Individualizing doses of antiepileptic drugs

Liparoti, Giulia; Burchiani, Beatrice; Mencaroni, Elisabetta; Tripodi, Domenico; Cara, Giuseppe Di; Verrotti, Alberto

doi:10.1080/17425255.2022.2075342

Cited by 5 publications

(4 citation statements)

References 67 publications

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“…Furthermore, pharmacogenetic testing may be indicated to adjust the dosage to the individual better from the initiation of therapy in those patients who have deviating drug metabolizing capacities or to avoid exposure of drugs such as carbamazepine in patients with HLA‐B*1502 polymorphism increasing the risk of serious adverse effects. Biochemical markers may also be used to monitor ASM therapy, 89 adverse effects, and avoid hepatotoxicity seen with valproic acid or cannabidiol.…”

Section: Main Bodymentioning

confidence: 99%

Pharmacological aspects of antiseizure medications: From basic mechanisms to clinical considerations of drug interactions and use of therapeutic drug monitoring

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Eyal

Burns

et al. 2023

Epileptic Disorders

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Antiseizure medications (ASMs) are the cornerstone of treatment for patients with epilepsy. Several new ASMs have recently been introduced to the market, making it possible to better tailor the treatment of epilepsy, as well as other indications (psychiatry and pain disorders). For this group of drugs there are numerous pharmacological challenges, and updated knowledge on their pharmacodynamic and pharmacokinetic properties is, therefore, crucial for an optimal treatment outcome. This review focuses on educational approaches to the following learning outcomes as described by the International League Against Epilepsy (ILAE): To demonstrate knowledge of pharmacokinetics and pharmacodynamics, drug interactions with ASMs and with concomitant medications, and appropriate monitoring of ASM serum levels (therapeutic drug monitoring, TDM). Basic principles in pharmacology, pharmacokinetic variability, and clinically relevant approaches to manage drug interactions are discussed. Furthermore, recent improvements in analytical technology and sampling are described. Future directions point to the combined implementation of TDM with genetic panels for proper diagnosis, pharmacogenetic tests where relevant, and the use of biochemical markers that will all contribute to personalized treatment. These approaches are clinically relevant for an optimal treatment outcome with ASMs in various patient groups.

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Section: Main Bodymentioning

confidence: 99%

Pharmacological aspects of antiseizure medications: From basic mechanisms to clinical considerations of drug interactions and use of therapeutic drug monitoring

Landmark

Eyal

Burns

et al. 2023

Epileptic Disorders

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“…Nevertheless, the reversibility of alopecia has been seen as a characteristic feature in all ASMs [ 73 ]. Noteworthily, the optimal therapeutic dosage of antiseizure medications should be carefully assessed, especially in individuals with multiple comorbidities due to the modified pharmacokinetics and pharmacodynamics of drugs, which can lead to high percentages of adverse events [ 172 ].…”

Section: Discussionmentioning

confidence: 99%

Antiseizure Medication-Induced Alopecia: A Literature Review

et al. 2023

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Background: Adverse effects of antiseizure medications (ASMs) remain one of the major causes of non-adherence. Cosmetic side effects (CSEs) are among the most commonly reported side effects of ASMs. In this context, alopecia is one of the CSEs that has a high intolerance rate leading to poor therapeutical compliance. Methods: We performed a literature review concerning alopecia as a secondary effect of ASMs. Results: There are 1656 individuals reported with ASM-induced alopecia. Valproate (983), lamotrigine (355), and carbamazepine (225) have been extensively reported. Other ASMs associated with alopecia were cenobamate (18), levetiracetam (14), topiramate (13), lacosamide (7), vigabatrin (6), phenobarbital (5), gabapentin (5), phenytoin (4), pregabalin (4), eslicarbazepine (3), brivaracetam (2), clobazam (2), perampanel (2), trimethadione (2), rufinamide (2), zonisamide (2), primidone (1), and tiagabine (1). There were no reports of oxcarbazepine and felbamate with drug-induced alopecia. Hair loss seen with ASMs was diffuse and non-scarring. Telogen effluvium was the most common cause of alopecia. A characteristic feature was the reversibility of alopecia after ASM dose adjustment. Conclusions: Alopecia should be considered one important adverse effect of ASMs. Patients reporting hair loss with ASM therapy should be further investigated, and specialist consultation is recommended.

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“…3 Thus, monitoring the blood concentration of AEDs is commonly required to optimize their individual dose, improve their therapeutic efficacy, and decrease their adverse and toxic effects in the clinical management of patients with epilepsy. 4 Phenytoin (PHT) and phenobarbital (PHB) are the rstgeneration AEDs used in the treatment of epilepsy. However, although they present obvious inter-individual variability, narrow therapeutic scopes, nonlinear pharmacokinetics and serious adverse effects, they are still widely used in the treatment of focal, generalized and neonatal seizures owing to their broad spectrum treatment range and low cost.…”

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%