Indications for plasma drug monitoring in patients with epilepsy. Implications for reducing costs.
Plasma anticonvulsant drug concentration monitoring has considerable potential to make the therapy of seizure disorders more efficient, provided that the approach is optimal. However, in recent years, a tendency has developed towards using monitoring as an unthinking routine in patients, rather than as an aid in resolving clinical problems. Such uncritical use of monitoring, particularly when the drug concentration values are allowed to take precedence over the assessment of the patient's clinical state in formulating treatment policy, is undesirable. It may lead to unnecessary therapeutic action and sometimes to therapeutic misadventure. Monitoring is indicated when an inappropriate anticonvulsant drug dosage is suspected on clinical grounds, or when a provisional indication of the potential adequacy of therapy is likely to be useful early in the course of a patient's treatment. The best 'yardstick' against which to assess plasma anticonvulsant drug concentrations in a given patient is the therapeutic threshold value for that individual, when it is practical to determine this. When it is not, the therapeutic range for the treated population is used, although the prescriber should remain aware that the optimal value for the individual may not lie within this range. Preoccupation with achieving plasma drug concentrations in the therapeutic range must never be allowed to override clinical common sense when treating patients with epilepsy.
Eadie
M J
MJ
Department of Medicine, University of Queensland, Brisbane, Australia.
D000927:Anticonvulsants / Q000097:blood*; D016903:Drug Monitoring; D004827:Epilepsy / Q000188:drug therapy*; D017048:Health Care Costs; D006801:Humans