title: Standards of laboratory practice: antiepileptic drug monitoring. National Academy of Clinical Biochemistry.
abstract: Discussion and development of standards for appropriate monitoring led to the following key recommendations for ordering, sampling, and analyzing antiepileptic drugs: Monitoring should usually be done on trough specimens after steady-state has been reached and always with an appropriate medical indication; non-steady-state concentrations may be indicated in selected situations. Monitoring of free phenytoin and free valproic acid is indicated in specific situations and should be done in serum. The metabolite of primidone, phenobarbital, should be measured concurrently with parent drug, but the active metabolite of carbamazepine does not need to be monitored unless the patient is exhibiting an unusual toxic response that cannot be otherwise explained. Assays used for antiepileptic drug monitoring should display a long-term CV of <10% and preferably <5%. Subtherapeutic and supratherapeutic drug concentrations should be investigated on a regular basis as part of a quality assurance process.
authors.affiliation: Department of Pathology and Laboratory Medicine, University of Cincinnati Medical Center, OH 45267-0714, USA.
authors.forename: A
authors.initials: A
authors.lastname: Warner
authors.forename: M
authors.initials: M
authors.lastname: Privitera
authors.forename: D
authors.initials: D
authors.lastname: Bates
mesh_terms: D000927:Anticonvulsants / Q000009:adverse effects / Q000097:blood* / Q000493:pharmacokinetics / Q000627:therapeutic use; D001800:Blood Specimen Collection / Q000592:standards; D002220:Carbamazepine / Q000009:adverse effects / Q000097:blood / Q000493:pharmacokinetics / Q000627:therapeutic use; D004347:Drug Interactions; D016903:Drug Monitoring / Q000592:standards*; D006801:Humans; D010634:Phenobarbital / Q000009:adverse effects / Q000097:blood / Q000493:pharmacokinetics / Q000627:therapeutic use; D010672:Phenytoin / Q000009:adverse effects / Q000097:blood / Q000493:pharmacokinetics / Q000627:therapeutic use; D011324:Primidone / Q000009:adverse effects / Q000097:blood / Q000493:pharmacokinetics / Q000627:therapeutic use; D011786:Quality Control; D014635:Valproic Acid / Q000009:adverse effects / Q000097:blood / Q000493:pharmacokinetics / Q000627:therapeutic use
chemical_list: D000927:Anticonvulsants; D011324:Primidone; D002220:Carbamazepine; D014635:Valproic Acid; D010672:Phenytoin; D010634:Phenobarbital