Safe Treatment of Seizures in the Setting of HIV/AIDS

Siddiqi, Omar K.; Birbeck, Gretchen L.

doi:10.1007/s11940-013-0237-6

Cited by 37 publications

(46 citation statements)

References 68 publications

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“…Coadministration of this or other enzyme-inducing AEDs and antiretroviral drugs can possibly result in virologic failure, breakthrough seizures, or AED or antiviral toxicity. 16 The teratogenic risk of PB in pregnancy may be higher than that of some other AEDs. 3 But for the moment, LMICs are often presented with either having a treatment with PB or having no treatment at all.…”

Section: Potential Cons Of Pbmentioning

confidence: 99%

Undue regulatory control on phenobarbital—an important yet overlooked reason for the epilepsy treatment gap

et al. 2015

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International audienceEpilepsy is a major chronic noncommunicable neurologic disorder. Although a simple, safe, efficacious, and low-cost treatment has been available for nearly 100 years, the treatment gap remains disturbingly high in many low- and middle-income countries (LMICs).[1] Treatment gap is generally defined as a “difference between the number of people with active epilepsy and the number being appropriately treated.” There are many reasons for this treatment gap; one important reason is an overly restrictive regulation on barbiturates such as phenobarbital (PB). These restrictive regulations deserve a wider and open discussion, even though epileptologists and others are intensely engaged on reducing the epilepsy treatment gap. With this article, we provide our viewpoint with an aim of raising an extremely important issue: undue regulatory restriction on phenobarbital, an essential lifesaving antiepileptic drug (AED)

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Section: Potential Cons Of Pbmentioning

confidence: 99%

Undue regulatory control on phenobarbital—an important yet overlooked reason for the epilepsy treatment gap

et al. 2015

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“…Conversely, certain ARVs, such as lopinavir, ritonavir, efavirenz, nevirapine, and maraviroc, may reduce serum levels of AEDs (Okulicz et al 2011). Lacosamide, gabapentin, and pregabalin are recommended AEDs in patients with focal epilepsy and/or those failing levetiracetam (Siddiqi and Birbeck 2013). …”

Section: Discussionmentioning

confidence: 99%

Predictors and characteristics of seizures in survivors of progressive multifocal leukoencephalopathy

et al. 2015

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This study aims to determine the risk factors for epileptogenesis and characteristics of seizures in patients with progressive multifocal leukoencephalopathy (PML) who survive more than 1 year from onset of neurological symptoms (PML survivors). We reviewed clinical data including seizure history and MR imaging studies from PML survivors evaluated at our institution between 1997 and 2014. PML progressors who passed away within 1 year and patients with a history of seizures prior to PML diagnosis were excluded from the analysis. Of 64 PML survivors, 28 (44 %) developed seizures. The median time from the onset of PML symptoms to the first seizure was 5.4 months (range 0–159) and 64 % of patients with seizures had them within the first year. The presence of juxtacortical PML lesions was associated with a relative risk of seizures of 3.5 (p<0.02; 95 % confidence interval (CI) 1.3– 9.4) in multivariate analyses. Of all seizure types, 86 % were focal and 60 % most likely originated from the frontal lobes. Among seizure patients, 89 % required treatment, including one (54 %), two (25 %), or three (10.5 %) antiepileptic drugs. Seizures are a frequent complication in PML and can develop throughout the entire course of the disease. However, late onset seizures did not signify PML relapse. Seizures may require treatment with multiple antiepileptic medications and are a significant co-morbidity in PML.

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“…Due to its broad spectrum, favorable side effect profile, and lack of drug-drug interactions, many experts recommend levetiracetam in combination with NNRTI-and PI-based ARV regimens [56].…”

Section: Anticonvulsant Medicationsmentioning

confidence: 99%

A Review of the Toxicity of HIV Medications II: Interactions with Drugs and Complementary and Alternative Medicine Products

et al. 2015

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For many patients today, HIV has become a chronic disease. For those patients who have access to and adhere to lifelong antiretroviral (ARV) therapy, the potential for drugdrug interactions has become a real and life-threatening concern. It is known that most ARV drug interactions occur through the cytochrome P450 (CYP) pathway. Medications for comorbid medical conditions, holistic supplements, and illicit drugs can be affected by CYP inhibitors and inducers and have the potential to cause harm and toxicity. Protease inhibitors (PIs) tend to inhibit CYP3A4, while most nonnucleoside reverse transcriptase inhibitors (NNRTIs) tend to induce the enzyme. As such, failure to adjust the dose of coadministered medications, such as statins and steroids, may lead to serious complications including rhabdomyolysis and hypercortisolism, respectively. Similarly, gastric acid blockers can decrease several ARV absorption, and warfarin doses may need to be adjusted to maintain therapeutic concentrations. Illicit drugs such as methylenedioxymethamphetamine (MDMA, "ecstasy") in combination with PIs lead to increased toxicity, while the concomitant administration of sedative drugs such as midazolam and alprazolam in patients taking PIs can result in prolonged sedation, delayed recovery, and increased length of stay. Even supplements like St. John's Wort can alter PI concentrations. In theory, any drug that is metabolized by CYP has potential for a pharmacokinetic drug-drug interaction with all PIs, cobicistat, and most NNRTIs. When adding a new medication to an ARV regimen, use of a drug-drug interaction software and/or consultation with a clinical pharmacist/pharmacologist or HIV specialist is recommended.

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Safe Treatment of Seizures in the Setting of HIV/AIDS

Cited by 37 publications

References 68 publications

Undue regulatory control on phenobarbital—an important yet overlooked reason for the epilepsy treatment gap

Undue regulatory control on phenobarbital—an important yet overlooked reason for the epilepsy treatment gap

Predictors and characteristics of seizures in survivors of progressive multifocal leukoencephalopathy

A Review of the Toxicity of HIV Medications II: Interactions with Drugs and Complementary and Alternative Medicine Products

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