STEADY-STATE ANTICONVULSANT DRUG LEVELS IN EPILEPTIC PATIENTS

Steady state concentrations of three anticonvulsant drugs (phenobarbit one, phenytoin and carbamazepine) were measured in plasma samples from fifteen patients (eight males and seven females; ages: 13-49 years; b ody weights: 44-70kg), attending the outpatient Neurology Clinic at Ke nyatta National Hospital. In addition, total protein and albumin level s were measured in plasma from patients taking phenytoin. Total protei n levels were normal (range:6.3-7.6g/dl) in all patients except in one patient (10.7g/dl). Albumin levels were also normal (range:3.7-4.1g/d l) in all patients except one (2.54g/dl). One patient on phenobarbiton e and three patients on phenytoin had no detectable drug levels in the ir plasma. In the remainder, phenobarbitone, phenytoin and carbamazepi ne steady state concentrations were 8.7-21.1mg/L (N=8), 9.3-27.3 mg/L (N=6) and 10-19.7mgn (N=5), respectively. The unbound fraction of phen ytoin in plasma (fu) was normal(approximately 0.1) in six patients, bu t relatively high (0.2) in one patient. Most patients in the study com plied with the prescribed treatment and their epilepsy was controlled. Cases where drug, levels were undetectable probably arose from a lack of money to purchase all prescribed medicines rather than deliberate non-compliance. Routine monitoring of anticonvulsant drug levels may i mprove management of epileptic patients.