Brodie used the Monostars score to compare antiepileptic drugs for use as monotherapy by assigning "stars" to each drug based on its pluses and minuses. This can help select the best drug for a patient. The author is from the Western Infirmary in Glasgow, Scotland.


Parameters for each drug:

(1) mechanism of action

(2) predictable kinetics

(3) drug interactions

(4) range of efficacy

(5) titration schedule

(6) idiosyncratic reactions

(7) sedative burden

(8) neuropsychiatric profile

(9) teratogenic potential

(10) long-term effects

(11) comfort factor


Drug Feature









total score for each drug =

= SUM(points for all 11 parameters)



• minimum score: -11

• maximum score: +11

• The antiepileptic drugs evaluated had scores that ranged from -3 to +1.

• The drug with the highest score should be the "best" drug for the patient.

Total Score

Number of Stars


5 stars


1 star


The Monostars system can be used in 2 ways.

(1) It can be used as a general tool for formulary management or guideline development.

(2) It can be used for the individual patient. For example, teratogenic potential would be important for a young woman but not for an elderly man. Drug interactions would be a serious drawback for a person on multiple drugs, but not for a person not taking other drugs.


To read more or access our algorithms and calculators, please log in or register.