Utilization of Antiepileptic Medicines in Swedish Children and Adolescents with Different Diagnoses

Lind, Linnéa Karlsson; Wide, Katarina; Wettermark, Björn; Euler, Mia von

doi:10.1111/bcpt.12981

Cited by 7 publications

(12 citation statements)

References 42 publications

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“…This correlates with the other study that reviewed clinical records, the UK study of the General Practice Research Database, which found 75% of prescriptions for ASMs in children were for epilepsy 20 . Studies of cohorts identified from local pharmaceutical databases in Europe and North America reported that 46% to 90% of ASMs were prescribed for a seizure indication 4,16–22 . Although this marked variation may reflect local paediatric practice of ASM use, it is more likely to reflect the methodology used to determine the indication for prescription.…”

Section: Discussionsupporting

confidence: 75%

“…Although this marked variation may reflect local paediatric practice of ASM use, it is more likely to reflect the methodology used to determine the indication for prescription. Studies used diagnostic coding data, sometimes combined with concomitant prescribing data for each patient, to determine the indication for ASM prescription 4,16–19,21,22 . These strategies were only able to provide estimates of non‐seizure indications and often had large numbers of children in which the indication could not be determined, up to 49% in one study 16 …”

Section: Discussionmentioning

confidence: 99%

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Indications and prescribing patterns of antiseizure medications in children in New Zealand

Ali

Stanley

Davis

et al. 2023

Develop Med Child Neuro

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Aim To determine indications and prescribing patterns for antiseizure medications (ASMs) in children by age, sex, and socioeconomic status. Method This retrospective study searched the New Zealand database of ASM prescriptions dispensed to individuals aged 18 years or under during 2015 in three regions of New Zealand (48% paediatric population). Medical records were reviewed by a paediatric neurologist for indication. ASMs were grouped into old or new (1993 onwards). Results In total, 2594 children (0 to 18 years, mean age 11 years 2 months, median 12 years; 51% male) were dispensed 3557 ASMs for seizures (76%), pain (6%), headache (5%), mental health (3%), and movement disorders (2%). After 10 years of age, lamotrigine was more likely and valproate less likely to be prescribed in females than males. No sex difference was observed for valproate prescriptions for non‐seizure indications. Topiramate prescriptions increased in adolescent females. Prescriptions for non‐seizure indications increased from 7% in children aged 6 years or under to 31% in 16‐ to 18‐year‐olds. The proportion of children receiving a new ASM compared to an old ASM was greater in children from higher than lower socioeconomic areas. Interpretation Our results highlight a need for focused ASM teratogenicity messaging to clinicians prescribing ASMs for non‐seizure indications. In addition, to improve equity of epilepsy care, it is critical for health policies to consider socioeconomic factors that impact on ASM prescribing.

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Section: Discussionsupporting

confidence: 75%

Section: Discussionmentioning

confidence: 99%

Indications and prescribing patterns of antiseizure medications in children in New Zealand

Ali

Stanley

Davis

et al. 2023

Develop Med Child Neuro

View full text Add to dashboard Cite

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“…AUC 0-24 h and C AV,SS were estimated as function of CL/F and daily dose of levetiracetam, as described previously in Equations ( 1) and (2). The best correlation between dose, AUC 0-24 h and C AV,SS was observed when dose was fitted by weight (r 2 = 0.433; p < 0.001).…”

Section: Resultsmentioning

confidence: 99%

“…Due to its efficacy and safety profiles, levetiracetam is a second-generation antiepileptic drug currently arising as the most frequently prescribed for the prophylaxis and treatment of focal and generalized epilepsy [ 1 , 2 ]. Although several therapeutic targets have been ascribed for levetiracetam, it is clear that it modulates the synaptic vesicle glycoprotein 2A, with consequent reduction of the release of synaptic excitatory neurotransmitters, restoring the balance between inhibitory and excitatory synaptic activities [ 3 , 4 , 5 , 6 , 7 ].…”

Section: Introductionmentioning

confidence: 99%

Pharmacokinetic Monitoring of Levetiracetam in Portuguese Refractory Epileptic Patients: Effect of Gender, Weight and Concomitant Therapy

et al. 2020

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Levetiracetam is a second-generation antiepileptic drug, widely used in the treatment of focal and generalized epilepsy due to its pharmacokinetic and safety profiles. Its pharmacokinetic monitoring is ascribed as useful to personalize its dosing regimen. The aim of the present study was to describe, for the first time, the pharmacokinetics of levetiracetam in Portuguese refractory epileptic patients. Therefore, a retrospective study was carried out on 65 Portuguese refractory epileptic patients (pharmacokinetic study: 48; validation study: 17) admitted to the Refractory Epilepsy Centre of the Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal. The pharmacokinetic parameters of levetiracetam were estimated by applying a one-compartment model with first-order absorption and elimination analysis. Male patients showed higher distribution volume (Vd/F) and oral clearance (CL/F) than female patients (median Vd/F: 52.40 L in males and 38.60 L in females, p = 0.011; median CL/F: 4.71 L/h in males and 3.91 L/h in females, p = 0.028). Higher values of Vd/F (p = 0.026) and CL/F (p = 0.003) were also found in overweight patients relative to normal weight and obese patients. Carbamazepine was the co-administered antiepileptic drug that mostly affected the pharmacokinetics of levetiracetam, increasing both Vd/F (61.30 L with carbamazepine and 39.10 L without carbamazepine, p = 0.007) and CL/F (6.71 L/h with carbamazepine and 3.91 L/h without carbamazepine, p < 0.001). The pharmacokinetics of levetiracetam was affected by gender, body mass index, and co-administration of carbamazepine. This study highlights the impact of several factors on the CL/ and Vd/F of levetiracetam when administered to refractory epileptic patients. The importance of its pharmacokinetic monitoring in clinical pharmacy stands out, thereby enabling the optimization of antiepileptic drug therapy.

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“…Levetiracetam has been one of the most frequently administered antiseizure drugs in the last decade, mainly due to its efficacy and safety profiles on the treatment of patients with focal and generalized epilepsy [ 16 , 17 , 18 , 19 ]. This second-generation antiseizure drug acts through the modulation of excitatory neurotransmission by binding to synaptic vesicle glycoprotein 2A.…”

Section: Introductionmentioning

confidence: 99%

Clinical Application of Pharmacokinetics to Appraise Adherence to Levetiracetam in Portuguese Epileptic Patients

et al. 2022

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Adherence to antiseizure drug treatment determines its effectiveness and safety, and consequently affects patients’ quality of life. Herein, we assessed adherence to levetiracetam in Portuguese patients with refractory epilepsy (n = 115), with resort to a pharmacokinetic drug monitoring approach. The pharmacokinetic parameters of levetiracetam in each patient were determined in steady-state while admitted to the hospital. Then, adherence was assessed by comparing the plasma concentration of the drug observed on the first day of hospitalization with the predicted plasma concentration, considering previously determined pharmacokinetic parameters. The rate of adherence was assessed according to gender, age, diagnosis, and antiseizure drug regimen. Among 115 enrolled patients, 49 (42.6%) were identified as non-adherent, 30 (26.1%) classified as under-consumers, and 19 (16.5%) as over-consumers. A relationship between adherence, daily dose and plasma concentrations was herein reported for the first time. Adherent patients received higher daily doses of levetiracetam [2500 (2000–3000) mg] than non-adherent over-consumers [1500 (1000–2000) mg] and non-adherent under-consumers [2000 (1500–3000) mg]. Higher average steady-state plasma concentrations of levetiracetam were found in non-adherent under-consumers [27.28 (15.33–36.36) mg/L], followed by adherent patients [22.05 (16.62–29.81) mg/L] and non-adherent over-consumers [17.50 (10.69–24.37) mg/L]. This study demonstrates that adherence (or lack thereof) influences the plasma concentrations of levetiracetam in steady-state and its pharmacological effects. Moreover, it emphasizes the importance of educating patients to encourage adherence to therapy. Otherwise, the risk of developing toxic and subtherapeutic concentrations is undeniable, compromising the therapeutic effect and safety of treatment.

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Utilization of Antiepileptic Medicines in Swedish Children and Adolescents with Different Diagnoses

Cited by 7 publications

References 42 publications

Indications and prescribing patterns of antiseizure medications in children in New Zealand

Indications and prescribing patterns of antiseizure medications in children in New Zealand

Pharmacokinetic Monitoring of Levetiracetam in Portuguese Refractory Epileptic Patients: Effect of Gender, Weight and Concomitant Therapy

Clinical Application of Pharmacokinetics to Appraise Adherence to Levetiracetam in Portuguese Epileptic Patients

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