QUARTERLY BEAT / APRIL 2025
ANTICONVULSANT
MONITORING
DRUG
Wondering when and how to monitor bloodwork for patients on anticonvulsant therapy? We’ve got you covered! In this VETgirl article, Dr. Missy Carpentier, DACVIM (Neurology) provides a comprehensive review of best practices for anticonvulsant therapy bloodwork monitoring. Read on to refresh your knowledge of what to test for and when for these common anticonvulsants!
Missy Carpentier, DVM, DACVIM (Neurology) Minnesota Veterinary Neurology, Columbus, MN Your epileptic patient just left the hospital, you have your anti-seizure medications prescribed, and you are feeling pretty good. Then you remember, you didn’t set up an appointment for the follow up blood work that is needed. But what blood work is needed, when is it needed, and is it necessary? Read along to find out! The ultimate goal for every epileptic patient is good seizure control with a good quality of life. We do our best to control the frequency, duration and severity of seizures with anticonvulsant medications. Currently, the most commonly prescribed anticonvulsant medications are phenobarbital, potassium bromide, levetiracetam (regular and extended release), zonisamide, and pregabalin. I have included a chart below that will help you determine when you should be collecting drug blood concentrations and if any other blood work is recommended. It should be noted that regardless of what medication a patient is receiving, I always recommend a yearly CBC and chemistry profile. Each and every patient needs to be looked at individually and it is important to recognize that despite what the number is that you receive on your drug
blood concentration, you need to correlate it to the patient. How are BOTH the patient and the owner handling the side effects of the medication, how is their seizure control, etc. Values for one patient may work great and for another the side effects may be significantly affecting their quality of life, and therefore adjustments need to be made. It is also important to recognize that the “therapeutic range” of a drug is just that, a range. A value in the therapeutic range doesn’t mean that you still cannot increase or decrease the dose of the medication, and it also doesn’t mean that you have maximized the potential of that drug. The chart to the right will help you with monitoring the drug blood levels of your patients and any other necessary blood work that is recommended. Remember, seizure management is an art and no two patients are alike!
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