title: An initial experience with therapeutic drug monitoring of levetiracetam as reported from a pediatric clinical setting in India.
abstract: OBJECTIVE
  Monitoring of levetiracetam in routine clinical practice is not strongly recommended. The aim of this study was to investigate any difference in serum levetiracetam concentration between patients on enzyme-inducing and -inhibiting antiepileptic co-medication and also to identify any correlation between levetiracetam concentration and clinical response.
  
  
  METHODS
  This study included pediatric patients with epilepsy from a tertiary care referral hospital in India. Details of antiepileptic co-medication, seizure frequency before and after initiating levetiracetam were recorded. Serum trough levetiracetam concentration was measured.
  
  
  RESULTS
  Of the 69 children recruited in the study, 55 children had >50% reduction in seizure frequency compared to baseline seizure frequency. Eight patients showed no improvement. The serum concentration of levetiracetam was more than 10 μg/ml in 78.2% of responders and 75% non-responders. There was no difference in dosing between responders and non-responders. Patients on enzyme-inducing co-medication had lower median serum levetiracetam concentrations (7.3 μg/ml) compared to those on enzyme-inhibiting co-medication (14.4 μg/ml) or those without interfering antiepileptic co-medication (16.6 μg/ml).
  
  
  CONCLUSIONS
  Levetiracetam monitoring has a role in patients on antiepileptic polypharmacy and for confirmation of compliance.
authors.affiliation: Department of Pharmacology and Clinical Pharmacology, Christian Medical College, Vellore, Tamil Nadu, India. clinpharm@cmcvellore.ac.in
authors.forename: B S
authors.initials: BS
authors.lastname: Mathew
authors.forename: D H
authors.initials: DH
authors.lastname: Fleming
authors.forename: M
authors.initials: M
authors.lastname: Thomas
authors.forename: R
authors.initials: R
authors.lastname: Prabha
authors.forename: K
authors.initials: K
authors.lastname: Saravanakumar
mesh_terms: D000293:Adolescent; D000927:Anticonvulsants / Q000008:administration & dosage* / Q000097:blood; D002648:Child; D002675:Child, Preschool; D016903:Drug Monitoring / Q000379:methods*; D004827:Epilepsy / Q000188:drug therapy*; D006801:Humans; D007194:India; D007223:Infant; D000077287:Levetiracetam; D010349:Patient Compliance; D010889:Piracetam / Q000008:administration & dosage / Q000031:analogs & derivatives* / Q000097:blood
chemical_list: D000927:Anticonvulsants; D000077287:Levetiracetam; D010889:Piracetam