Therapeutic drug monitoring of antiepileptic drugs in Sarawak General Hospital

Introduction : The position of antiepileptic drugs (AEDs) out of all therapeutic dmg monitoring data between March 2007 to February 2008 for Phenytoin, Valproic Acid (VPA) and Carbamazepine (CBZ) were demonstrated. These AEDs assays analyzed using Fluorescene Polarization Immunoassay (FPIA) method performed by TDX FLX machine.

Method : 1 year retrospective study (from 1st March 2007 to 29th February 2008) was carried out in Sarawak General Hospital (SGH). Total of 742 AED's samples were performed, but only 704 of the samples were included according to their inclusion criteria. Data expressed as percentage.

Aim : The primary aim of conducted this research was to study the rationale of TOM in management of AEDs therapy. Hence, this study needs to prove that TOM service plays an essential role to achieve the therapeutic goal of AEDs in SGH.

Result : Phenytoin, 54% (n = 385) was the most requested among these three types of AEDs. Most of analyses, 49.9% were subtherapeutic (n =351). Most of the results, Phenytoin 57.14% (n =220) and VPA 46% (n =109), were sub-therapeutic, whereas most of the result of CBZ analyses were within therapeutic range, 54.9% (n =45). However, most of the recommendations were to maintain dose, 60.8% (n =428). Most of the requests came from the IPD of SGH and requested from male patients, 55.3%(n= 389). Of the impression of patient' clinical response for TOM request were mostly inadequate, 27.6% (n= 194), whereas most of the reason for request were for therapeutic confirmation (70.2%).

Conclusion : These findings prove that TD M service of Sarawak General Hospital (SGH) plays an essential role to achieve the therapeutic goal of AED's in SGH. Thus, in conclusion this research study was achieved the stated aim to study the rationale of TOM in management of AED's therapy.