PEDIATRICS Vol. 86 No. 2 August 1990, pp. 263-266
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Rapid Loading of Critically III Patients With Carbamazepine Suspension

Michael V. Miles PharmD1, Stephen T. Lawless MD1, Michael B. Tennison MD1, Amo L. Zaritsky MD1, and Robert S. Greenwood MD1

1 From the Division of Pharmacy Practice, School of Pharmacy, Departments of Pediatrics and Neurology, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina

To determine the rate and factors that affect carbamazepine absorption, six patients being treated in the pediatric intensive care unit for frequent seizures received loading doses (7.4 to 10.4 mg/kg) of carbamazepine suspension by either nasogastric or nasoduodenal tube. Carbamazepine serum concentrations were determined 15, 30, 60, 120, and 480 minutes after administration by fluorescence polarization immunoassay. One patient who had an ileus did not attain therapeutic concentrations (> 4.0 mg/L). The other five patients with normal gastrointestinal function achieved mean serum concentrations at 1 hour and 2 hours of 4.3 mg/L and 7.3 mg/L, respectively. Delayed gastric emptying and concurrent enteral feedings appear to slow the absorption of carbamazepine. No adverse effects were observed. Rapid loading with carbamazepine suspension appears to be a useful alternative for the management of critically ill pediatric patients who are experienced frequent seizures.

Key Words: carbamazepine • seizures • epilepsy

Submitted on June 28, 1989
Accepted on August 22, 1989




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