Therapeutic Drug Monitoring of Antiepileptic Medications
Summary
Therapeutic drug monitoring (TDM) of antiepileptic medications plays a critical role in optimising treatment for individuals with epilepsy. Antiepileptic drugs (AEDs) exhibit considerable interindividual variability in absorption, distribution, metabolism and excretion, influenced by genetic polymorphisms, age, comorbidities and concomitant therapies. Monitoring plasma or blood concentrations allows clinicians to tailor dosing regimes to achieve concentrations within established therapeutic ranges, reducing the risk of breakthrough seizures or toxicity. Traditional sampling of plasma has been supplemented by microsampling techniques such as dried blood spots, facilitating paediatric and ambulatory monitoring. Advances in bioanalytical methods, including high‐performance liquid chromatography and tandem mass spectrometry, have improved sensitivity and specificity for parent drugs and active metabolites. Particular attention is paid to highly protein‐bound agents, where measurement of the free fraction may correlate more closely with pharmacodynamic effects. In special populations—such as pregnant patients, the elderly, those with renal impairment or patients on polytherapy—TDM informs dose adjustments and identifies clinically significant drug–drug interactions. The integration of pharmacokinetic modelling, pharmacogenetic profiling and biochemical markers promises further refinement of personalised therapy, with the ultimate goal of maximising efficacy while minimising adverse effects.
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Therapeutic Drug Monitoring of Antiepileptic Medications publication trend
The graph below shows the total number of articles in therapeutic drug monitoring of antiepileptic medications 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 guide dosage adjustments and optimise therapeutic outcomes.
Pharmacokinetics: Study of the processes of drug absorption, distribution, metabolism and excretion that determine concentration–time profiles.
Pharmacodynamics: Relationship between drug concentration at the site of action and the resulting therapeutic or adverse effects.
Dried blood spots (DBS): Microsampling technique in which small volumes of capillary blood are collected on filter paper for subsequent bioanalysis.
Liquid chromatography–tandem mass spectrometry (LC-MS/MS): Analytical technique combining chromatographic separation with mass spectrometric detection for sensitive quantification of drugs and metabolites.
Plasma protein binding: Proportion of a drug that is reversibly bound to plasma proteins, affecting its free (unbound) fraction and pharmacological activity.
References
- An LC-MS/MS Method for Quantification of Lamotrigine and Its Main Metabolite in Dried Blood Spots. Pharmaceuticals (2024).
- Simple HPLC-UV Method for Therapeutic Drug Monitoring of 12 Antiepileptic Drugs and Their Main Metabolites in Human Plasma. Molecules (2023).
- Pharmacological aspects of antiseizure medications: From basic mechanisms to clinical considerations of drug interactions and use of therapeutic drug monitoring. Epileptic Disorders (2023).
- The Effect of Plasma Protein Binding on the Therapeutic Monitoring of Antiseizure Medications. Pharmaceutics (2021).
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