Therapeutic Drug Monitoring in Antiepileptic Therapy: Optimizing Efficacy and Safety

Therapeutic drug monitoring (TDM) is an essential tool in the management of epilepsy, aiming to optimize antiepileptic drug (AED) therapy by balancing efficacy and minimizing toxicity. Due to the narrow therapeutic index, significant pharmacokinetic variability, and potential drug interactions of AEDs, individualized dosing guided by TDM enhances seizure control and reduces adverse effects. This review summarizes the principles of TDM in epilepsy management, discusses the pharmacokinetic considerations of commonly used AEDs, and evaluates clinical evidence supporting TDM implementation. Recommendations for integrating TDM into routine clinical practice are provided to improve patient outcomes. Epilepsy is a chronic neurological disorder characterized by recurrent seizures that require long-term antiepileptic drug (AED) therapy for effective management. Therapeutic drug monitoring (TDM) plays a critical role in optimizing antiepileptic treatment by ensuring drug concentrations remain within a therapeutic range that maximizes efficacy while minimizing toxicity. This review explores the principles and clinical applications of TDM in antiepileptic therapy, highlighting its impact on dose individualization, assessment of patient adherence, and management of drug interactions. Current evidence supporting the use of TDM for various AEDs including phenytoin, carbamazepine, valproate, and newer agents is evaluated. Challenges and future directions in integrating TDM into routine epilepsy care are discussed with an emphasis on personalized medicine approaches.