Klin Farmakol Farm. 2016;30(2):9-15 | DOI: 10.36290/far.2016.013

Therapeutic monitoring of antiepileptic drugs, part I - general principles, “old” antiepileptics

Milan Grundmann¹, Ivana Kacířová^1,2

¹ Ústav klinické farmakologie, Lékařská fakulta, Ostravská univerzita, Ostrava

² Oddělení klinické farmakologie, Ústav laboratorní diagnostiky, Fakultní nemocnice Ostrava

Therapeutic drug concentration monitoring has been used as a tool to optimize treatment of epilepsy for almost 60 years. The concept

of the method rests on the assumption that clinical effects correlate better with drug concentrations than with the dose. It seeks

to optimize the seizure suppressing effects of antiepileptic drugs while minimizing their adverse effects by managing their medication

regimen with the assistance of information on the concentration of antiepileptic drugs in the serum, plasma or saliva. For

most antiepileptic drugs, “reference ranges” have been reported which define the serum concentrations at which most patients are

expected to exhibit an optimal clinical response. Due to individual variation, however, many patients may require concentrations

outside the reference ranges. In many situations, patient management is best guided by determination of the “individual therapeutic

concentration,” defined as the concentration at which an individual has been found to achieve seizure freedom with good tolerability,

or the best compromise between improvement in seizure control and concentration-related adverse effects.

Keywords: therapeutic drug concentration monitoring, antiepileptic drugs, reference ranges

Published: September 19, 2016  Show citation