Salivary Therapeutic Drug Monitoring in Epileptic Patients
Summary
Therapeutic drug monitoring (TDM) of antiepileptic drugs is essential for optimising efficacy while minimising adverse effects, particularly given the narrow therapeutic index of many agents. Traditional TDM relies on venous blood draws, which can be cumbersome and distressing. Saliva has emerged as a promising alternative matrix, reflecting the unbound drug fraction that is pharmacologically active. Advances in analytical platforms, including ultra performance liquid chromatography coupled with tandem mass spectrometry and immunoassays, have enabled sensitive and precise quantification of drugs in oral fluid. Sample preparation techniques such as solid phase extraction and deproteinization ensure reliable analyte recovery. Correlation studies across diverse populations—children, adults and pregnant women—have demonstrated robust saliva/plasma relationships for drugs such as levetiracetam, phenytoin and carbamazepine. Emerging point-of-care devices and microfluidic systems are under development to facilitate rapid, on-site measurements. By enabling non-invasive, home-based sampling, salivary TDM may enhance adherence, support telemedicine initiatives and extend personalised dosing strategies globally, particularly in resource-limited settings.
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Salivary Therapeutic Drug Monitoring in Epileptic Patients publication trend
The graph below shows the total number of articles in salivary therapeutic drug monitoring in epileptic patients across all publications each year (not limited to Nature Index journals).
Technical terms
Therapeutic drug monitoring (TDM): Measurement of drug concentrations in biological fluids to optimise dosing and ensure therapeutic efficacy.
Biofluid: Any fluid derived from living organisms, such as blood or saliva, used for diagnostic analysis.
Ultra performance liquid chromatography–tandem mass spectrometry (UPLC-MS/MS): An analytical technique combining high-resolution chromatography with mass analysis for sensitive quantification of compounds.
Solid phase extraction (SPE): A sample preparation method that isolates target analytes from complex matrices by adsorption on a solid adsorbent.
Deproteinization: A purification step that removes proteins from biological samples to improve analytical accuracy.
References
- Monitoring levetiracetam concentration in saliva during pregnancy is stable and feasible. CNS Neuroscience & Therapeutics (2024).
- Salivary Biomarkers of Anti-Epileptic Drugs: A Narrative Review. Diagnostics (2023).
- Phenytoin concentration in people with epilepsy: a comparative study in serum and saliva. Pharmacia (2022).
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