Anticonvulsants

Until recently, it was difficult to explain why an identical drug dosage may exert a toxic effect in one patient and a therapeutic, or no, response in another patient. It has now been demonstrated that the concentration of drug at the tissue receptor site is the most important parameter for adjusting drug dosage. However, the concentration of drug at the receptor site cannot be measured directly, and must therefore be correlated with the concentration of drug in body fluids in contact with these tissue receptors. The ability to correlate plasma drug concentration with tissue concentrations and with therapeutic or toxic effects has enabled those interested in optimizing drug dosages to generate much of the information needed to make useful therapeutic decisions. The exact nature of drug-receptor interactions is not firmly established. It is, however, known that the concentration of free drug correlates best with therapeutic effect. The free drug in plasma is in equilibrium with protein-bound drug and, because of this relationship, it is important to understand to what extent a particular drug is protein-bound. Various attempts to measure free drug concentration in saliva (1 ) and cerebrospinal fluid (2 ) have been reported.