Antiepileptic drugs—best practice guidelines for therapeutic drug monitoring: A position paper by the subcommission on therapeutic drug monitoring, ILAE Commission on Therapeutic Strategies

Summary 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 antiepilep...

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Published in:	Epilepsia (Copenhagen) Vol. 49; no. 7; pp. 1239 - 1276
Main Authors:	Patsalos, Philip N., Berry, David J., Bourgeois, Blaise F. D., Cloyd, James C., Glauser, Tracy A., Johannessen, Svein I., Leppik, Ilo E., Tomson, Torbjörn, Perucca, Emilio
Format:	Journal Article
Language:	English
Published:	Malden, USA Blackwell Publishing Inc 01.07.2008 Blackwell
Subjects:	Adolescent Aged Anticonvulsants - blood Anticonvulsants - pharmacokinetics Anticonvulsants - therapeutic use Anticonvulsants. Antiepileptics. Antiparkinson agents Biological and medical sciences Biological Availability Child Child, Preschool Children Cooperative Behavior Drug compliance Drug Monitoring - methods Drug Therapy, Combination Elderly Epilepsy - drug therapy Half-Life Headache. Facial pains. Syncopes. Epilepsia. Intracranial hypertension. Brain oedema. Cerebral palsy Humans Infant Infant, Newborn Medical sciences Nervous system (semeiology, syndromes) Neurology Neuropharmacology Pharmacokinetics Pharmacology. Drug treatments Pregnancy Reference Values Saliva Human Nervous system diseases Epilepsy Anticonvulsant Cerebral disorder Pregnancy Drug compliance Treatment Central nervous system disease Children Pharmacokinetics Child Elderly Saliva Monitoring
ISSN:	0013-9580, 1528-1167, 1528-1167
Online Access:	Get full text
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Abstract	Summary 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.
AbstractList	Summary 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. 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. 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.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.
Author	Berry, David J. Bourgeois, Blaise F. D. Perucca, Emilio Cloyd, James C. Johannessen, Svein I. Leppik, Ilo E. Glauser, Tracy A. Tomson, Torbjörn Patsalos, Philip N.
Author_xml	– sequence: 1 givenname: Philip N. surname: Patsalos fullname: Patsalos, Philip N. – sequence: 2 givenname: David J. surname: Berry fullname: Berry, David J. – sequence: 3 givenname: Blaise F. D. surname: Bourgeois fullname: Bourgeois, Blaise F. D. – sequence: 4 givenname: James C. surname: Cloyd fullname: Cloyd, James C. – sequence: 5 givenname: Tracy A. surname: Glauser fullname: Glauser, Tracy A. – sequence: 6 givenname: Svein I. surname: Johannessen fullname: Johannessen, Svein I. – sequence: 7 givenname: Ilo E. surname: Leppik fullname: Leppik, Ilo E. – sequence: 8 givenname: Torbjörn surname: Tomson fullname: Tomson, Torbjörn – sequence: 9 givenname: Emilio surname: Perucca fullname: Perucca, Emilio
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IsPeerReviewed	true
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Issue	7
Keywords	Human Nervous system diseases Epilepsy Anticonvulsant Cerebral disorder Pregnancy Drug compliance Treatment Central nervous system disease Children Pharmacokinetics Child Elderly Saliva Monitoring
Language	English
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PublicationPlace	Malden, USA
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PublicationTitle	Epilepsia (Copenhagen)
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Publisher	Blackwell Publishing Inc Blackwell
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Snippet	Summary Although no randomized studies have demonstrated a positive impact of therapeutic drug monitoring (TDM) on clinical outcome in epilepsy, evidence from... Although no randomized studies have demonstrated a positive impact of therapeutic drug monitoring (TDM) on clinical outcome in epilepsy, evidence from...
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SubjectTerms	Adolescent Aged Anticonvulsants - blood Anticonvulsants - pharmacokinetics Anticonvulsants - therapeutic use Anticonvulsants. Antiepileptics. Antiparkinson agents Biological and medical sciences Biological Availability Child Child, Preschool Children Cooperative Behavior Drug compliance Drug Monitoring - methods Drug Therapy, Combination Elderly Epilepsy - drug therapy Half-Life Headache. Facial pains. Syncopes. Epilepsia. Intracranial hypertension. Brain oedema. Cerebral palsy Humans Infant Infant, Newborn Medical sciences Nervous system (semeiology, syndromes) Neurology Neuropharmacology Pharmacokinetics Pharmacology. Drug treatments Pregnancy Reference Values Saliva
Title	Antiepileptic drugs—best practice guidelines for therapeutic drug monitoring: A position paper by the subcommission on therapeutic drug monitoring, ILAE Commission on Therapeutic Strategies
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