TY - JOUR
T1 - Antiepileptic drugs - Best practice guidelines for therapeutic drug monitoring
T2 - A position paper by the subcommission on therapeutic drug monitoring, ILAE Commission on Therapeutic Strategies
AU - Patsalos, Philip N.
AU - Berry, David J.
AU - Bourgeois, Blaise F D
AU - Cloyd, James C.
AU - Glauser, Tracy A.
AU - Johannessen, Svein I.
AU - Leppik, Ilo E.
AU - Tomson, Torbjörn
AU - Perucca, Emilio
PY - 2008/7
Y1 - 2008/7
N2 - Although no randomized studies have demonstrated a positive impact of therapeutic drug monitoring (TDM) on clinical outcome in epilepsy, evidence from nonrandomized studies and everyday clinical experience does indicate that measuring serum concentrations of old and new generation antiepileptic drugs (AEDs) can have a valuable role in guiding patient management provided that concentrations are measured with a clear indication and are interpreted critically, taking into account the whole clinical context. Situations in which AED measurements are most likely to be of benefit include (1) when a person has attained the desired clinical outcome, to establish an individual therapeutic concentration which can be used at subsequent times to assess potential causes for a change in drug response; (2) as an aid in the diagnosis of clinical toxicity; (3) to assess compliance, particularly in patients with uncontrolled seizures or breakthrough seizures; (4) to guide dosage adjustment in situations associated with increased pharmacokinetic variability (e.g., children, the elderly, patients with associated diseases, drug formulation changes); (5) when a potentially important pharmacokinetic change is anticipated (e.g., in pregnancy, or when an interacting drug is added or removed); (6) to guide dose adjustments for AEDs with dose-dependent pharmacokinetics, particularly phenytoin.
AB - Although no randomized studies have demonstrated a positive impact of therapeutic drug monitoring (TDM) on clinical outcome in epilepsy, evidence from nonrandomized studies and everyday clinical experience does indicate that measuring serum concentrations of old and new generation antiepileptic drugs (AEDs) can have a valuable role in guiding patient management provided that concentrations are measured with a clear indication and are interpreted critically, taking into account the whole clinical context. Situations in which AED measurements are most likely to be of benefit include (1) when a person has attained the desired clinical outcome, to establish an individual therapeutic concentration which can be used at subsequent times to assess potential causes for a change in drug response; (2) as an aid in the diagnosis of clinical toxicity; (3) to assess compliance, particularly in patients with uncontrolled seizures or breakthrough seizures; (4) to guide dosage adjustment in situations associated with increased pharmacokinetic variability (e.g., children, the elderly, patients with associated diseases, drug formulation changes); (5) when a potentially important pharmacokinetic change is anticipated (e.g., in pregnancy, or when an interacting drug is added or removed); (6) to guide dose adjustments for AEDs with dose-dependent pharmacokinetics, particularly phenytoin.
KW - Children
KW - Drug compliance
KW - Elderly
KW - Pharmacokinetics
KW - Pregnancy
KW - Saliva
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U2 - 10.1111/j.1528-1167.2008.01561.x
DO - 10.1111/j.1528-1167.2008.01561.x
M3 - Article
C2 - 18397299
AN - SCOPUS:45749150011
VL - 49
SP - 1239
EP - 1276
JO - Epilepsia
JF - Epilepsia
SN - 0013-9580
IS - 7
ER -