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Nonstereoselective disposition of ethosuximide in humans.

The total concentration of ethosuximide varied between 80 and 770 mumol/L in plasma samples obtained from 33 patients on long-term treatment with the racemic drug. The ratios between the two enantiomers measured by chiral gas chromatography in the same samples were close to unity (mean +/- SD = 1.06 +/- 0.14; range = 0.76-1.39). This suggests that the disposition of ethosuximide in humans is not stereoselective and that the measurement of total concentrations of ethosuximide is sufficient for therapeutic monitoring.

Adolescent↗

Determination of phenobarbital, ethosuximide, and primidone in human serum by micellar electrokinetic capillary chromatography with direct sample injection.

The determination of antiepileptic drugs in human serum by micellar electrokinetic capillary chromatography (MECC) with direct sample injection is discussed. Nanoliter quantities of patient sera are applied to the beginning of a fused silica capillary filled with a phosphate/borate buffer (pH 9.2) containing 75 mM sodium dodecylsulfate. Upon application of an electric field along the capillary, endogenous and drug substances are transported toward the cathode and separate into distinct zones which are detected by on-column UV absorption. Phenobarbital, ethosuximide, and primidone are shown to elute in front of the solubilized proteins, thus permitting quantitation of these drugs without any sample pretreatment. For phenobarbital and ethosuximide, MECC data obtained using the external standard method and peak areas as the basis for quantitation are shown to be in excellent agreement with those of nonisotopic immunoassays and, for ethosuximide, also with those of high-performance liquid chromatography. The correlation coefficients (n = 50) are between 0.972 and 0.986. Intraday and interday reproducibility data are 2.0-4.5% and 4.5-8.0%, respectively. For primidone, insufficient samples have been available for a comprehensive comparison of MECC data with those of other analytic techniques.

Anticonvulsants↗

Ethosuximide enantiomers in pregnancy and lactation.

A gas-chromatographic method was used to determine plasma concentrations of the ethosuximide enantiomers during three pregnancies in two epileptic women, in samples from the umbilical cord in one, and in breast milk in two patients. The ratio of the two enantiomers of ethosuximide ranged from 1.00 to 1.36 and was apparently unaffected by pregnancy, passage into breast milk, and transfer over the placenta. Hence, determination of total ethosuximide concentrations appear to be sufficient for therapeutic drug monitoring during pregnancy and lactation.

Adult↗

Simultaneous quantitative gas-chromatographic analysis of ethosuximide, phenobarbitone, primidone and diphenylhydantoin.

1 Therapeutic serum concentrations of ethosuximide, phenobarbitone, primidone, and dipheylhydantoin were assayed from 1 ml of human serum. The extraction procedure was common to all four drugs and three internal standards. 2 Subsequent isothermal gas chromatographic analysis of serum extracts produced well resolved peaks for the underivatized quantitation of ethosuximide and phenobarbitone. Primidone and diphenylhydantoin were determined as methylated derivatives. 3 Mean coefficients of variation for the assay of each drug were less 7% on a newly packed and conditioned column and less than 10% after the technique had been in continuous use for 3 months. 4 The advantage of quantitation relative to peak area ratios rather than peak height ratios was minimal for the determination of ethosuximide, primidone and diphenylhydantoin but appeared significant for the assay of phenobarbitone.

Chromatography, Gas↗

Effect of anticonvulsant drugs on gamma-hydroxybutyrate release from hippocampal slices: inhibition by valproate and ethosuximide.

The effects of some anticonvulsant drugs have been investigated on gamma-hydroxybutyrate release from rat hippocampal and striatal slices. Sodium valproate and ethosuximide inhibited the depolarization-evoked release of gamma-hydroxybutyrate induced by 40 mM K+. The IC50 values for these two drugs are in the concentration range of valproate and ethosuximide that exists in rat brain after administration of anticonvulsant doses to the animals. Trimethadione and pentobarbital are without significant effects. It can be concluded that the inhibition of gamma-hydroxybutyrate release, particularly that observed for hippocampus, might explain the protective effect of valproate and ethosuximide on gamma-hydroxybutyrate-induced seizures and perhaps on other kinds of epileptoid phenomenon.

Animals↗

Aplastic anemia during ethosuximide medication. Treatment with bolus-methylprednisolone.

A girl, born in 1975, developed severe aplastic anemia in November 1982 while on ethosuximide monotherapy for petit mal epilepsy, about 3 months after starting the ethosuximide medication. She was treated with bolus-methylprednisolone as described by Bacigalupo et al. (13), transfusions and antibiotics. During the third week on this regimen slight improvements in granulocyte and reticulocyte counts were demonstrated, and after approximately 6 weeks she was in stable condition without further need of transfusions. Blood status should be checked regularly during ethosuximide therapy, particularly during the first 6 months.

Anemia, Aplastic↗

Ethosuximide-induced lupus-like syndrome with renal involvement.

A 20-year-old man developed fever and urinary abnormalities with positive antinuclear antibody (ANA) two months after the start of ethosuximide. A renal biopsy showed mild mesangial cell proliferation and cellular crescents predominantly occupying a vascular pole in 7 out of 80 (8.8%) glomeruli. In the arteriole, mainly in close proximity to the glomerulus, proliferation of smooth muscle cells and luminal narrowing were observed. Discontinuation of ethosuximide led to the disappearance of fever, ANA and urinary abnormalities. These findings are strongly suggestive of a causal relationship between ethosuximide and a lupus-like syndrome with peculiar renal involvement.

Adult↗

Ethosuximide induced lymphadenopathy--a case report.

A wide range of adverse effects has been reported following prolonged use of anticonvulsant drugs. More commonly reported adverse effects for ethosuximide include gastric disturbances, psychiatric disorders and Systemic Lupus Erythematosus (SLE). Rare instances of leukopenia and pancytopenia have been noted. A case is presented of a 12 year old girl who developed generalized lymphadenopathy with progressive weight loss and leukopenia following prolonged use of ethosuximide for simple absence seizures. The enlarged lymph nodes regressed with withdrawal of the drug but re-appeared when the drug was recommenced. Sodium valproate was then introduced and ethosuximide discontinued. The seizures were successfully controlled with sodium valproate. Histopathology report of the lymphnode biopsy showed marked reactive lymphnode hyperplasia.

Anticonvulsants↗

Comparison of antiepileptic action of valproate and ethosuximide in adult and immature rats.

The antiepileptic action of ethosuximide and valproate was studied in immature rats in the pentetrazole (PTZ) model. Valproate antagonized the effect of PTZ in rats of all ages, while ethosuximide was effective only in rats of 25 or more days of age: in 18 day old rats it modified the PTZ seizure pattern and was ineffective in younger animals or only slightly affected the PTZ seizure pattern. Similarly, the ECoG studies have shown that valproate antagonizes PTZ action at all ages, while ethosuximide only in mature rats.

Animals↗

Effect of stimulus intensity on the profile of anticonvulsant activity of phenytoin, ethosuximide and valproate.

The relative ability of phenytoin, ethosuximide and valproate to prevent minimal (clonic) threshold, maximal (tonic extension of the hindlimbs) threshold and supramaximal (tonic extension of the hindlimbs) seizures elicited by electrical and chemical (Metrazol, bicuculline, and picrotoxin) stimulation was determined. Ethosuximide and valproate were effective against minimal (clonic) threshold seizures, whereas phenytoin was ineffective and even activated them. All three anticonvulsants were effective against maximal (tonic extension of the hindlimbs) threshold seizures. Phenytoin and valproate, but not ethosuximide, were effective against supramaximal (tonic extension of the hindlimbs) seizures. The results suggest that the specificity of experimental models of epilepsy used in the evaluation of potential antiepileptic drugs is primarily due to the intensity rather than the nature of the stimulus used or the kind of seizure component evoked. Models based only on maximal (tonic extension of the hindlimbs) threshold seizures may identify anticonvulsant activity, but do not differentiate between substances that prevent seizure spread and those that increase seizure threshold.

Animals↗

Excitable channel currents and gating times in the presence of anticonvulsants ethosuximide and valproate.

The effects of the anticonvulsants ethosuximide and valproate on the excitable Na and K channels of the squid giant axon are evaluated and compared. The drugs are highly specific in their effects on channel gating and ion permeability with regard to the membrane side of application. Both drugs when applied internally affect Na activation gating in ways that lead to the conclusion that they do not act as channel blockers. However, external ethosuximide is clearly a voltage-independent Na channel blocker with no effect on channel gating. On the K channel, ethosuximide appears to have a mixed action affecting both gating and the ion flux through open channels. However, valproate slows K channel gating without effect on the flux through open channels. The dose-response curve of the effects has a shape similar to that for ethanol. The implications for paroxysmal discharge and synchronous impulse generation are discussed in a preliminary way.

Animals↗

Effects of anticonvulsants on learning: performance of pigeons under a repeated acquisition procedure when exposed to phenobarbital, clonazepam, valproic acid, ethosuximide and phenytoin.

The effects of phenobarbital, clonazepam, valproic acid, ethosuximide and phenytoin were examined in pigeons performing under a repeated acquisition procedure. Clonazepam (0.06-0.75 mg/kg), valproic acid (40-120 mg/kg), ethosuximide (40-160 mg/kg) and phenytoin (2.5-15 mg/kg) produced generally dose-dependent decreases in rate of responding, whereas phenobarbital (5-50 mg/kg) had little consistent effect on response rate across the dose range studied. Phenobarbital and clonazepam produced dose-dependent increases in error rates. Although valproic acid and phenytoin generally increased errors relative to control values, this effect was not directly dose-dependent or consistent across subjects. A within-session analysis of the distribution of drug-induced increases in errors revealed that the main effect of phenobarbital, clonazepam, valproic acid and phenytoin was to increase errors during early acquisition (i.e., before the procurement of 15 or fewer reinforcers). Later in the session, a similar number of errors per reinforcer was made during drug and control sessions. In contrast to the other anticonvulsants examined, ethosuximide had little effect on error rates. These results suggest that there are qualitative as well as quantitative differences in the effects of anticonvulsant drugs under the repeated acquisition procedure.

Animals↗

Influence of ethosuximide on metrazol-induced seizures during ontogenesis in rats.

Effects of metrazol (pentylenetetrazole and ethosuximide were studied in male albino rats aged 7, 12, 18 and 90 days. The 18-day-old rats exhibited the highest sensitivity to metrazol. CD50s in the remaining three age groups were nearly the same. Ethosuximide was reliably effective against metrazol only in adult rats; in young animals it did not significantly change CD50s. Metrazol induced in ethosuximide-pretreated young rats either modified (long-lasting minimal seizures in 18-day-old animals) or new seizure patterns (minimal seizures in 7- and 12-day-old rats).

Aging↗

[A gaschromatographic method for the simultaneous determination of ethosuximide and valproate in serum (author's transl)].

A gaschromatographic procedure for the simultaneous determination of ethosuximide and valproate is presented. After addition of the two internal standards the serum sample is acidified and extracted by chloroform. 2 microliters of the organic phase is directly injected into the gaschromatograph without previous evaporation. The gaschromatographic analysis is carried out on SP 1000 under isothermal conditions without derivatisation. The coefficients of variation for the precision from day to day were 2.6% (ethosuximide) and 5.2% (valproate). In external quality control the results for both substances always differed less than one standard deviation from the mean. The detection limits (11.6 mumol/l for ethosuximide and 2.3 mumol/l for valproate) were far below the usual therapeutic range. The specificity of the method was proven by comparison of the relative retention times of about 100 drugs, the investigated antiepileptic drugs and their internal standards.

Chromatography, Gas↗

A single liquid-chromatographic procedure for therapeutic monitoring of theophylline, acetaminophen, or ethosuximide.

Simultaneous and semi-automated determinations of theophylline, acetaminophen, and ethosuximide from human serum are possible through use of a programmable autoinjector, an isocratic mobile phase, and reversed-phase "high-performance" liquid chromatography on a muBondapak C18 column. To avoid salt damage to the valves and the fittings of the autoinjector and solvent pump, we used only volatile, ion-pairing buffers such as triethylamine/acetic acid or N-ethylmorpholine/acetic acid at apparent pH 4.8 in acetonitrile/water (1/11 by vol). With this method we can separate theophylline, acetaminophen, and ethosuximide from 26 other drugs, metabolites, and related substances. Results by this procedure and the EMIT procedure for theophylline and ethosuximide in patient and control sera correlated well (r = 0.944 and 0.968, respectively). We conclude that this single chromatographic system reliably and economically yields analysis of three widely used therapeutic drugs on a routine or emergency basis.

Acetaminophen↗

Pharmacokinetics of ethosuximide in the dog.

The pharmacokinetics of ethosuximide were studied in dogs and compared with the data known for man. After intravenous injection of 40 mg/kg to 9 dogs, the concentration-time curve in serum could be described by the open one-compartment model. Serum half-lives were between 11 and 25 hr, the volume of distribution correspond to between 44 and 66% of body weight. After oral administration of the same dose, maximal serum concentrations were reached within 1-4 hr and the absorption amounted to 88-95%. By treatment with three daily doses, a plateau in serum concentrations could be reached and maintained. At serum concentrations above 100 microliter/ml, half-lives seemed prolonged when compared to the values determined previously with a dose of 40 mg/kg. Ethosuximide rapidly enters the cerebrospinal fluid, equilibrium was established after 20-30 min. Plasma protein binding of the drug was negligible. Comparison of the pharmacokinetic data for dog and man reveals, in spite of the somewhat shorter half-life in the dog, a rather good agreement. In female rats, ethosuximide had an average half-life of 10 hr, in mice of hardly 1 hr. Concentrations in serum and brain of mice equilibrated within 10 min.

Administration, Oral↗

Effect of ethosuximide on dopaminergically mediated behaviours.

Pretreatment with ethosuximide, a drug of choice for petit mal epilepsy, was found to inhibit the conditioned avoidance response in rats and the traction response in mice and to antagonise methamphetamine induced stereotyped behaviour in rats. Our results, which indicate the ethosuximide is capable of inhibiting the dopaminergically mediated behaviours, are in agreement with the recent reports stating that ethosuximide exerts central dopamine receptor blocking activity.

Animals↗

[Photically released trains of potentials following local application of ethosuximide into the corpus geniculatum laterale].

The influence of ethosuximide injected into the lateral geniculate body (LGB) on photically evoked afterdischarges (PhAD) and recruiting responses (PhR) after 0,3/s or 7/s light flash series was compared with the effect of intraperitoneally administered ethosuximide in freely moving albino rats with chronic electrodes. Whereas i. p. application of ethosuximide reduces or abolishes photically evoked afterdischarges and recruiting, administration into the LGB does not change these potentials or the photic evoked potential. This points to an action not immediately in the LGB.

Animals↗