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Therapeutic drug monitoring in a paediatric epilepsy clinic
1Department of Clinical, University of Natal and King Edward VIII Hospital, Durban.
Insights
A therapeutic drug monitoring program using clinical pharmacokinetics improved anticonvulsant therapy for 55% of pediatric neurology patients. This approach, especially for phenytoin, optimized drug dosing, reducing seizures and side effects.
Area of Science:
- Clinical Pharmacology
- Pediatric Neurology
Background:
- Introduction of a therapeutic drug monitoring program for anticonvulsants in a pediatric neurology clinic.
- Shift from routine serum drug level measurement to applying clinical pharmacokinetics for individualized patient profiles.
Observation:
- Case reports illustrate the value of serum drug level monitoring combined with pharmacokinetic analysis.
- 58 patients were enrolled over one year.
Findings:
- 55% (32/58) of patients benefited from the monitoring program, with dosage adjustments reducing seizure frequency or side effects.
- The program was most valuable for rationalizing phenytoin use, improving seizure control in 91% (10/11) of patients due to individualized dosing via Bayesian forecasting.
Implications:
- Individualized pharmacokinetic profiling enhances anticonvulsant therapy effectiveness in pediatric neurology.
- Bayesian forecasting is a valuable tool for optimizing phenytoin dosage in patients with variable pharmacokinetics.
Abstract:
In 1988 a therapeutic drug monitoring programme for anticonvulsants was introduced in the paediatric neurology clinic at King Edward VIII Hospital, Durban. Although before this serum drug levels were routinely measured, the new approach involved the application of clinical pharmacokinetics to the results so that an individualised drug profile was available for use in conjunction with clinical evaluation at the patient's next visit. Case reports are presented to illustrate the value of using serum levels in this way. Of the 58 patients entered into the study in the course of 1 year, 32 (55%) benefited from the monitoring programme in that the pharmacokinetic report contributed to a dosage adjustment that resulted in a reduction in either seizure frequency or side-effects. The greatest value of the programme proved to be in rationalizing the use of phenytoin. Because of wide inter-patient variation and non-linear kinetics, it is difficult to establish an optimum maintenance dose for this drug. The individualised dose achieved in the present study using Bayesian forecasting resulted in improved seizure control in 10 of the 11 patients (91%) receiving phenytoin.