SUMMARY Purpose To describe the clinical outcomes of a compulsory switch from branded to generic levetiracetam (LEV) among people with epilepsy (PWE) in an outpatient setting. Methods We conducted a retrospective chart review of 760 unduplicated consecutive adult patients attending a tertiary care epilepsy clinic at Ben Taub General Hospital. On November 1, 2008 hospital policy required all patients receiving branded LEV to be automatically switched to generic LEV. We calculated the proportion of patients switching back to branded LEV and reasons for the switch back. Key Findings Of the 260 patients (34%) being prescribed LEV (generic and brand name) during the study period, 105 (42.9%) were switched back to brand name LEV by their treating physicians. Reasons for switch back included increase in seizure frequency (19.6% vs. 1.6%; p < 0.0001) and adverse effects (AEs) (3.3%). AEs included headache, fatigue, and aggression. Patient age was associated with switchback when controlling for gender, epilepsy classification, and treatment characteristics [relative risk (RR) 2.44; 95% confidence interval (CI) 2.09–2.84; p < 0.05)]. An increase in seizure frequency subsequent to generic substitution was associated with polytherapy compared to monotherapy (3.225; 1.512–6.880; p < 0.05). Significance A significant proportion of patients in our cohort on generic LEV required switch back to the branded drug. Careful monitoring is imperative because a compulsory switch from branded to generic LEV may lead to poor clinical outcomes, with risk of AEs and increased seizure frequency.
The numbers of hospitalizations, multiorgan complications, and deaths continued to rise during the H1N1 influenza pandemic. Although there are several reports of H1N1 influenza associated neurologic complications in all ages, there is no clear suggestion that the 2009 influenza A (H1N1) virus is associated with a disproportionate amount of neurologic illness beyond that observed with seasonal influenza. We describe the serious neurologic complications of children hospitalized with H1N1 influenza in Houston, Texas during the 2009 season. We retrospectively studied five hospitalized children with neurological complications who were polymerase chain reaction positive for the H1N1 virus. In these five children, two had stroke (ischemic and/or hemorrhagic), two had seizures, and three had encephalopathic features. Regarding the outcome, improvement in neurological function occurred in four and one child died. These five children with neurologic complications represented 21% of the children with H1N1 influenza admitted to the pediatric intensive care unit.
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