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Clinical Drug Investigation
Published in: Clinical Drug Investigation 1/2017

01-01-2017 | Review Article

Antiepileptic Drug Removal by Continuous Renal Replacement Therapy: A Review of the Literature

Author: Sherif Hanafy Mahmoud

Published in: Clinical Drug Investigation | Issue 1/2017

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Abstract

Continuous renal replacement therapy (CRRT) is used for managing acute kidney injury in critically ill patients. Removal of antiepileptic drugs (AEDs) by CRRT could be significant and may complicate patients’ intensive care unit stay. The objective of the current review was to summarize the available evidence for AED removal by CRRT. An electronic literature search of PubMed (1946 to May 2016), Medline (1946 to May 2016), and Embase (1974 to May 2016) databases for studies discussing AED removal by CRRT was conducted. A total of 31 case reports discussing 32 patients were found. AEDs reported were levetiracetam (n = 3), valproic acid (n = 9), carbamazepine (n = 10), phenytoin (n = 3), phenobarbital (n = 4), lacosamide (n = 1), gabapentin (n = 1), and topiramate (n = 1). Two-thirds of the reports were about using CRRT in drug overdose and one-third was about AED removal by CRRT during therapy. Based on the current limited evidence and pharmacokinetic characteristics of AEDs, renally eliminated AEDs and/or AEDs with limited protein binding such as levetiracetam are more likely to be removed by CRRT than AEDs that are mainly metabolized and extensively protein bound such as carbamazepine. In conclusion, there is not enough evidence to provide robust dosing recommendations for AEDs in patients undergoing CRRT. Further studies are needed.
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Metadata
Title
Antiepileptic Drug Removal by Continuous Renal Replacement Therapy: A Review of the Literature
Author
Sherif Hanafy Mahmoud
Publication date
01-01-2017
Publisher
Springer International Publishing
Published in
Clinical Drug Investigation / Issue 1/2017
Print ISSN: 1173-2563
Electronic ISSN: 1179-1918
DOI
https://doi.org/10.1007/s40261-016-0457-0

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