Review on the relevance of therapeutic drug monitoring of levetiracetam

Seizure : the Journal of the British Epilepsy Association
Jo SourbronMarian Majoie

Abstract

Therapeutic Drug Monitoring (TDM) of anti-epileptic drugs (AEDs) is not routinely performed, although this can guide the dosage regimen to achieve greater efficacy and safety. Levetiracetam (LEV) has been introduced as an AED with an almost perfect pharmacokinetic (PK) profile. Nonetheless, recent research challenges this statement and therefore we aimed to explore factors that modify LEV PK. Age and enzyme-inducing drugs (EIDs) appear to be major factors influencing the PK profile of LEV. Therefore, 30-50% lower dosages should be used in the elderly (> 65 years of age) and the dosing regimen should be guided by monitoring SDC (TDM). In contrast, higher LEV dosages are necessary in children aged between 2 months and 12 years (compared to adults) due to a 30-70% increase of LEV clearance (CL). Higher dosages are also required if a patient receives EIDs, again due to a higher CL of LEV (range 24-60%). This could also be true for pregnant women. LEV TDM is currently not common in the clinical setting due to the wide therapeutic range and the low prevalence of side-effects. However, LEV dose should on the one hand be increased in certain physiological situations (pregnancy, neonates) and patients on EIDs (especially carbamazepine)....Continue Reading

Citations

Feb 12, 2020·Clinical Chemistry and Laboratory Medicine : CCLM·Thierry P I J M CanisiusH J Marian Majoie
Aug 7, 2019·Dose-response : a Publication of International Hormesis Society·Hugo Juárez Olguín
Nov 6, 2020·Molecules : a Journal of Synthetic Chemistry and Natural Product Chemistry·Karina Sommerfeld-KlattaFranciszek K Główka

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