[Skip to Content]
[Skip to Content Landing]
March 13, 1996

Appropriateness of Antiepileptic Drug Level Monitoring-Reply

Author Affiliations

Brigham and Women's Hospital Boston, Mass

JAMA. 1996;275(10):758. doi:10.1001/jama.1996.03530340021019

In Reply.  —Dr Gambino has two main concerns about our study: that the low ordering appropriateness rate of 27% was found largely because blood samples were drawn at an inappropriate time, and that we did not address the issue of undermonitoring, which he considers more serious than over-monitoring. In fact, most levels were judged inappropriate because they were redundant (performed 1 or more days before they were indicated) and not simply drawn at the wrong time. This occurred because routine once-per-day determination of antiepileptic drug levels was performed regularly without pharmacological or clinical justification, accounting for the majority of the inappropriate determinations. Moreover, we did not consider the ordering of a level inappropriate if it was sampled at the wrong time, but incorrect sampling was an additional important problem: of the 27% of levels with an appropriate indication, 49% were sampled incorrectly. Dr Dorizzi and colleagues describe patterns of inappropriate