Mayo Clinic, Rochester, Minnesota, USA.
Curr Neuropharmacol. 2009 Jun;7(2):115-9. doi: 10.2174/157015909788848938.
Despite advances in epilepsy therapeutics, some physicians feel uncomfortable with newer antiepileptic drugs (AEDs) due to difficulty in promptly obtaining blood levels to guide medication adjustment, and even when levels for newer AEDs are obtained, many practitioners feel they are not very useful. Lacking confidence in AEDs whose levels that cannot readily or expeditiously be measured, many clinicians share uncertainty about proper use of the newer AEDs and monitoring AED administration. Similarly, some epilepsy patients inflate the importance of AED blood level monitoring, feeling that blood levels falling within traditionally therapeutic ranges are a fail-safe for seizure control, regardless of their compliance or personal behavior aggravating seizure burden, such as poor sleep or use of illicit substances. This review examines the elusive concept of therapeutic AED blood levels and potential uses and abuses of blood level monitoring, reinforcing appropriate uses for blood levels to ensure compliance and adjust for altered AED pharmacokinetics in the context of aging and disease states, pregnancy, or drug interactions.
尽管癫痫治疗学取得了进展，但由于难以迅速获得血药水平来指导药物调整，一些医生对新型抗癫痫药物（AEDs）感到不自在，即使获得了新型 AEDs 的血药水平，许多医生也觉得它们不是很有用。由于缺乏对那些不能轻易或迅速测量其血药水平的 AED 的信心，许多临床医生对新型 AED 的正确使用和监测 AED 给药存在不确定性。同样，一些癫痫患者夸大了 AED 血药浓度监测的重要性，认为血药浓度在传统治疗范围内波动是控制癫痫发作的安全保障，而不管他们的依从性如何，或者个人行为是否加重了癫痫发作的负担，如睡眠不佳或使用非法物质。这篇综述探讨了治疗性 AED 血药浓度的难以捉摸的概念，以及血药浓度监测的潜在用途和滥用，强调了血药浓度监测的适当用途，以确保在老龄化和疾病状态、妊娠或药物相互作用的情况下，根据药物的药代动力学来调整药物的依从性。
