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Fig. 9. Butalbital.

9-hydroxytopiramate. The package insert for zonisamide reports negligible cross-reactivity for the metabolite N-acetyl zonisamide and a small degree (but clinically insignificant) of cross-reactivity with the metabolite 2-sulfamoylacetyl phenol.

Anticonvulsants are a good example of drugs that should be monitored therapeu-tically, because there is a well-defined relationship between blood concentration and therapeutic effects, but a lack of good correlation between dose and the serum blood concentration. Clinical situations where anticonvulsant drugs should be monitored include establishing baseline effective concentrations, evaluating causes for toxicity or lack of efficacy, evaluating non-compliance versus loss of efficacy, minimization of side effects, and evaluation of serum levels when the therapeutic regimen is changed. Many different methods have been developed for measuring blood concentrations of anticonvulsants. In chromatographic methods (including those coupled to mass spectrometry), potential interferences come from serum components and other drugs with extraction, or co-eluting substances during chromatography. Immunoassays for measurement of drug concentrations allow for an automated, simple analyses of drugs; however, a different source for assay interference must be considered, because cross-reactivity of drugs (or metabolites) with similar structural epitopes must be considered. Important cross-reactivities have been discovered for certain assays including HPPH, HPPG, and fosphenytoin for selected phenytoin assays. In certain carbamazepine immunoassays, there is cross-reactivity with 10,11-carbamazepine epoxide, as well as from benzhydrylpiperazine antihistamine drugs. Minor, but clinically insignificant,

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