Drug–drug interaction between levetiracetam and non-vitamin K antagonist anticoagulants

Mathy, François‐Xavier; Dohin, Elisabeth; Bonfitto, François; Pelgrims, Barbara

doi:10.1093/eurheartj/ehy780

Cited by 23 publications

(16 citation statements)

References 5 publications

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“…In animal studies, induction of P-gp was found by levetiracetam, phenobarbital and phenytoin [ 19 , 20 ]. However, the clinical data show that levetiracetam is not a P-gp inducer [ 27 ]. In contrast, in a recent case report, levetiracetam seems to reduce rivaroxaban plasma levels acting as P-gp inducer [ 28 ].…”

Section: Discussionmentioning

confidence: 99%

Concomitant Use of Direct Oral Anticoagulants and Antiepileptic Drugs: A Prospective Cohort Study in Patients with Atrial Fibrillation

et al. 2020

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Section: Discussionmentioning

confidence: 99%

Concomitant Use of Direct Oral Anticoagulants and Antiepileptic Drugs: A Prospective Cohort Study in Patients with Atrial Fibrillation

et al. 2020

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“…Von Oertzen et al [ 68 ] objected to this suggestion, as no clinical evidence of a LEV–DOAC interaction has been reported, and the increased risk of mortality associated with PSE following stroke should be a more serious consideration. Further pharmacogenetic studies have supported this lack-of-interaction [ 69 , 70 ]. By contrast, enzyme-inducing ASM, such as CBZ, PHT, phenobarbital, and primidone, can interact significantly with common post-stroke drugs, including anticoagulants, antihypertensives, and statins, with potentially severe risks for stroke patients.…”

Section: Interrelation Of Therapies For Stroke and Post-stroke Epilepsymentioning

confidence: 99%

Seizures and epilepsy in patients with ischaemic stroke

Zöllner

Schmitt

Rosenow

et al. 2021

Neurol. Res. Pract.

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Background With the increased efficacy of stroke treatments, diagnosis and specific treatment needs of patients with post-stroke seizures (PSS) and post-stroke epilepsy have become increasingly important. PSS can complicate the diagnosis of a stroke and the treatment of stroke patients, and can worsen post-stroke morbidity. This narrative review considers current treatment guidelines, the specifics of antiseizure treatment in stroke patients as well as the state-of-the-art in clinical and imaging research of post-stroke epilepsy. Treatment of PSS needs to consider indications for antiseizure medication treatment as well as individual clinical and social factors. Furthermore, potential interactions between stroke and antiseizure treatments must be carefully considered. The relationship between acute recanalizing stroke therapy (intravenous thrombolysis and mechanical thrombectomy) and the emergence of PSS is currently the subject of an intensive discussion. In the subacute and chronic post-stroke phases, important specific interactions between necessary antiseizure and stroke treatments (anticoagulation, cardiac medication) need to be considered. Among all forms of prevention, primary prevention is currently the most intensively researched. This includes specifically the repurposing of drugs that were not originally developed for antiseizure properties, such as statins. PSS are presently the subject of extensive basic clinical research. Of specific interest are the role of post-stroke excitotoxicity and blood–brain barrier disruption for the emergence of PSS in the acute symptomatic as well as late (> 1 week after the stroke) periods. Current magnetic resonance imaging research focussing on glutamate excitotoxicity as well as diffusion-based estimation of blood–brain barrier integrity aim to elucidate the pathophysiology of seizures after stroke and the principles of epileptogenesis in structural epilepsy in general. These approaches may also reveal new imaging-based biomarkers for prediction of PSS and post-stroke epilepsy. Conclusion PSS require the performance of individual risk assessments, accounting for the potential effectiveness and side effects of antiseizure therapy. The use of intravenous thrombolysis and mechanical thrombectomy is not associated with an increased risk of PSS. Advances in stroke imaging may reveal biomarkers for PSS.

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“…In 2018 though, The European Heart Rhythm Association cautioned prescribers for interactions not only with the stronger CYP inducers but also with levetiracetam based on the risk of interaction on P‐gp level 19 . Even though this recommendation has been criticized as it is based on animal data and not supported in clinical data, it may explain our finding 33 …”

Section: Discussionmentioning

confidence: 93%

Post‐stroke epilepsy and antiepileptic drug use in men and women

Loikas

Linnér

Sundström

et al. 2021

Basic Clin Pharma Tox

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Evidence‐based recommendations for choice of antiepileptic drug (AED) in post‐stroke epilepsy (PSE) are lacking. The aim of this study was to describe the use and persistence of AEDs when initiating treatment in men and women with PSE. An observational study based on individual‐level patient data from a regional healthcare register in Stockholm, Sweden, was conducted. Adults (≥18 years) with a stroke diagnosis 2012‐2016, a dispensed prescription of any AED within two years after the stroke, and with an epilepsy‐related diagnosis were identified. Multinomial logistic regression and logistic regression were used to identify factors associated with choice of AED and discontinuation within 90 days, respectively. Of 9652 men and 9844 women with a stroke diagnosis, 287 men and 273 women had PSE and were dispensed AED. More than 60% of both men and women with PSE were treated with levetiracetam. Carbamazepine was the second most common drug followed by lamotrigine and valproic acid. There were significant differences in AED choice depending on for instance sex, age and renal impairment. Levetiracetam had the highest persistence in both men and women. Choice of AED, oral anticoagulant use and percutaneous endoscopic gastrostomy (PEG) showed an association with the persistence to therapy. We conclude that in both men and women with PSE, levetiracetam was the most used AED for initiation of treatment and also had the highest persistence.

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Drug–drug interaction between levetiracetam and non-vitamin K antagonist anticoagulants

Cited by 23 publications

References 5 publications

Concomitant Use of Direct Oral Anticoagulants and Antiepileptic Drugs: A Prospective Cohort Study in Patients with Atrial Fibrillation

Concomitant Use of Direct Oral Anticoagulants and Antiepileptic Drugs: A Prospective Cohort Study in Patients with Atrial Fibrillation

Seizures and epilepsy in patients with ischaemic stroke

Post‐stroke epilepsy and antiepileptic drug use in men and women

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