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PubMed1989

The effect of concurrent administration of sodium valproate on serum levels of primidone and its metabolite phenobarbital.

The effect of associated therapy on serum primidone (PRM) and derived phenobarbital (PB) concentrations, and on serum concentrations to PRM dose ratios (L/D ratio) were evaluated retrospectively from 100 consecutive PRM and derived PB determinations in 100 chronically treated epileptic patients. PRM administered was significantly (P less than 0.01) correlated with both serum PRM (r = 0.799 approximately 0.933) and derived PB levels (r = 0.545 approximately 0.870) in patients taking PRM. Derived PB L/D ratios and PB/PRM concentration ratios were higher in patients taking PRM in combination with phenytoin (PHT) and/or sodium valproate (VPA). Therefore, serum levels of PRM and derived PB should be monitored closely in patients taking PRM with PHT and/or VPA.

Adolescent↗
PubMed1978

Consecutive gas chromatographic determination of phenytoin, phenobarbital, primidone, phenylethylmalondiamide, carbamazepine, trimethadione, dimethadione, ethosuximide, and valproate from the same serum specimen.

A quantitative gas-liquid chromatographic procedure is described for the consecutive determination of phenytoin, phenobarbital, primidone, phenylethylmalondiamide, carbamazepine, trimethadione, dimethadione, ethosuximide and valproate from a single serum specimen of 1.2 ml. After extraction from serum by two different procedures, the anticonvulsants are chromatographed without further purification on a 3% OV 17 column either with or without derivative formation by means of "on-column" methylation. Multiple internal standards are employed in order to enhance the reproducibility of drug-concentration measurement.

Anticonvulsants↗
PubMed1981

Diphenylhydantoin and primidone in tears.

Diphenylhydantoin (PHT) and primidone (PRM) were determined by the EMIT technique in the plasma, tears, saliva, and CSF of epileptic patients. Results indicate for PHT that tear values are more strictly correlated than are the saliva values to plasma and CSF concentrations. As for PRM, the data obtained show great interindividual variability of concentration in the different body fluids--in agreement with the wide range of both protein binding and half-life of this drug.

Adult↗
PubMed1984

Effectiveness and toxicity of phenobarbital, primidone, and sodium valproate in the prevention of febrile convulsions, controlled by plasma levels.

The effectiveness and toxicity of phenobarbital (PB), primidone (PRM), and sodium valproate (VPA), used exclusively in monotherapy, were compared in 95 children affected with febrile convulsions. Treatment was restricted to either complicated or simple febrile convulsions with risk factors. The effectiveness and toxicity of each drug were related to the daily dose and the steady-state plasma levels. PB (4.8 +/- 0.7 mg/kg/day) achieved plasma levels of 16.4 +/- 2.8 micrograms/ml and prevented febrile convulsions in 80% of the patients. Side effects were observed in 76.7% of the patients, a change in dose being required only in 13.3%. PRM (17.8 mg/kg/day) yielded PB plasma levels of 14.1 +/- 3.7 micrograms/ml and was effective in 88.2% of the patients. The incidence of side effects was 53%, but no change in treatment was required. VPA (35.2 +/- 5.9 mg/kg/day) achieved plasma levels of 57.2 +/- 15.3 micrograms/ml (measured before the first dose in the morning) and was effective in 91.7% of the patients. Side effects were detected in 45% (significantly lower than after PB, p less than 0.01), and required a change in treatment in 14.3%. No differences in doses and plasma levels were found between patients with or without recurrence of febrile convulsions and with or without side effects; an exception was the higher doses of VPA administered to patients who showed side effects. It is concluded that PRM and VPA were at least as effective and well tolerated as PB. Because the plasma levels of the three drugs were near the lower limit of the therapeutic range, it remains to be elucidated whether higher doses may increase the benefit without adding unacceptable toxicity.

Child↗
PubMedDate not supplied

Relationship between dose and serum concentrations of carbamazepine, phenytoin, phenobarbital, and primidone in a Sri Lankan population compared with a European population.

Concentrations of carbamazepine, phenytoin, phenobarbital, and primidone have been measured by high pressure liquid chromatography (HPLC) in serums of 177 Sri Lankan epileptic patients. Relationships between concentrations and dose per kg body weight of these drugs have been compared with those of patients in the Netherlands, using a matching procedure. Although variabilities in dose-concentration ratios were somewhat larger in Sri Lanka than in the Netherlands, no evidence was found of a systematic difference in pharmacokinetics between both populations.

Adolescent↗
PubMedDate not supplied

Clinical side effects of phenobarbital, primidone, phenytoin, carbamazepine, and valproate during monotherapy in children.

The rate of onset of side effects was examined in 392 pediatric outpatients who received long-term monotherapy with phenobarbital (PB), primidone (PRM), phenytoin (PHT), carbamazepine (CBZ), or valproate (VPA) for epilepsy or febrile convulsions. The severity of side effects (based on need to alter treatment), the nature of each drug's most common side effects, and the doses and plasma levels of occurrence were recorded. Our results show that usually accepted therapeutic ranges are well tolerated. Indeed, although some form of side effect occurred in 50% of patients, treatment had to be changed in only 18% and the drug had to be stopped in only 7%. In decreasing order, the rates for side effects were PHT (71%) greater than PB (64%) greater than CBZ (43%) greater than VPA (43%) greater than PRM (29%). Serious side effects requiring withdrawal of treatment occurred at the following rates: PHT (10%) greater than VPA (8%) greater than PRM (8%) greater than PB (4%) greater than CBZ (3%). Among our patients, the best tolerated antiepileptic drug (AED) was CBZ, and the least tolerated was PHT. Behavioral disorders were most common with PB, neurologic disorders with PHT, digestive tract disorders with VPA, and gingival hyperplasia and hirsutism with PHT. Behavioral disorders involving excitement seen with PB and PRM occurred most commonly at low plasma levels. Behavioral disorders involving depression seen with PB and VPA, those involving excitement seen with PHT and VPA, and digestive disorders seen with VPA occurred particularly when plasma levels were high.

Adolescent↗
PubMed1996

Systematic testing of medical intractability for carbamazepine, phenytoin, and phenobarbital or primidone in monotherapy for patients considered for epilepsy surgery.

PURPOSE: To assess medical intractability in patients considered for restrictive epilepsy surgery. METHODS: Seventy-four patients received single drug treatment with carbamazepine (CBZ), phenytoin (PHT), and either phenobarbital (PB) or primidone (PRM). Medical intractability was established if seizure control was not obtained despite maximum tolerable doses of the drug. In all, 120 single drug treatments were administered with the drugs that has not been administered at maximal doses in monotherapy before the study. RESULTS: Complete seizure control was not achieved in any patient. However, 7 patients (9.5%) had significant seizure reduction of at least 80%. In 4 patients, only the third antiepileptic drug (AED) proved effective. CONCLUSION: The poor result of AED monotherapy in our patients may be attributed to the patients' long-standing chronic epilepsies and high seizure frequencies. Our findings suggest that despite the failure of one or two major AEDs in controlling seizures completely, further single drug treatment may still improve the quality of life in some patients who are candidates for epilepsy surgery.

Adolescent↗
PubMed1988

Primidone and phenobarbital during lactation period in epileptic women: total and free drug serum levels in the nursed infants and their effects on neonatal behavior.

A total of 35 newborns whose mothers had been treated with either primidone (PMD), phenobarbital (PB) or a combination of one of these drugs with other antiepileptic drugs were included in this study. Fetal/maternal serum concentration ratios at birth, milk/serum concentration ratios and neonatal half-lives were determined for PMD, PB and phenylethylmalondiamide (PEMA). Steady-state serum levels of PMD in 2 nursed infants were 2.5 and 0.7 micrograms/ml, respectively, for PEMA values of 1.4 and 0.4 micrograms/ml. PB steady-state concentrations ranged between 2.0 and 13.0 micrograms/ml (6 infants). Maternal PB serum protein binding did not change during and after pregnancy. Neonatal free-fraction values at birth were similar to maternal values: 63.2 +/- 17.2% (n = 11). In the postnatal period, however, PB free-fraction values rose to more than 90% in some infants. In one case, neonatal free concentrations of PB were even higher during the 1st week after birth than the corresponding maternal values. Symptoms of sedation were observed in these neonates for which elevated free-fraction values of PB could be responsible. Behavior problems, such as withdrawal symptoms, were observed in neonates who eliminated PMD with short half-lives, while other infants with longer PMD half-lives or slower elimination because of nursing showed no such symptoms.

Behavior↗
PubMed1983

Primidone, phenobarbital, and PEMA: II. Seizure protection, neurotoxicity, and therapeutic index of varying combinations in mice.

Neurotoxicity and protection against maximal electroshock (MES) and pentylenetrazol (Metrazol) seizures were determined in mice for various combinations of primidone (PRM), phenobarbital (PB), and phenylethylmalonamide (PEMA). The results suggest that PRM and PB together are superior to either one alone in terms of spectrum of activity and relative toxicity. The protection against Metrazol and the toxicity of PB are both potentiated by PEMA at low concentrations. PEMA also potentiates the toxicity of combined PRM plus PB, without altering their protection against MES, thus lowering their therapeutic index. We conclude that PRM and PB together have an advantage over PB alone, especially when their brain concentration ratio is at or above 1 and PEMA concentrations are low. These conditions are usually not present at steady state in patients treated with PRM.

Animals↗
PubMed1994

Turbidimetric latex agglutination inhibition immunoassay for primidone.

We have developed a quick, highly sensitive immunoassay method for drugs by latex agglutination inhibition. An antiserum against primidone (PRM) was obtained by immunizing rabbits with PRM-bovine serum albumin conjugate. PRM-rabbit serum albumin conjugate sensitized latex was agglutinated with diluted antiserum, and the agglutination was inhibited by free PRM quantitatively. Turbidity of the agglutination suspension was measured by spectrophotometry as absorbance. Larger latex gave higher sensitivity than the smaller, because its agglutination was inhibited more intensely by free PRM. The assay values of this method were correlated well with those obtained by an enzyme immunoassay method.

Animals↗
PubMed1983

Simultaneous high performance liquid-chromatographic determination of carbamazepine, carbamazepine-10,11-epoxide, ethosuximide, phenobarbital, phenytoin, primidone and phenylethylmalonamide in plasma.

A common methodology is reported for the determination of five major anticonvulsants (carbamazepine, ethosuximide, phenobarbital, phenytoin, primidone) and their active metabolites (carbamazepine-10,11-epoxide, phenylethylmalonamide) in 30 microliters of plasma. After a single step of deproteinisation and extraction with acetonitrile, leading to an almost complete recovery of all the analytes, 5 microliters is injected on a reversed-phase column (Lichrosorb RP-18, 5 microns). The anticonvulsants are eluted isocratically at a column temperature of 50 degrees C with a mobile phase consisting of acetonitrile/phosphate buffer p' 6.9 (40/60 by vol), and monitored at 208 nm. Quantitation, using peak height or peak area, is based on the ratio of analyte to internal standard (allylisobutylbarbital) referenced to a serum-based multiple drug standard. The composition and pH of the mobile phase, temperature of the column, choice of wavelength of detection and size of the column material are crucial for the optimal separation of these five drugs and their two active metabolites in a chromatographic time of only 12 min, without sacrificing high sensitivity and column life.

Anticonvulsants↗
PubMed1975

Study of the hepatic metabolism of primidone by improved methodology.

The metabolism of the anticonvulsant drug primidone (PRM) was studied in the isolated perfused rat liver by a radiotracer methodology that permits nearly quantitative accounting of the dose as drug and identified metabolites. 14C-PRM and its metabolites were separated by thin-layer chromotography and quantitated by liquid-scintillation counting PRM was extensively converted to known active metabolites: phenobarbital (PB), 15%, and phenylethylmalonamide, 80%, in control livers during 120 minutes. Pretreatment of rats with PB greatly accelerated the rate of PRM metabolism, pretreatment with PRM only moderately so. There was no differential induction of the two metabolism pathways. Addition of phenylethylmalonamide to the perfusate reduced the rate of PRM metabolism but addition of PB did not. It is concluded that conversion of PRM to its active metabolites may be simultaneously influenced by the processes of metabolite induction (PB) and metabolite inhibition (phenylethylmalonamide).

Animals↗
PubMed1976

Simultaneous gas-chromatographic analysis for phenobarbital, diphenylhydantoin, carbamazepine, and primidone in serum.

We describe a simple, sensitive determination of phenobarbital, diphenylhydantoin, carbamazepine, and primidone in serum, by use of gas-liquid chromatography with temperature programming. The methylated derivatives of these anticonvulsants are well resolved, as was 5-(p-methyl-phenyl)-5-phenylhydantoin, the internal standard. The proposed procedure requires only 0.20 ml of serum and can be done in less than 30 min. The lower limit of detection for each of the drugs is 0.5 mg/liter. Analytical recoveries of drug from serum were excellent and peak height and concentration were linearly related up to twice the toxic concentration for serum.

Carbamazepine↗
PubMed1976

Primidone analyses: correlation of gas-chromatographic assay with enzyme immunoassay.

Serum specimens from patients on primidone therapy were assayed by two currently available procedures: a commercially available enzyme immunoassay (EMIT) and a published gas-chromatographic procedure. Both procedures were done with commercially available materials and equipment. Results by the two procedures agreed well, which suggests that the two methods could be used interchangeably. For the 94 specimens studied, the correlation coefficient was 0.98, and the least-squares values of slope and intercept were, respectively, 0.97 and 0.51 mg/liter.

Chromatography, Gas↗
PubMed1977

Simultaneous measurement of phenobarbital, phenytoin, primidone, ethosuximide, and carbamazepine in serum by high-pressure liquid chromatography.

We present a method for simultaneously determining five anticonvulsants [phenobarbital, phenytoin (diphenylhydantoin), primidone, ethosuximide, and carbamazepine] in as little as 25 microliters of serum. The proteins are precipitated with an acetonitrile solution containing hexobarbital as an internal standard. The anticonvulsants are eluted from a reversed-phase column with a mobile phase consisting of an acetonitrile/phosphate buffer (19/81 by vol) at a flow rate of 3.0 ml/min. The eluted drugs are detected by their absorption at 195 nm, and quantities estimated from their peak heights. Each analysis requires about 14 min. at an optimum column temperature of 50 degrees C. The lower unit of detection for all of these drugs is less than 10 ng. Sensitivities, for serum samples, of 1.0 mg/liter for all the drugs analyzed are attained routinely. Analytical recoveries for the five drugs varied from 97 - 107%, with good day-to-day precision (CV between 3.9 and 5.9%). Of more than 30 drugs tested for possible interference, only ethotoin interferes with the analysis of phenobarbital.

Anticonvulsants↗
PubMedDate not supplied

[Usefulness of the evaluation of plasma levels of primidone and phenobarbital].

We tested 187 blood samples to measure Primidone and Phenobarbital plasma levels. 63 were on monotherapy, whereas 124 on polytherapy. We founded a good relationship between PRI dosage and PB plasma levels. However, from our data, we can't find any correlation between PRI dosage and PRI level. Looking at correlations of polytherapy, BDZ and DPA do not change PRI and PB levels, whereas CBZ and DPH increase PB and decrease PRI, probably by inducing the biotransformation of the drug. In conclusion, we suggest the usefulness to measure together PRI and PB levels in order to obtain the best evaluation.

Adolescent↗
PubMed1987

Primidone-carbamazepine interaction: clinical consequences.

A 15-year old boy, suffering from partial complex seizures, was treated with primidone (PR) and carbamazepine (CBZ). In spite of daily doses in the usual range (PR = 12 mg/kg, CBZ = 30 mg/kg), he was not free from seizures and serum levels of CBZ were remarkably low (4.8 micrograms/ml). A good control of seizures was obtained after gradually stopping treatment with PR. This lead to a substantial increase of CBZ serum levels to a decrease of carbamazepine-10, 11-epoxide levels and a 60% reduction in total CBZ clearance.

Adolescent↗
PubMedDate not supplied

Liquid chromatographic determination of primidone in tablets: collaborative study.

Six laboratories collaboratively studied a liquid chromatographic (LC) method for the quantitative determination of primidone in tablets. Two lots each of commercially prepared 50 and 250 mg tablets and 2 authentic mixtures, at 50 and 250 mg levels, were sent to each collaborator. Samples were dissolved in the mobile phase, filtered, and injected into the chromatograph. Average recoveries for the 8 samples ranged from 97.5 to 101.2%, and coefficients of variation ranged from 0.53 to 3.01%. The LC method has been adopted interim official first action.

Chromatography, Liquid↗