Co-medication and potential drug interactions among patients with epilepsy

Abstract

This study aimed to analyze the extent of co-medication and to assess potential interactions between antiepileptic drugs (AEDs) and other drugs among patients with epilepsy. Methods: We studied 663 consecutive patients with epilepsy seen in tertiary outpatient clinic. Data on epilepsy and current treatment with AED(s) were collected from structured interview and medical records. Other medications used regularly were classified according to the Anatomical Therapeutic Chemical classification system. Possible drug interactions between AEDs and other drugs were analyzed with the use of IBM Micromedex® database. Results: Studied sample included 395 women; 54.5% of subjects were on monotherapy. Enzyme-inducing AED(s) were used by 127 patients (19.2%). Among 265 patients who used medications other than AEDs (40.0% of all subjects), potential major and moderate interactions between AEDs and other drugs were found in 80 patients (30.1%). Most prevalent major interactions included: ethinylestradiol/estradiol-valproate/oxcarbazepine/ carbamazepine, sertraline-carbamazepine, and simvastatin-carbamazepine. A total number of currently used medications (OR = 1.26 [1.07-1.48] per one additional medication; p = 0.005) and the use of enzyme-inducing AEDs (OR = 2.78 [1.51-5.12]; p < 0.001) were independent predictors of interactions between AEDs and other drugs. Conclusions: Co-medication is common (40%) among patients with epilepsy. Potential major or moderate interactions between AED(s) and other drugs are noted in 30.1% of patients exposed to at least one medication other than AED (12.1% of the entire cohort). The risk of potential interactions increases with the number of medications used chronically and with the use of hepatic enzyme-inducing AEDs.

Influence of Risk of Drug–Drug Interactions and Time Availability on Patient Trust, Satisfaction, and Cooperation with Clinical Pharmacists

“…A sample item was “during the clinic visit, how would you rate your overall quality of care from the physician?” on a 5-point Likert scale of “excellent,” “very good,” “good,” “fair,” and “poor.” Cooperation with clinical pharmacists was measured using five items from Weingarten, Issa, and Posluszny [38]. A sample item was “I’m willing to cooperate with the physician.” Risk of DDI was measured using four items from Bosak et al [39]. A sample item was “interactions between given medications might be life-threatening.” Time availability was measured using five items from Gendelman et al [40] and Pozsgai et al [41].…”

Medication burden in epilepsy: Exploring the impact of non-epilepsy concomitant drugs load

“…A lower estimate of chronic medication use apart from antiseizure medications (40%) was reported in a survey at a tertiary outpatient clinic in Poland. 34 This can be partially explained by the difference in definition of chronic medication (medication that was used on a daily or weekly basis versus medication for which at least two prescriptions were dispensed in one calendar year), and the study method (questionnaires versus insurers' dispensing information). Questionnaires are more prone to bias, whereas insurance data is complete and objective.…”

Epileptic Seizures: the challenge continues

“…If both exams are normal, the risk of recurrence of seizures is less than 30%, being higher in the first months after the initial crisis, decreasing progressively. When both exams are abnormal, the risk of recurrence reaches 80% (Bosak et al, 2019).…”