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Journal of Pharmacy Practice
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Salivary Monitoring of Antiepileptic Drugs

Robert J. Baumann, MD

Department of Neurology, Kentucky Clinic, College of Medicine, University of Kentucky, Lexington, Kentucky, baumann @uky.edu

Therapeutic drug monitoring is widely used in the anticonvulsant treatment of persons with epilepsy. Most monitoring uses serum, but many anticonvulsant drugs can as easily be monitored using saliva, including phenobarbital, phenytoin, carbamazepine, lamotrigine, oxcarbazepine, topiramate, levetiracetam, and gabapentin. For highly protein-bound medications such as phenobarbital, phenytoin, and carbamazepine, saliva has the advantage of providing an approximation of the serum free level, the free level presumably being the active moiety. Salivary therapeutic drug monitoring offers a number of advantages over serum therapeutic drug monitoring, including lack of pain, lower cost, and wide potential acceptability by patients and physicians. It has the potential to open new approaches to treatment with strategic at-home monitoring at the time a seizure or adverse event occurs and to allow the collection of cohort-based, pharmacokinetic, and pharmcodynamic data for populations of persons of varying ages and with different medical conditions who require anticonvulsant medications.

Key Words: Saliva • anticonvulsant medication • epilepsy.

Journal of Pharmacy Practice, Vol. 20, No. 2, 147-157 (2007)
DOI: 10.1177/0897190007305139
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