Choosing Wisely:

Avoid routine testing for antiepileptic drug levels in people with epilepsy.

Rationale and Comments: Antiepileptic drug level testing should not be routinely ordered when seizures are well controlled, and no adverse effect is suspected. The reference ranges should not be used as a rigid framework. The effectiveness and tolerability of treatments should be determined by the clinical responses. Antiepileptic drug levels should be ordered to address a specific question. Some examples include weight-based dosing adjustments in young children, adherence, suspected toxicity, and pregnant women.
Sponsoring Organizations:
  • American Epilepsy Society
  • Sources:
  • Cochrane Database of Systematic Reviews
  • Disciplines:
  • Neurologic
  • References: • Eadie MJ Therapeutic drug monitoring – antiepileptic drugs. Br J Clin Pharmacol. 1998;46:185-193.
    • Patsalos PN et al. Antiepileptic drugs—best practice guidelines for therapeutic drug monitoring: A position paper by the subcommission on therapeutic drug monitoring, ILAE Commission on Therapeutic Strategies. Epilepsia 2008;49(7):1239-1276.
    • St. Louis EK Monitoring Antiepileptic Drugs: A Level-Headed Approach. Current Neuropharmacology, 2009;7:115-119.
    • Affolter N et al. Appropriateness of serum level determinations of antiepileptic drugs. Swiss Med Wkly. 2003;133:591-597.
    • Tomson T et al. Therapeutic monitoring of antiepileptic drugs for epilepsy (Review). Cochrane Database of Systematic Reviews 2007, Issue 2. Art. No.: CD002216. Copyright © 2010 The Cochrane Collaboration. John Wiley & Sons, Ltd.
    • Walters RJL et al. Inappropriate requests for serum anti-epileptic drug levels in hospital practice. Q J Med 2004;97:337-341.
    • Stepanova D, Beran RG. The benefits of antiepileptic drug (AED) blood level monitoring to complement clinical management of people with epilepsy. Epilepsy Behav. 2015; 42:7-9.

    Email Alerts

    Don't miss a single issue. Sign up for the free AFP email table of contents.

    Sign Up Now