Research Progress on Therapeutic Drug Monitoring of Lamotrigine for Epileptic Patients
Objective To provide a reference for the rational use of lamotrigine(LTG)in clinical practice.Methods Literature related to the therapeutic drug monitoring(TDM)of LTG in the CNKI,WanFang,VIP,PubMed and Web of Science from the inception of each database to November 2023 were searched.The research progress of TDM of LTG was summarized from the therapeutic window,pharmacokinetic characteristics,pharmacokinetic characteristics of special populations(pregnant women,children,elderly),and effect of metabolic enzyme-related gene polymorphisms on the plasma concentration.Results LTG is a drug for epilepsy and bipolar disorder,and its clinical application needs to be based on the latest therapeutic window.The clinical monitoring sample of LTG is mainly plasma,hair and saliva are also non-invasive samples.The detection method of LTG concentration is mainly liquid chromatography,fluorescence spectroscopy and electrochemical sensor are gradually being applied.The bioavailability of LTG is about 98%,the protein binding rate is about 55%,and the time to peak is not limited by the dosage of the drug.Pay attention to adjusting the dosage of LTG when used in combination with other drugs.LTG is priority for epileptic women with potential fertility,it is more suitable for newly-diagnosed epileptic patients for elderly,and plasma concentration should be monitored for epileptic children to avoid adverse reactions.Uridine 5'-diphosphate glucuronosyltransferases is the main enzyme involved in LTG metabolism,and the polymorphism of its related genes is an important factor affecting the plasma concentration.Conclusion We should detect LTG concentration through suitable samples and methods,pay attention to different populations and genotypes to prevent the occurrence of serious adverse reactions.
epilepsylamotriginetherapeutic drug monitoringpharmacokineticsgenetic polymorphismadverse drug reactionresearch progress
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