The study aimed to evaluate the three-year trend of ASM use by comparing older versus newer ASMs through TDM requests. A retrospective analysis involved 122 patients who received 448 ASMs over three years. Significant portion of the sample comprised older ASMs (252 out of 448, 56.25% (95% C.I. 46-65%)). Older ASMs were more frequently tested than newer ones (p<0.01), with a noticeable shift towards newer ASMs. Monotherapy and polytherapy differed significantly (p<0.05), with polytherapy trending. The most frequent combination in polytherapy was phenytoin and levetiracetam. The maximum was five ASMs, seen in 2 out of 74 polytherapy cases. Eighteen percent of referrals cited therapeutic failures, with four ADRs documented at therapeutic levels. The trend analysis revealed increased use of newer ASMs from 2019 to 2021. TDM requests were higher for older drugs, with most epilepsy patients treated with multiple AEDs achieving satisfactory seizure control and minimal adverse drug reactions.