02 October 2008
Limited place for plasma monitoring of new antiepileptic drugs in clinical practice
Salvatore Striano, Pasquale Striano, Domenico Capone, Francesco PisaniMed Sci Monit 2008; 14(10): RA173-178 :: ID: 869402
Abstract
Therapeutic drug monitoring (TDM) has been recognized as a useful guide in the clinical management of patients with epilepsy, in particular those on therapy with traditional antiepileptic drugs (AEDs). The demonstration of significant drug interactions and the introduction of the concept "therapeutic range" have also contributed to the view that monotherapy should be considered the "gold standard" in the treatment of epilepsy. Ten new AEDs have been approved and released to the market in the last fifteen years. The most obvious consequence has been an increased number of patients on polytherapy. In general, newer AEDs have better and more predictable pharmacokinetics than older AEDs and usually show lower risk of interactions leading to toxicity as well as large therapeutic indexes. This pragmatic review focuses on practical suggestions about the potential clinical usefulness of TDM of newer AEDs in relation to their mechanism of action and pharmacokinetic characteristics and in response to patient-specific problems. Overall, the usefulness of TDM of newer AEDs seems to be limited and its indiscriminate use is not justified. However, in selected cases or in response to a specific clinical question, a wise use of TDM of some new AEDs could represent a useful tool in the management of epileptic patients. Exceptions are thus represented by special conditions such as renal failure, dialysis, ascertainment of non-compliance, and pregnancy. For some new AEDs, TDM could be selectively and properly used in response to a single patient-specific pharmacokinetic or pharmacodynamic issue.
Keywords: Epilepsy - drug therapy, Clinical Trials as Topic, Drug Monitoring, Pregnancy, Anticonvulsants - therapeutic use
Editorial
01 April 2024 : Editorial
Editorial: Forty Years of Waiting for Prevention and Cure of HIV Infection – Ongoing Challenges and Hopes for Vaccine Development and Overcoming Antiretroviral Drug ResistanceDOI: 10.12659/MSM.944600
Med Sci Monit 2024; 30:e944600
In Press
05 Mar 2024 : Clinical Research
Role of Critical Shoulder Angle in Degenerative Type Rotator Cuff Tears: A Turkish Cohort StudyMed Sci Monit In Press; DOI: 10.12659/MSM.943703
06 Mar 2024 : Clinical Research
Comparison of Outcomes between Single-Level and Double-Level Corpectomy in Thoracolumbar Reconstruction: A ...Med Sci Monit In Press; DOI: 10.12659/MSM.943797
21 Mar 2024 : Meta-Analysis
Economic Evaluation of COVID-19 Screening Tests and Surveillance Strategies in Low-Income, Middle-Income, a...Med Sci Monit In Press; DOI: 10.12659/MSM.943863
10 Apr 2024 : Clinical Research
Predicting Acute Cardiovascular Complications in COVID-19: Insights from a Specialized Cardiac Referral Dep...Med Sci Monit In Press; DOI: 10.12659/MSM.942612
Most Viewed Current Articles
17 Jan 2024 : Review article
Vaccination Guidelines for Pregnant Women: Addressing COVID-19 and the Omicron VariantDOI :10.12659/MSM.942799
Med Sci Monit 2024; 30:e942799
14 Dec 2022 : Clinical Research
Prevalence and Variability of Allergen-Specific Immunoglobulin E in Patients with Elevated Tryptase LevelsDOI :10.12659/MSM.937990
Med Sci Monit 2022; 28:e937990
16 May 2023 : Clinical Research
Electrophysiological Testing for an Auditory Processing Disorder and Reading Performance in 54 School Stude...DOI :10.12659/MSM.940387
Med Sci Monit 2023; 29:e940387
01 Jan 2022 : Editorial
Editorial: Current Status of Oral Antiviral Drug Treatments for SARS-CoV-2 Infection in Non-Hospitalized Pa...DOI :10.12659/MSM.935952
Med Sci Monit 2022; 28:e935952