147 serum samples from epileptic patients under treatment with carbamazepine (CBZ) and/or phenytoin (PHT) and/or valproic acid (VPA) were obtained to study the correlation between total concentrations and free fractions, and the effect of antiepileptics coadministrated on the free fractions.CBZ free fractions were found to vary from 14 to 33%, and they were not effected by PHT or VPA coadoministrated. PHT free fractions were found to vary from 5 to 14%, but they increased significantly in the presence of VPA, and VPA and CBZ.There was no correlation between total concentrations and free fractions in PHT or CBZ, respectively.Whereas n VPA whose free fractions were found to vary from 4 to 18%, there was strong linear correlation between total concentrations and free fractions.However, the degree of variation of free fractions was not smaller even in lower total concentrations.In the serial monitoring of total concentrations and free fractions of antiepileptics in the same patients, there was the diurnal variation of free fraction, and the side effects were observed when the free fractions were higher.
From these results, it is necessary to monitor the serum free drug concentrations rather than total drug concentrations for deciding the dosage when as follows:(1) In patients concomitantly taking PHT and VPA, or VPA and CBZ, (2) In patients taking VPA which reveals the wide variation of free fractions in serum, and (3) In patients who are difficult to control clinical conditions even though total concentrations are in the therapeutic level and in the steady states.
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