Antiepileptic Drug Management in Renal Dysfunction

Management of antiepileptic drugs (AEDs) in patients with impaired renal function presents a complex challenge that demands careful adjustment of dosing regimens, vigilant monitoring of drug levels and collaborative input from nephrology and neurology specialists. Many modern AEDs such as levetiracetam, gabapentin, pregabalin and topiramate are predominantly excreted by the kidneys, making dose reduction essential as glomerular filtration rate declines. Failure to tailor treatment can lead to drug accumulation, neurotoxicity and increased hospitalisations, whereas excessive dose reduction may precipitate breakthrough seizures. Therapeutic drug monitoring and assessment of renal replacement modalities—including intermittent haemodialysis, continuous renal replacement therapy (CRRT) and peritoneal dialysis—are central to optimising efficacy and minimising harm. Emerging evidence underscores the need for evidence-based dosing algorithms that integrate estimated glomerular filtration rate (eGFR), modality of dialysis and individual pharmacokinetics. In an era of growing chronic kidney disease prevalence, standardised guidance facilitates global consistency in care and promotes patient safety across diverse clinical settings.

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Antiepileptic Drug Management in Renal Dysfunction publication trend

The graph below shows the total number of articles in antiepileptic drug management in renal dysfunction across all publications each year (not limited to Nature Index journals).

Technical terms

Continuous renal replacement therapy (CRRT): A blood-purifying technique used continuously over 24 hours in critically ill patients to remove solutes and fluid at slower rates than intermittent dialysis.

Peritoneal dialysis: A dialysis modality in which the peritoneal membrane serves as the filter, allowing solute and fluid exchange via instilled dialysate in the abdominal cavity.

Therapeutic drug monitoring: The measurement of drug concentrations in biological fluids to guide dosing adjustments and ensure effective, non-toxic levels in individual patients.

References

1. A missed opportunity – consequences of unknown levetiracepam pharmacokinetics in a peritoneal dialysis patient. BMC Nephrology (2014).
2. High Phenobarbital Clearance During Continuous Renal Replacement Therapy. Medicine (2014).
3. Case report: A comatose patient with pregabalin overdose successfully treated with continuous renal replacement therapy. Frontiers in Medicine (2023).