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Routine monitoring of antiepileptic drug levels does not alter seizure or side effect rates. Monitoring dosage increases of drugs with nonlinear kinetics, such as phenytoin Dilantin, may be useful. SOR: C, based on expert opinion. Antiepileptic drug level monitoring has been routinely used since the advent of reliable assays of phenytoin levels in the s. One RCT assessed the impact of antiepileptic drug level monitoring in patients with new-onset epilepsy.

Using an open-label, parallel group design, patients were randomized to two groups a monitored group or a control group. In the monitored group, drug dosage was adjusted to achieve a therapeutic level. In the control group, drug dosage was adjusted on clinical grounds. Sixty-four percent of the patients completed the two-year study. The incidence of side effects was similar in the monitored and control groups 48 versus 47 percent, respectively.

As for the newer antiepileptic drugs, including gabapentin Neurontin, lamotrigine Lamictal, oxcarbazepine Trileptal, and topiramate Topamax, there are no well-established therapeutic or toxic drug levels. There are several clinical situations in which antiepileptic drug level monitoring may be useful. These are summarized in Table 1. Also, monitoring drug level is reasonable when drugs with zero order nonlinear kinetics e.

First, the data presented here indicate active clinical assessment and surveillance for antiepileptic side effects. Physicians treating patients with seizure disorders should be familiar with common agent-specific side effects, including gastrointestinal side effects, vertigo, and ataxia with carbamazepine; nystagmus, ataxia, mental status changes with phenytoin; and tremor, ataxia, lethargy, facial edema, anorexia, weight gain, and platelet dysfunction with valproate.

Physicians should also be aware of rare but serious side effects, such as blood dyscrasias, Stevens-Johnson syndrome, respiratory depression, hepatic failure, and pancreatitis. Third, drug level monitoring is not the only monitoring required with these drugs. For example, carbamazepine and phenytoin require a complete blood count at initiation and periodic hepatic and renal function monitoring; and valproate requires periodic monitoring of liver function tests, especially in the first six months.

Fourth, in my teaching practice we see many patients with epilepsy and developmental delays who are nonverbal or who may exhibit symptoms similar to antiepileptic side effects at baseline e. Finally, knowing the proper timing of sample collection is essential to avoiding errors. Carbamazepine, valproate, and oral phenytoin should be tested after steady state has been reached, just before the next dose is given, and at a consistent time of day.

Eadie MJ. Therapeutic drug monitoring—antiepileptic drugs.

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Inhibitors of IL- use in combination with methotrexate for rheumatoid arthritis that is unresponsive to methotrexate alone. Anakinra is given by sub-cutaneous injection once weekly. National Rituximab is a monoclonal antibody that destroys B lymphocytes. It was previously licensed only for the treatment of particular types of leukaemia.

Overuse of mail order dilantin of blood concentrations of antiepileptic drugs. Also, date of publication or study setting. Members of the network select questions based on their relevance to family medicine. Clinical Question Is monitoring antiepileptic drug levels necessary. Dilantin 30mg.

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Authored by Mr. Sadril Mohammad, PA-C


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Thiazide diuretics work by inhibiting sodium and chloride ion transport in the distal convoluted tubule of the kidney and therefore limit water reabsorption. Thiazides are particularly recommended in older people.

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