Tiagabine serum levels are decreased in patients also treated with enzyme-inducing drugs.35,36 The marked variability in kinetics and the fact that tiagabine elimination is affected by other antiepileptic drugs suggest that there may be a need for therapeutic monitoring of tiagabine. However, the establishment of a target range is complicated by the pronounced fluctuations in tiagabine plasma concentrations due to the short half-life. In addition, the need to monitor free rather than total levels needs to be explored, considering the high protein binding of tiagabine. A more pronounced reduction in seizures was observed at trough plasma concentrations >40 ^g/l in a preliminary analysis of data from a clinical trial of patients with complex partial seizures given three different dosages of tiagabine.37 The authors are not aware of any other systematic study exploring the relationship between tiagabine concentration in plasma and effects, and no target concentration has been proposed.

The available data are clearly not sufficient to recommend routine monitoring of tiagabine concentrations, and more studies are needed.

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