Lamotrigine therapeutic thresholds

SummaryPurposeTo evaluate therapeutic drug monitoring (TDM) of lamotrigine (LTG) with establishment of individual therapeutic thresholds (TT) in outpatients of a tertiary epilepsy centre on monotherapy.MethodsIn the outpatient clinic of the Danish Epilepsy Centre, Dianalund, all patients treated in 2004 with LTG monotherapy were identified. Patients who had not reported seizures or adverse reactions in the last 6 months were considered seizure free and well-medicated on LTG monotherapy, and were further evaluated. Plasma levels from routine LTG TDM obtained by reversed-phase high-pressure liquid chromatography (HPLC) during up-titration were used to calculate the TT for each patient as the mean of the highest subtherapeutic and the lowest therapeutic level.ResultsEighty-two patients undergoing LTG monotherapy were reported seizure free as defined above. In 34 the TT could not be calculated because they became seizure free on the first chosen dose. TTs of the remaining 48 patients ranged from 4.0 to 42.0μmol/l. There were no differences between children and adults, and between generalized and localization-related epilepsies. The therapeutic levels of patients with undefined TT tended to be lower. The level–dose ratio in both groups varied only moderately indicating absence of major exogenous influences.ConclusionEven in patients of a tertiary referral centre only a minority had high TTs and needed therapeutic levels in a range where toxicity is increasingly observed. TDM appears useful in LTG treatment both for the establishment of individual reference ranges and for the identification of the individual level-to-dose ratio

Salt content in canteen and fast food meals in Denmark

Background: A high salt (=NaCl) intake is associated with high blood pressure, and knowledge of salt content in food and meals is important, if the salt intake has to be decreased in the general population. Objective: To determine the salt content in worksite canteen meals and fast food. Design: For the first part of this study, 180 canteen meals were collected from a total of 15 worksites with in-house catering facilities. Duplicate portions of a lunch meal were collected from 12 randomly selected employees at each canteen on two non-consecutive days. For the second part of the study, a total of 250 fast food samples were collected from 52 retail places representing both city (Aarhus) and provincial towns. The canteen meals and fast food samples were analyzed for chloride by potentiometric titration with silver nitrate solution, and the salt content was estimated. Results: The salt content in lunch meals in worksite canteens were 3.8±1.8 g per meal and 14.7±5.1 g per 10 MJ for men (n=109), and 2.8±1.2 g per meal and 14.4±6.2 g per 10 MJ for women (n=71). Salt content in fast food ranged from 11.8±2.5 g per 10 MJ (burgers) to 16.3±4.4 g per 10 MJ (sausages) with a mean content of 13.8±3.8 g per 10 MJ. Conclusion: Salt content in both fast food and in worksite canteen meals is high and should be decreased