Doctors are urged not to increase the dose of antiepileptic drugs automatically if they see a fall in plasma levels in pregnant women. In some cases there may be just as much active drug in the plasma, while total levels appear to be falling.
Dr. Svein Johannessen of the National Centre for Epilepsy, in Sandvika, Norway, told delegates to the Fifth European Congress on Epileptology here that biochemical and metabolic changes during pregnancy mean levels of individual drugs vary during each trimester of pregnancy.
Changes in protein binding during pregnancy means that while total carbamazepine plasma levels usually fall in the third trimester of pregnancy, the pharmacologically active drug that is not bound to proteins remains at much the same levels. Increasing the dose would risk increased levels of side effects as well as posing an increased possible risk to the foetus
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