Variability of Anti-Seizure Medication Concentrations in Older Adult Nursing Home Residents

Approximately 10% of nursing home (NH) residents are taking an anti-seizure medication (ASM), and 7.8% have an epilepsy/seizure indication. In one recent study, levetiracetam (LEV) and phenytoin (PHT) were the most commonly prescribed ASMs in US NH residents. There are major differences in pharmacokinetics (PK) among ASMs. PHT has complicated PK and its absorption is pH-dependent, and LEV is very water-soluble with few drug interactions. The side effect profiles also differ, with PHT being associated with ataxia and LEV with behavioral problems.