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Pharmacokinetic Properties of New Antiepileptic Drugs

College of Pharmacy, Department of Pharmacy: Clinical and Administrative Sciences, University of Oklahoma Health Sciences Center, P.O. Box 26901, Oklahoma City, OK 73190michele-splinter{at}ouhsc.edu; Department of Pharmacy, Clinical and Administrative Sciences at the College of Pharmacy, University of Oklahoma Health Sciences Center, Oklahoma City

Eight new antiepileptic drugs (AEDs) have been approved for use within the United States within the past decade. They are felbamate, gabapentin, lamotrigine, levetiracetam, oxcarbazepine, tiagabine, topiramate, and zonisamide. These afford clinicians with more options to increase efficacy and tolerability in the treatment of patients with epilepsy. Pharmacokinetic properties and drug interactions with other AEDs and other medications taken for comorbidities are individually discussed for each of these new agents. Drug concentrations are not routinely monitored for these newer agents, and there have been few studies designed to investigate their concentration-effect relationships. For most of these medications, the concentrations observed in responders and nonresponders overlap considerably and levels associated with efficacy are often associated with adverse events, complicating the definition of target ranges. Also, epilepsy manifests itself sporadically causing difficulty in clinically monitoring efficacy of medications. Therapeutic drug monitoring provides for the individualization of treatment for these agents, which is important because they demonstrate significant variability in inter- and intraindividual pharmaco-kinetic properties. Therapeutic drug monitoring also allows for identification of noncompliance, drug interactions, and toxicity. Current knowledge of the relationships between efficacy, toxicity, and drug concentrations is discussed.

Key Words: Antiepileptic therapy • pharmacokinetics • therapeutic drug monitoring • drug interactions

Journal of Pharmacy Practice, Vol. 18, No. 6, 444-460 (2005)
DOI: 10.1177/0897190005282733


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