Journal article
Therapeutic Drug Monitoring of Pentobarbital: Experience at an Academic Medical Center
Therapeutic drug monitoring, Vol.37(6), pp.783-791
12/2015
DOI: 10.1097/FTD.0000000000000217
PMID: 26565790
Abstract
Pentobarbital is used for management of intractable seizures and for reducing elevated intracranial pressure. Dosing of pentobarbital can be aided by therapeutic drug monitoring (TDM). There is no commercially available automated assay for measurement of pentobarbital serum/plasma concentrations; consequently, chromatography-based assays are often used.
Pentobarbital TDM was studied over a 14-year period at an academic medical center. 154 patients (94 adult, 60 pediatric) were identified who had pentobarbital levels ordered at least once during a hospital encounter. Chart review included patient diagnosis, indication for pentobarbital therapy, recent or concomitant medication with other barbiturates, patient disposition, organ donation, pentobarbital dosing changes, and neurosurgical procedures. Pentobarbital serum/plasma concentrations were determined on an automated clinical chemistry platform with a laboratory-developed test adapted from a urine barbiturates immunoassay.
Chart review showed therapeutic use of pentobarbital generally consistent with previously published literature. The most common errors observed involved confusion in barbiturate names (eg, mix-up of pentobarbital and phenobarbital in test ordering or in provider notes) that seemed to have minimal impact on TDM effectiveness, with pentobarbital serum/plasma concentrations generally within target ranges. The laboratory-developed pentobarbital immunoassay showed cross-reactivity with phenobarbital and butalbital that was eliminated by alkaline and heat pretreatment. The immunoassay was linear to 20 mcg/mL and correlated closely with gas chromatography-mass spectrometry measurements at a reference laboratory.
Pentobarbital TDM can be performed by immunoassay on an automated clinical chemistry platform, providing an alternative to chromatography-based methods. Confusion in barbiturate names is common, especially pentobarbital and phenobarbital.
Details
- Title: Subtitle
- Therapeutic Drug Monitoring of Pentobarbital: Experience at an Academic Medical Center
- Creators
- Robert M Humble - Department of Pathology, University of Iowa Hospitals and Clinics, Iowa City, IowaAlexandra EhlersBrittany L PakalniskisCory MorrisDenny DreesJeff KulhavyMatthew D Krasowski
- Resource Type
- Journal article
- Publication Details
- Therapeutic drug monitoring, Vol.37(6), pp.783-791
- Publisher
- United States
- DOI
- 10.1097/FTD.0000000000000217
- PMID
- 26565790
- ISSN
- 0163-4356
- eISSN
- 1536-3694
- Language
- English
- Date published
- 12/2015
- Academic Unit
- Pathology
- Record Identifier
- 9984047635002771
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