Background and Importance In 2016 therapeutic drug monitoring programme (TDMP) began for new anticonvulsant drugs (NAD) for inpatients and outpatients at our hospital. Weekly multidisciplinary meetings were held to revise out-of-range trough drug levels (TDL) on epileptic outpatients, and to make early drug adjustment interventions (EDAI) before their scheduled clinical follow-up.
Aim and Objectives To evaluate the impact of NAD TDMP on the activity of the Pharmacy and Neurology departments.
Inpatients Quantification of pharmacokinetic interventions (PI) and patients monitored between 2016-2021.
Outpatients Activity analysis between July 2017 and May 2019: TDL revision, patients monitored and number of EDAI made. TDL and EDAI percentage calculation for each drug.
Inpatients Anticonvulsant drug PI were 56% of all PI (6.067 of 10.910) during the study period. PI of classic anticonvulsant drugs (CAD) decreased from 934 in 2016 to 348 in 2021 (63%). In 2021 the percentage of PI of NAD and CAD were 27% and 16% (602 and 348 out of 2.209) respectively. Levetiracetam and Lacosamide accounted for 63% (380) and 27% (163) of all monitored NAD. Regarding CAD monitoring Valproate was the most 86% (299) and Fenitoin the least 4% (15) monitored.
Outpatients 1.096 TDL out of 2.324 ordered were revised (47%) which belonged to 424 patients of a total of 877 monitored (48%). 273 TDL (25%) led to an EDAI, which affected 196 patients, that is 46% of revised patients and 22% of all monitored patients. Most EDAI supposed an increase or reduction of dosage, 51% and 34% (139 and 92 out of 273) respectively. Levetiracetam, Perampanel and Lacosamide were the most monitored NAD: 26% (286), 13% (145) and 10% (110) respectively, and the most EDAI-prone: 29% (79), 27% (73) and 11% (29) respectively.
Conclusion and Relevance Inclusion of outpatients to TDMP allowed early drug adjustment of almost half of the revised patients.
The creation of a multidisciplinary team that includes pharmacists and neurologists with a focus on active monitoring of NAD TDL might be significant to better care for epileptic outpatients.
Conflict of Interest No conflict of interest
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