Conclusions

Therapeutic drug monitoring of strongly protein-bound antiepileptic drugs such as phenytoin, valproic acid, and carbamazepine is useful for patients with uremia, liver disease, and hypoalbuminemia. Drug-drug interactions may also increase Fu of antiepileptic drugs without significantly altering total drug concentrations. Monitoring free concentration of immunosuppressant drugs such as cyclosporine, tacrolimus, and mycophenolic acid may have clinical value but are technically more difficult to perform. Monitoring free protease inhibitors may be useful but need further studies for establishing guidelines. Monitoring free lidocaine and free quinidine concentrations may be beneficial for certain patient populations.

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