Assessing Knowledge and Attitude of Pediatricians and Pharmacists Regarding Monitoring Unbound Valproic Acid Concentration in Pediatric Patients With Hypoalbuminemia
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Abstract
Background: Valproic acid (VPA), an antiepileptic medication, is widely used in pediatric settings. Around 90%–95% of VPA is bound to plasma proteins, predominately albumin. Physiological alterations leading to hypoalbuminemia may increase free VPA concentrations. In such a case, a total VPA may reflect therapeutical total concentration, while the free VPA concentration could be supratherapeutic. Monitoring of total VPA concentrations solely in hypoalbuminemia patients may mislead clinical decisions. The aim of this study is to assess the awareness, knowledge, and attitude levels of pediatric’ physicians and pharmacists regarding monitoring of unbound VPA concentrations in pediatric patients with hypoalbuminemia.
Method: A cross-sectional study was conducted from September to October 2023 in multicenter in Makkah, Saudi Arabia. Sociodemographic information of registered pediatric clinicians and pharmacists were collected. Participants’ knowledge and practice regarding monitoring of VPA were assessed via a reviewed questionnaire.
Result: A total of 226 participants completed the survey. Around 62% of respondents (n = 141) stated knowing how to monitor VPA levels, but only 19.9% (n = 45) were aware of the association between VPA and albumin plasma concentrations. About half of participants reported availability of total VPA assay in their institutions (n = 121, 53%), while minor percentage reported the availability of measuring free VPA concentrations in their institutions (n = 24, 10.6%). Over half of participants do not check albumin levels while monitoring VPA (n = 132, 58.4%). A statistically significant associations between VPA positive knowledge score were noted with age (p = 0.019), gender (p = 0.009), healthcare specialty (p < 0.001), and years of experience (p = 0.001). None of these factors were significantly associated with positive practice toward VPA monitoring.
Conclusion: The suboptimal practice of monitoring free VPA concentrations in cases of hypoalbuminemia in pediatric settings, mainly due to lack of awareness. Healthcare providers should be educated regarding the importance of monitoring free VPA concentration in the case of hypoalbuminemia.
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