Ion-Channel Antiepileptic Drugs: An Analytical Perspective on the Therapeutic Drug Monitoring (TDM) of Ezogabine, Lacosamide, and Zonisamide

Abstract

The term seizures includes a wide array of different disorders with variable etiology, which currently represent one of the most important classes of neurological illnesses. As a consequence, many different antiepileptic drugs (AEDs) are currently available, exploiting different activity mechanisms and providing different levels of performance in terms of selectivity, safety, and efficacy. AEDs are currently among the psychoactive drugs most frequently involved in therapeutic drug monitoring (TDM) practices. Thus, the plasma levels of AEDs and their metabolites are monitored and correlated to administered doses, therapeutic efficacy, side effects, and toxic effects. As for any analytical endeavour, the quality of plasma concentration data is only as good as the analytical method allows. In this review, the main techniques and methods are described, suitable for the TDM of three AEDs belonging to the class of ion channel agents: ezogabine (or retigabine), lacosamide, and zonisamide. In addition to this analytical overview, data are provided, pertaining to two of the most important use cases for the TDM of antiepileptics: drug–drug interactions and neuroprotection activity studies. This review contains 146 references.

On the benefits of therapeutic drug monitoring for patients undergoing treatment with antipsychotic agents

“…It should also be mentioned that TDM data are only as good as the analytical methods that are used to obtain them, and that the analytical choices available can be limited, or non-existent, especially for newer drugs (Kapur and Aleksa, 2020). For this reason, many efforts are being made in the last few years to increase the reliability and availability of analytical methods for drug and metabolite determination (Mandrioli et al, 2015(Mandrioli et al, , 2018(Mandrioli et al, , 2021Mandrioli and Mercolini, 2017;Protti et al, 2020a). Moreover, recent research is also focusing on making analysis less expensive and more acceptable to patients through the use of microsampling coupled with miniaturised sample preparation (Protti et al, 2018(Protti et al, , 2020bMarasca et al, 2020Marasca et al, , 2022Stern et al, 2020).…”

Editorial: Advances in therapeutic drug monitoring of psychiatric subjects: Analytical strategies and clinical approaches

“…Thus, any scientific advance and any practice that could lead to even a slight increase in psychiatric therapy effectiveness would also bring with them enormous benefits for both citizens and healthcare institutions. It is a strong conviction, after many years of practice and study, that therapeutic drug monitoring (TDM) is one of these practices, one that is continually advancing and progressing both from the analytical and clinical points of view, toward the final goal of better, personalized, precision medicine ( 2 – 7 ).…”