Pregnancy and epilepsy: pharmacokinetic insights into antiseizure medications

Introduction: Absorption, distribution, metabolism and excretion of antiseizure medications may undergo significant modifications throughout pregnancy. These necessitate careful and proactive monitoring to avoid breakthrough seizures during pregnancy with potentially lethal consequences for both mother and child. Areas covered: Based on the available literature, pharmacokinetics of both older and newer antiseizure medications are examined by the authors, emphasizing the important available data and the missing ones for which it is necessary to expand knowledge. Expert opinion: Therapeutic drug monitoring is a valuable tool for tailoring antiseizure treatment in women with epilepsy. When monitoring is not feasible, clinicians may need to adjust doses based on seizure severity and the well-documented pharmacokinetic changes of specific medications such as lamotrigine, levetiracetam, oxcarbazepine. The goal is to maintain effective seizure control while minimizing teratogenic risks and ensuring safe fetal development.