Individualizing doses of antiepileptic drugs

ABSTRACT

Introduction

This review aims to identify the optimal therapeutic dosage of anti-epileptic drugs in terms of efficacy and safety in patients with multiple comorbidities.

Areas covered

We have analyzed changes in terms of pharmacokinetics and pharmacodynamics of Brivaracetam, Carbamazepine, Lacosamide, Lamotrigine, Levetiracetam, Topiramate, Valproate, and Zonisamide in liver disease, chronic kidney disease, and in patients admitted to intensive care unit. Our literature search covers the past 5 years. We used PubMed, Google Scholar, and EMBASE database’s to support our article.

Expert opinion

To ensure that the patient with seizure receives the best treatment in relation to their comorbidities, careful clinical-laboratory monitoring is necessary to maximize effectiveness while maintaining safety, especially in the case of polytherapy.

KEYWORDS:

• Brivaracetam
• carbamazepine
• chronic kidney disease
• critical ill patients
• epilepsy
• lamotrigine
• levetiracetam
• liver disease topiramate
• valproate
• zonisamide

Article highlights

• Anti-seizure medications are often administered in patients with multiple comorbidities, and this could modify the pharmacokinetics and pharmacodynamics of drugs.

• In patients with liver disease, the best choices among ASMs are topiramate and levetiracetam.

• In chronic kidney disease, the best therapeutic options are the use of valproate and carbamazepine, which also do not require dose supplementations after hemodialysis.

• In critically ill patients who are treated with carbapenems and macrolides, valproate and carbamazepine should be avoided.

• In pharmacoresistant epilepsies, due to interactions between antiepileptic drugs, it is mandatory to be careful during the assessment of therapy.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Author contributions

All the authors have contributed to the text and to the analysis of data of the literature. A Verrotti has critically revised the text.

Additional information

Funding

This paper was not funded.