Seizures occur sporadically, so antiepileptic drug therapy is generally experiential and prophylactic. |
Therapeutic drug monitoring can help establish an individual’s optimal serum/plasma concentration range and benchmark the serum concentrations at which seizures are restrained or at which antiepileptic drug-specific adverse effects occur. |
Therapeutic drug monitoring enables more decisive and effective optimization of therapy and disease management. |
1 Introduction
Drug | Oral bioavailability (%) | Reference concentration range (mg/l) |
t
max (h) | Time to steady state (days) |
t
½ (h) | Protein binding (%) | Volume of distribution (l/kg) | Active metabolite | Need for TDM | References |
---|---|---|---|---|---|---|---|---|---|---|
Rufinamide | ≥85 | 5–30 | 5–6 | 2 | 8–12 | 30 | 07–1.1 | No | Intermediate to frequent | |
Stiripentol | ≥90 | 4–22 | 1–2 | 1–2 | 4.5–13 | 99 | Variable | No | Frequent | |
Perampanel | 100 |
a
| 05–1.5 | 14–21 | 70–110 | 96 | 77 | No |
a
| |
Retigabine | 60 |
a
| 0.5–2 | 1–2 | 8 | 80 | 6.2 | No |
a
| |
Eslicarbazepine acetate | ≥80 | 10–35 | 1–4 | 4–5 | 20–40 | 35 | 2.7 | Yes | Intermediate | |
Vigabatrin | ≥60 | 0.8–36 | 1–2 | 1–2 | 5–8 | 0 | 0.8 | No | Intermediate | [55] |
Lacosamide | ≥95 | 5–10 | 05–4 | 2–4 | 12–13 | 15 | 0.6 | No | Uncommon | [60] |
Pregabalin | ≥90 | 2–5 | 1–2 | 1–2 | 5–7 | 0 | 0.5 | No | Intermediate | |
Zonisamide | ≥65 | 10–40 | 2–5 | 9–12 | 50–70 | 50 | 1.45 | No | Frequent | [96] |
Levetiracetam | ≥95 | 12–46 | 1 | 1–2 | 6–8 | 0 | 0.5–0.7 | No | Intermediate | |
Tiagabine | ≥90 | 0.02–0.2 | 0.5–2 | 1–2 | 5–9 | 96 | 1–1.3 | No | Frequent | |
Topiramate | ≥80 | 5–20 | 2–4 | 4–5 | 20–30 | 15 | 0.6–0.8 | No | Intermediate | |
Lamotrigine | ≥95 | 2.5–15 | 1–3 | 3–6 | 15–35 | 55 | 1–1.4 | No | Frequent | |
Felbamate | >90 | 30–60 | 2–6 | 3–4 | 16–22 | 25 | 0.8 | No | Intermediate | |
Gabapentin | <60 | 2–20 | 2–3 | 1–2 | 5–9 | 0 | 0.6–0.8 | No | Uncommon | [170] |