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

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 dru...

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Published inEpileptic disorders Vol. 25; no. 4; pp. 454 - 471
Main Authors Johannessen Landmark, Cecilie, Eyal, Sara, Burns, Margrete Larsen, Franco, Valentina, Johannessen, Svein I.
Format Journal Article
LanguageEnglish
Published Boston, USA Wiley Periodicals, Inc 01.08.2023
Wiley Subscription Services, Inc
Subjects
analytical methods
antiepileptic drugs
Biochemical markers
Drug interaction
Drug interactions
Epilepsy
interations
Patients
Pharmacodynamics
pharmacokinetic variability
Pharmacokinetics
Serum levels
Therapeutic drug monitoring
epilepsy
antiepileptic drugs
pharmacokinetic variability
analytical methods
interations
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Summary: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.
Bibliography:ObjectType-Article-2
SourceType-Scholarly Journals-1
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ObjectType-Review-1
ISSN:1294-9361
1950-6945
DOI:10.1002/epd2.20069