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An Updated Overview on Therapeutic Drug Monitoring of Recent Antiepileptic Drugs.
Drugs R D 2016; 16(4):303-316DR

Abstract

Given the distinctive characteristics of both epilepsy and antiepileptic drugs (AEDs), therapeutic drug monitoring (TDM) can make a significant contribution to the field of epilepsy. The measurement and interpretation of serum drug concentrations can be of benefit in the treatment of uncontrollable seizures and in cases of clinical toxicity; it can aid in the individualization of therapy and in adjusting for variable or nonlinear pharmacokinetics; and can be useful in special populations such as pregnancy. This review examines the potential for TDM of newer AEDs such as eslicarbazepine acetate, felbamate, gabapentin, lacosamide, lamotrigine, levetiracetam, perampanel, pregabalin, rufinamide, retigabine, stiripentol, tiagabine, topiramate, vigabatrin, and zonisamide. We describe the relationships between serum drug concentration, clinical effect, and adverse drug reactions for each AED as well as the different analytical methods used for serum drug quantification. We discuss retrospective studies and prospective data on the serum drug concentration-efficacy of these drugs and present the pharmacokinetic parameters, oral bioavailability, reference concentration range, and active metabolites of newer AEDs. Limited data are available for recent AEDs, and we discuss the connection between drug concentrations in terms of clinical efficacy and nonresponse. Although we do not propose routine TDM, serum drug measurement can play a beneficial role in patient management and treatment individualization. Standardized studies designed to assess, in particular, concentration-efficacy-toxicity relationships for recent AEDs are urgently required.

Authors+Show Affiliations

Department of Pharmaceutics, College of Pharmacy, Gulf Medical University, University Street, P.O.Box No.4184, Ajman, UAE. sheryjacob6876@gmail.com.Department of Pharmaceutics, College of Clinical Pharmacy, King Faisal University, Al-Ahsa, Saudi Arabia.

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

27766590

Citation

Jacob, Shery, and Anroop B. Nair. "An Updated Overview On Therapeutic Drug Monitoring of Recent Antiepileptic Drugs." Drugs in R&D, vol. 16, no. 4, 2016, pp. 303-316.
Jacob S, Nair AB. An Updated Overview on Therapeutic Drug Monitoring of Recent Antiepileptic Drugs. Drugs R D. 2016;16(4):303-316.
Jacob, S., & Nair, A. B. (2016). An Updated Overview on Therapeutic Drug Monitoring of Recent Antiepileptic Drugs. Drugs in R&D, 16(4), pp. 303-316.
Jacob S, Nair AB. An Updated Overview On Therapeutic Drug Monitoring of Recent Antiepileptic Drugs. Drugs R D. 2016;16(4):303-316. PubMed PMID: 27766590.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - An Updated Overview on Therapeutic Drug Monitoring of Recent Antiepileptic Drugs. AU - Jacob,Shery, AU - Nair,Anroop B, PY - 2016/10/22/pubmed PY - 2018/2/16/medline PY - 2016/10/22/entrez SP - 303 EP - 316 JF - Drugs in R&D JO - Drugs R D VL - 16 IS - 4 N2 - Given the distinctive characteristics of both epilepsy and antiepileptic drugs (AEDs), therapeutic drug monitoring (TDM) can make a significant contribution to the field of epilepsy. The measurement and interpretation of serum drug concentrations can be of benefit in the treatment of uncontrollable seizures and in cases of clinical toxicity; it can aid in the individualization of therapy and in adjusting for variable or nonlinear pharmacokinetics; and can be useful in special populations such as pregnancy. This review examines the potential for TDM of newer AEDs such as eslicarbazepine acetate, felbamate, gabapentin, lacosamide, lamotrigine, levetiracetam, perampanel, pregabalin, rufinamide, retigabine, stiripentol, tiagabine, topiramate, vigabatrin, and zonisamide. We describe the relationships between serum drug concentration, clinical effect, and adverse drug reactions for each AED as well as the different analytical methods used for serum drug quantification. We discuss retrospective studies and prospective data on the serum drug concentration-efficacy of these drugs and present the pharmacokinetic parameters, oral bioavailability, reference concentration range, and active metabolites of newer AEDs. Limited data are available for recent AEDs, and we discuss the connection between drug concentrations in terms of clinical efficacy and nonresponse. Although we do not propose routine TDM, serum drug measurement can play a beneficial role in patient management and treatment individualization. Standardized studies designed to assess, in particular, concentration-efficacy-toxicity relationships for recent AEDs are urgently required. SN - 1179-6901 UR - https://www.unboundmedicine.com/medline/citation/27766590/An_Updated_Overview_on_Therapeutic_Drug_Monitoring_of_Recent_Antiepileptic_Drugs_ L2 - https://dx.doi.org/10.1007/s40268-016-0148-6 DB - PRIME DP - Unbound Medicine ER -