Efficacy and tolerability of anti-epileptic drugs-an internet study

Wieshmann, Udo; Baker, Gus A.

doi:10.1111/ane.12698

Cited by 11 publications

(8 citation statements)

References 24 publications

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“…9 While there is evidence to support the use of carbamazepine for pain relief in TN (number need to treat [NNT] of 2) 10 , its use must be considered in light of a poor tolerability profile and adverse effects that can include dizziness, liver damage, and cognitive impairment (number needed to harm for carbamazepine withdrawal of 24, 95% CI 14 -112). 10,11,[12][13][14][15][16] Further, caution is recommended in patients with comorbidities due to the potential for drug interactions. 17 Oxcarbazepine has greater tolerability and a reduced risk of drug interactions than carbamazepine, but its efficacy has not been confirmed in well-conducted randomized controlled trials.…”

Section: Introductionmentioning

confidence: 99%

Characterizing Treatment Utilization Patterns for Trigeminal Neuralgia in the United States

Zakrzewska

Lee

et al. 2018

The Clinical Journal of Pain

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Background and aim: Trigeminal neuralgia (TN) is a rare orofacial disorder characterized by severe unilateral paroxysmal pain in the region of the fifth cranial nerve. Clinical guidelines recommend carbamazepine (only US Food and Drug Administration-approved drug for TN) and oxcarbazepine as first-line therapies. We utilized the US Truven Health MarketScan ® database to examine treatment patterns among patients with TN. Methods: Included patients were aged ≥18 years, newly diagnosed with TN (≥2 TN diagnoses ≥14 days apart; no diagnosis in the prior year), continuously enrolled 1 year preindex, with ≥3 years' follow-up post-index. We assessed utilization of selected pharmacotherapies (carbamazepine, oxcarbazepine, pregabalin, gabapentin, baclofen, duloxetine, topiramate), surgery (posterior fossa, radiosurgery), and injections (peripheral anesthetic injections, Gasserian ganglion procedures) for TN. Results: 3685 patients were included (2425 commercial, 1260 Medicare; 71.8% female; mean[SD] age, 59[15] years). Overall, 72.5% of patients received at least 1 studied medication, most commonly carbamazepine (51.7%) or gabapentin (48.6%). Sixty-five percent of pharmacologically treated patients had ≥2 treatment episodes; 41.6% had ≥3 (defined by a change in pharmacotherapy [monotherapy/combination] regimen). Overall, 12.3% had surgery and 7.3% injections; 42.9% received opioids for TN. Conclusions: In the 3 years after diagnosis, patients with TN in the United States receive a variety of pharmacological treatments, including opioids, despite carbamazepine being the only approved medication. A notable proportion utilize surgeries/injections. A high proportion of pharmacologically treated patients receive multiple treatment episodes, suggesting frequent therapy switching, perhaps due to suboptimal efficacy/tolerability. Our data suggest a high burden of illness associated with TN.

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Section: Introductionmentioning

confidence: 99%

Characterizing Treatment Utilization Patterns for Trigeminal Neuralgia in the United States

Zakrzewska

Lee

et al. 2018

The Clinical Journal of Pain

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“…Minor metabolites include M14 (formed by amide hydrolysis) and M16 (formed by oxidation of M14), which comprise 24% and < 1%, respectively, of the dose excreted in urine [16]. [8][9][10][11]. On day 12, participants received a single dose of the oral contraceptive (ethinyl estradiol 30 μg and levonorgestrel 150 μg, which are standard doses for contraceptive purposes [30]; Portia, Pandia Health, Sunnyvale, CA, USA; inactive tablets removed) and then self-administered the oral contraceptive (at the same dose as on day 12) once daily at approximately the same time on days 13 through 23.…”

Section: Methodsmentioning

confidence: 99%

“…Although patients with TN experience periods of remission, up to half have continuous or nearly continuous pain between attacks [4,5]. Treatment options for TN are limited; carbamazepine, a sodium channel blocker, is recommended as a first-line treatment for pain control in patients with TN [6,7], but has a problematic safety and tolerability profile that includes tiredness, sleepiness, concentration difficulties, dizziness, liver damage, and cognitive impairment [7][8][9][10][11][12]. Patients may require invasive surgical options.…”

Section: Introductionmentioning

confidence: 99%

Evaluation of the Potential Pharmacokinetic Interactions Between Vixotrigine and an Oral Contraceptive

Versavel¹,

Tidemann-Miller

Christmann

et al. 2020

Clin Drug Investig

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Background and Objective Vixotrigine is a voltage-and use-dependent sodium channel blocker in development for neuropathic pain management. This study evaluated the effect of coadministration of vixotrigine (metabolized primarily via uridine diphosphate-glucuronosyltransferases) and an oral contraceptive containing ethinyl estradiol (uridine diphosphateglucuronosyltransferase inducer) and levonorgestrel on the pharmacokinetics and safety of all three compounds. Methods In this phase I, open-label, fixed-sequence, multiple-dose study, 36 healthy women received oral vixotrigine 150 mg three times daily for 6 days and once on day 7. This was followed by a washout period, days 8-11. The oral contraceptive was administered alone on days 12-25 and with vixotrigine 150 mg three times daily on days 26-32. Serial blood samples were collected for pharmacokinetic analysis. Safety was assessed. Results The geometric least-squares mean ratios (90% confidence intervals) for the area under the concentration-time curve over 8 h and maximum concentration of vixotrigine co-administered with an oral contraceptive vs vixotrigine alone were 0.85 (0.82-0.89) and 0.91 (0.87-0.96), respectively. The geometric least-squares mean ratios (90% confidence interval) for area under the concentration-time curve over 24 h and maximum concentration of ethinyl estradiol with vixotrigine vs ethinyl estradiol alone were 0.94 (0.91-0.97) and 0.89 (0.84-0.94), respectively; the ratios for levonorgestrel with vixotrigine vs levonorgestrel alone were 1.06 (0.98-1.16) and 1.05 (0.98-1.13), respectively. No adverse events occurring with vixotrigine alone were deemed related to the study drug by the investigators. Conclusions Coadministration of vixotrigine and an oral contraceptive containing ethinyl estradiol and levonorgestrel had no clinically relevant effect on exposure of all three compounds. Trial Registration ClinicalTrials.gov registration number: NCT03324685 (registered 25 October, 2017).

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“…Открытые исследования, включавшие большие выборки пациентов, доказывают максимальную эффективность ВК при недифференцированных формах эпилепсии [17], а ЛТД и КБЗ -при фокальных [18]. В одном из последних исследований проанализированы эффективность и переносимость КБЗ (n=91), ВК (n=61), ЛТД (n=105) и ЛЕВ (n=72) у пациентов с эпилепсией в сравнении со здоровыми испытуемыми аналогичного возраста (n=51 [19].…”

Section: вк кбзunclassified

Use of valproate and carbamazepine in the therapy of epilepsy (guidelines for the practitioner)

Власов

2018

Nevrologiâ, nejropsihiatriâ, psihosomatika

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The paper gives comparative data on the efficacy and tolerability of valproic acid (VA, valproate) and carbamazepine (CBZ) for different types of epilepsy and seizures in different age and clinical groups. The results of studies suggest that despite a more than 50-year history of their effective use, the extended-release formulations of VA and CBZ remain the drugs of first choice for many types of epilepsy.CBZ is effective for focal epilepsy and isolated generalized tonic-clonic seizures. However, its use is substantially limited by properties, such as cytochrome P450 induction and autoinduction, high drug-drug interactions, the aggravation of absences, negative myoclonus, myoclonic and atonic seizures, an effect on the profile of steroid sex hormones, elevated concentrations of atherogenic lipids and cholesterol, myocardial conduction disorders, and hyponatremia.Due to the multiple mechanism of action, VA is prescribed for almost all types of epilepsy and seizures in patients of different ages. VA should not be used (if the clinical situation allows) in women of childbearing age, in some infantile epileptic encephalopathy, inherited metabolic diseases, and chromosomal abnormalities. Effectiveness against different types of seizures and epilepsy, good tolerability, minimal aggravation risk, high retention rate of monotherapy, the presence of a variety of dosage forms, and favorable pharmacokinetic and pharmacodynamic profiles still make VA essential in many clinical situations.

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Efficacy and tolerability of anti-epileptic drugs-an internet study

Cited by 11 publications

References 24 publications

Characterizing Treatment Utilization Patterns for Trigeminal Neuralgia in the United States

Characterizing Treatment Utilization Patterns for Trigeminal Neuralgia in the United States

Evaluation of the Potential Pharmacokinetic Interactions Between Vixotrigine and an Oral Contraceptive

Use of valproate and carbamazepine in the therapy of epilepsy (guidelines for the practitioner)

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