Antiepileptic Drugs in the Treatment of Neuropathic Pain: Drug‐to‐drug Interaction in Elderly People

Abstract

the total dose of Dysport administered per patient was 500 MU per 2.5 mL of saline. The appropriate conversion factor of Botox:Dysport varies from 1:3 to 1:6 MU in studies using these agents in dystonia. 7 The different potency of these agents in treating sialorrhea in PD is unknown. Therefore, given a conversion factor of 1:6 MU, our dosage of 80 MU appeared to be similar to that used in the report by Nó brega et al. 2 Moreover, our study showed that BTX-A decreased the volume and the frequency of sialorrhea, as demonstrated in other studies, 5,8 whereas in the study by Nó brega et al., only the volume was reduced. We agree with Nó brega et al. 9 on the possibility that in patients with PD, sialorrhea may be secondary to swallowing disorders, although in our study, the effect of the toxin on drooling frequency was less relevant than that on the volume, and it may be linked to the severity of PD in our patients, which was not specified in the report by Nó brega et al. 2 Finally, another important issue to discuss may be the duration of effectiveness of treatment with BTX-A in Parkinsonian-related sialorrhea. Some patients treated with BTX-A develop secondary immune resistance or do not obtain effective control of symptoms. Therefore, given the efficacy and safety of botulinum toxin type B (BTX-B) also in the management of sialorrhea in PD, 8 we propose switching therapy from BTX-A to BTX-B in patients who are nonresponders or poor responders to BTX-A. 10

Remitting-Relapsing Carbamazepine Overdosage Mimicking Vertebrobasilar Transient Ischemic Attacks

“…Symptoms and laboratory findings indicative of CBZ toxicity occurred in our patient about 5-7 hours after the intake of the morning dose, with a time interval corresponding to its peak plasma concentration (Lordos et al, 2009); therefore, this issue strongly suggests that the transient CBZ overdosage would result from its interaction with other drugs taken in the morning as well.…”

“…Given to its pharmacological kinetic properties (Lordos et al, 2009), the chance of occurrence of CBZ-related adverse effects is increased in patients who need multiple drug use as a consequence of drug interactions (Bertilsson, 1978;Diaz et al, 2008;Hosia-Randell et al, 2008).…”

Drug interactions in palliative care – it’s more than cytochrome P450

“…Carbamazepine is well known as a potent CYP-inducing and highly interacting drug 53 and also a potent cause of life-threatening or symptomatic hyponatremia. 4 Clonazepam is a potent enzyme inductor and long-term administration usually leads to decreasing effectiveness due to receptor down regulation. 54,55 Concerning antiepileptic therapy, no drug was used frequently enough (<10 patients) in our patients to provide sufficient data.…”

“…antibiotics, neuroleptics, antiviral drugs) or populations (e.g. elderly, psychiatric or cardiologic patients 4 ). Patients receiving palliative care (PC) form a unique clinical population and literature relating to DDIs in PC is extremely scarce.…”