Abstract
Objective: The purpose of the study was to estimate the pharmacokinetic parameters and calculate the precision (%RMSE) of the predicted lithium concentration equation.Methods: This research was studied from blood Lithium levels of Children who had visited Yuwaprasart Waithayopathum Child Psychiatric Hospital from 31 December 2009-1 January 2011 The accuracy and precision of the equation were evaluated by the mathematical principle. The assist package software (WIN-NONLIN) was used to create pharmacokinetic parameters.Results: Twenty-nine patients were recruited. The characteristics (mean+SD) presented as the following; age = 15.79+2.64 y, weight = 69.75+22.28 kg and the daily dose = 858.62+274.53 mg. The trough Lithium concentrations (mean+SD) = 0.56+19 mg/l. The kinetic parameter (Mean+SD) presented as the following; t1/2 =7.23+3.38 hr., ke =0.12+0.07 hr-1, Vd = 48.83+15.60 L, AUC0-12 =11.01+5.61 mg x hr/l. The population pharmacokinetic parameters; ke, and AUC (0-∞) = 0.151 hr-1 and 169.81, mg x hr./l respectively. The modified equation from Yukawa for lithium clearance calculation and prediction lithium concentrations were CL (mL/min) = [36.5+(0.242x BW (kg)-7.79]/Scr (mg/dL) and lithium concentration (mg/l) = 4 x Dose (mg)/CL (mL/min)x73.89, respectively with 6.39 %RMSE (test for 20 patients data).Conclusion: In conclusion, the modified Yukawa equation may be used for the prediction of lithium concentration with 6.39% RMSE.
Highlights
Lithium is the drug of choice in treating patients with mood disorders, especially in children [1-3]
The information of serum lithium concentration in children less than 18 y who used lithium treatment in Yuwaprasart Waithayopathum Child Psychiatric Hospital was collected since 1 January 2009 to 31 December 2011
The results from this study demonstrated that the modified Yukawa equation can use to predict serum lithium concentration with 93.61% accuracy
Summary
Lithium is the drug of choice in treating patients with mood disorders, especially in children [1-3]. The difficulty for drug use is adverse drug reactions [4-7] that needed to monitor serum drug concentrations [8-13]. Yuwaprasart Waithayopathum Child Psychiatric Hospital which one of the hospital that responsible for caring child psychiatric disorders patient, for example; autistic child use lithium. While lithium prescribing is most common in this group, it has a problem of initiative lithium dosing design and monitoring. The application of the individual pharmacokinetic model for dosing adjustment by estimation pharmacokinetic parameters in individualized patients will be useful for lithium therapy monitoring. The aim of the study is to estimate the pharmacokinetic parameters and calculate the precision (% RMSE) of the predicted lithium concentration equation in child psychiatric patients
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