms

  • Acetamides / administration & dosage
  • Acute Kidney Injury / complications
  • Acute Kidney Injury / therapy*
  • Amines / administration & dosage
  • Anticonvulsants / administration & dosage*
  • Anticonvulsants / adverse effects
  • Carbamates / administration & dosage
  • Critical Illness
  • Cyclohexanecarboxylic Acids / administration & dosage
  • Dibenzazepines / administration & dosage
  • Dose-Response Relationship, Drug
  • Ethosuximide / administration & dosage
  • Felbamate
  • Fructose / administration & dosage
  • Fructose / analogs & derivatives
  • Gabapentin
  • Humans
  • Isoxazoles / administration & dosage
  • Lacosamide
  • Lamotrigine
  • Levetiracetam
  • Phenobarbital / administration & dosage
  • Phenylcarbamates / administration & dosage
  • Phenylenediamines / administration & dosage
  • Phenytoin / administration & dosage
  • Piracetam / administration & dosage
  • Piracetam / analogs & derivatives
  • Propylene Glycols / administration & dosage
  • Renal Dialysis*
  • Renal Replacement Therapy
  • Seizures / complications
  • Seizures / drug therapy*
  • Topiramate
  • Triazines / administration & dosage
  • Valproic Acid / administration & dosage
  • Zonisamide
  • gamma-Aminobutyric Acid / administration & dosage

Substances

  • Acetamides
  • Amines
  • Anticonvulsants
  • Carbamates
  • Cyclohexanecarboxylic Acids
  • Dibenzazepines
  • Isoxazoles
  • Phenylcarbamates
  • Phenylenediamines
  • Propylene Glycols
  • Triazines
  • Topiramate
  • ezogabine
  • Fructose
  • Levetiracetam
  • Zonisamide
  • gamma-Aminobutyric Acid
  • Lacosamide
  • Ethosuximide
  • Valproic Acid
  • Phenytoin
  • Gabapentin
  • Lamotrigine
  • Felbamate
  • Phenobarbital
  • Piracetam