From the Guidelines
If a dose of antiepileptic medication is missed, it should be taken as soon as possible to maintain therapeutic levels and prevent breakthrough seizures. This approach is crucial in managing epilepsy, as consistent medication levels are essential for effective seizure control 1.
Key Considerations
- The primary goal is to maintain steady blood levels of antiepileptic medications to prevent seizures.
- Abrupt changes in medication levels can trigger breakthrough seizures.
- If it's close to the next scheduled dose, the missed dose should be skipped to avoid double dosing and potential side effects.
Medication-Specific Guidance
- For medications like levetiracetam, a loading dose can be considered if the patient has been off the medication for a short period 1.
- However, the choice of administration route (oral vs. parenteral) depends on the specific medication and clinical scenario, as there is a lack of evidence to support one route over the other in preventing early recurrent seizures 1.
General Recommendations
- Patients should be advised to take their missed dose as soon as they remember, unless it's almost time for their next dose.
- Setting alarms, using pill organizers, or medication reminder apps can help prevent missed doses.
- If multiple doses are missed or seizure activity occurs after missing a dose, patients should contact their healthcare provider for potential adjustments to their treatment plan.
From the Research
Missed Dose Management
- A missed dose of antiepileptic medication should generally be taken as soon as it is remembered, and doses should not be doubled 2.
- However, individual drug-specific instructions about missed-dose management are available for certain medications, and patients should follow these instructions 2.
- A study on handling delayed or missed doses of antiseizure medications found that the optimal remedial dosing regimens were highly correlated with delayed time, scheduled dosing interval, and half-life of the medication 3.
Pharmacokinetic Perspective
- From a pharmacokinetic perspective, patients should not skip late doses of medication, but rather take them as soon as possible 4.
- Mathematical analysis has shown that taking a late dose can result in differences in drug concentration time courses, and metrics such as the integral of the absolute difference and the maximum of the difference can be used to quantify these effects 4.
- Population variability can be incorporated into these results, and general principles and strategies for dealing with dosing irregularities can be proposed 4.
Patient Information and Guidance
- Patient information leaflets and summaries of product characteristics often lack specific advice on what to do if a dose is missed, and pharmaceutical companies and regulatory authorities should produce clear and concise instructions with supporting evidence where necessary 5.
- A systematic review found that only 9% of summaries of product characteristics provided specific instructions on missed doses, and 52% had no instructions at all 5.
- Patients should be advised to take a missed dose as soon as possible, unless specific instructions are provided for their medication 2, 5.