Therapeutic drug monitoring of the newer antiepileptic drugs

Svein I. Johannessen, Dina Battino, David J. Berry, Meir Bialer, Günter Krämer, Torbjörn Tomson, Philip N. Patsalos

Research output: Contribution to journalArticle

252 Citations (Scopus)

Abstract

The aim of the present review is to discuss the potential value of therapeutic drug monitoring (TDM) of the newer antiepileptic drugs (AEDs) felbamate, gabapentin, lamotrigine, levetiracetam, oxcarbazepine, tiagabine, topiramate, vigabatrin, and zonisamide. Studies of the relationship between serum concentrations and clinical efficacy of these drugs are reviewed, and the potential value of TDM of the drugs is discussed based on their pharmacokinetic properties and mode of action. Analytical methods for the determination of the serum concentrations of these drugs are also briefly described. There are only some prospective data on the serum concentration-effect relationships, and few studies have been designed primarily to study these relationships. As TDM is not widely practiced for the newer AEDs, there are no generally accepted target ranges for any of these drugs, and for most a wide range in serum concentration is associated with clinical efficacy. Furthermore, a considerable overlap in drug concentrations related to toxicity and nonresponse is reported, Nevertheless, the current tentative target ranges for felbamate, gabapentin, lamotrigine, levetiracetam, oxcarbazepine (10-hydroxy-carbazepine metabolite), tiagabine, topiramate, vigabatrin, and zonisamide are 125 to 250 μmol/L, 70 to 120 μmol/L, 10 to 60 μmol/L, 35 to 120 μmol/L, 50 to 140 μmol/L, 50 to 250 nmol/L, 15 to 60 μmol/L, 6 to 278 μmol/L, and 45 to 180 μmol/L, respectively. Further systematic studies designed specifically to evaluate concentration-effect relationships of the new AEDs are urgently needed. Although routine monitoring in general cannot be recommended at present, measurements of some of the drugs is undoubtedly of help with individualization of treatment in selected cases in a particular clinical setting.

Original languageEnglish
Pages (from-to)347-363
Number of pages17
JournalTherapeutic Drug Monitoring
Volume25
Issue number3
DOIs
Publication statusPublished - Jun 2003

Fingerprint

Drug Monitoring
Anticonvulsants
zonisamide
etiracetam
felbamate
Monitoring
Pharmaceutical Preparations
Vigabatrin
Serum
Metabolites
Pharmacokinetics
Toxicity

Keywords

  • New antiepileptic drugs
  • Serum concentrations
  • Therapeutic drug monitoring

ASJC Scopus subject areas

  • Toxicology
  • Health, Toxicology and Mutagenesis
  • Pharmacology
  • Biochemistry
  • Biochemistry, Genetics and Molecular Biology(all)
  • Pharmacology (medical)
  • Public Health, Environmental and Occupational Health

Cite this

Johannessen, S. I., Battino, D., Berry, D. J., Bialer, M., Krämer, G., Tomson, T., & Patsalos, P. N. (2003). Therapeutic drug monitoring of the newer antiepileptic drugs. Therapeutic Drug Monitoring, 25(3), 347-363. https://doi.org/10.1097/00007691-200306000-00016

Therapeutic drug monitoring of the newer antiepileptic drugs. / Johannessen, Svein I.; Battino, Dina; Berry, David J.; Bialer, Meir; Krämer, Günter; Tomson, Torbjörn; Patsalos, Philip N.

In: Therapeutic Drug Monitoring, Vol. 25, No. 3, 06.2003, p. 347-363.

Research output: Contribution to journalArticle

Johannessen, SI, Battino, D, Berry, DJ, Bialer, M, Krämer, G, Tomson, T & Patsalos, PN 2003, 'Therapeutic drug monitoring of the newer antiepileptic drugs', Therapeutic Drug Monitoring, vol. 25, no. 3, pp. 347-363. https://doi.org/10.1097/00007691-200306000-00016
Johannessen, Svein I. ; Battino, Dina ; Berry, David J. ; Bialer, Meir ; Krämer, Günter ; Tomson, Torbjörn ; Patsalos, Philip N. / Therapeutic drug monitoring of the newer antiepileptic drugs. In: Therapeutic Drug Monitoring. 2003 ; Vol. 25, No. 3. pp. 347-363.
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