Safety and efficacy of anticonvulsants in elderly patients with psychiatric disorders: oxcarbazepine, topiramate and gabapentin

Sommer, Barbara R.; Fenn, Howard H.; Ketter, Terence A.

doi:10.1517/14740338.6.2.133

Cited by 20 publications

(8 citation statements)

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“…Of the 24 publications that met our criteria for inclusion , 15 contained original data (case reports or case series) , whereas nine were solely reviews of the literature with no original data . One of the 15 papers that contained an original report additionally included a narrative review.…”

Section: Resultsmentioning

confidence: 99%

Gabapentin and pregabalin to treat aggressivity in dementia: a systematic review and illustrative case report

Supasitthumrong

Bolea-Alamañac

Asmer

et al. 2019

Brit J Clinical Pharma

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AIMSThe prevalence of dementia is rising as life expectancy increases globally. Behavioural and psychological symptoms of dementia (BPSD), including agitation and aggression, are common, presenting a challenge to clinicians and caregivers. METHODSFollowing PRISMA guidelines, we systematically reviewed evidence for gabapentin and pregabalin against BPSD symptoms of agitation or aggression in any dementia, using six databases (Pubmed, CINHL, PsychINFO, HealthStar, Embase, and Web of Science). Complementing this formal systematic review, an illustrative case of a patient with BPSD in mixed Alzheimer's/vascular dementia, who appeared to derive benefits in terms of symptom control and functioning from the introduction of gabapentin titrated up to 3600 mg day À1 alongside other interventions, is presented. RESULTSTwenty-four relevant articles were identified in the systematic review. There were no randomized trials. Fifteen papers were original case series/case reports of patients treated with these compounds, encompassing 87 patients given gabapentin and six given pregabalin. In 12 of 15 papers, drug treatment was effective in the majority of cases. The remaining nine papers were solely reviews, of which two were described as systematic but predated PRISMA guidelines. Preliminary low-grade evidence based on case series and case reviews suggests possible benefit of gabapentin and pregabalin in patients with BPSD in Alzheimer's disease. These benefits cannot be confirmed until well-powered randomized controlled trials are undertaken. Evidence in frontotemporal dementia is lacking. CONCLUSIONGabapentin and pregabalin could be considered for BPSD when medications having stronger evidence bases (risperidone, other antipsychotics, carbamazepine and citalopram) have been ineffective or present unacceptable risks of adverse outcomes.British Journal of Clinical Pharmacology Br J Clin Pharmacol (2019) 85 690-703 690 Gabapentin and pregabalin in dementia treatment Br J Clin Pharmacol (2019) 85 690-703 691 Nomenclature of targets and ligandsKey protein targets and ligands in this article are hyperlinked to corresponding entries in the http://www. guidetopharmacology.org, the common portal for data from the IUPHAR/BPS Guide to PHARMACOLOGY [90], and are permanently archived in the Concise Guide to PHARMA-COLOGY 2017/18 [91].

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Section: Resultsmentioning

confidence: 99%

Gabapentin and pregabalin to treat aggressivity in dementia: a systematic review and illustrative case report

Supasitthumrong

Bolea-Alamañac

Asmer

et al. 2019

Brit J Clinical Pharma

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“…Gabapentin and lamotrigine are used clinically, and are better tolerated by patients. There are numerous case reports, case series, and open‐label studies demonstrating that gabapentin and lamotrigine are well‐tolerated and can improve agitation,29–32 but large‐scale randomized, placebo‐controlled trials are lacking.…”

Section: Neuropsychiatric/behavioral Disturbancesmentioning

confidence: 99%

Alzheimer's Disease: Diagnosis and Treatment Across the Spectrum of Disease Severity

Neugroschl

Wang

2011

Mount Sinai J Medicine

102

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Alzheimer’s disease exists along a spectrum, from early memory changes to functional dependence and death. Using a case illustration, we review the evaluation and diagnosis of mild cognitive impairment and the diagnosis and management of Alzheimer’s disease at each stage, including the management of both cognitive and behavioral/psychiatric aspects of the disease and end-stage and end-of-life care.

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“…TOP has a good tolerability profile but a possible cognitive impairment has to be taken into account when applied to demented patients [60]. …”

Section: Topiramatementioning

confidence: 99%

Anticonvulsants in the treatment of aggression in the demented elderly: an update

Amann

Pantel

Grunze

et al. 2009

Clinical Practice and Epidemiology in Mental Health

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IntroductionComplex psychopathological and behavioral symptoms, such as delusions and aggression against care providers, are often the primary cause of acute hospital admissions of elderly patients to emergency units and psychiatric departments. This issue resembles an interdisciplinary clinically highly relevant diagnostic and therapeutic challenge across many medical subjects and general practice. At least 50% of the dramatically growing number of patients with dementia exerts aggressive and agitated symptoms during the course of clinical progression, particularly at moderate clinical severity.MethodsCommonly used rating scales for agitation and aggression are reviewed and discussed. Furthermore, we focus in this article on benefits and limitations of all available data of anticonvulsants published in this specific indication, such as valproate, carbamazepine, oxcarbazepine, lamotrigine, gabapentin and topiramate.ResultsTo date, most positive and robust data are available for carbamazepine, however, pharmacokinetic interactions with secondary enzyme induction limit its use. Controlled data of valproate do not seem to support the use in this population. For oxcarbazepine only one controlled but negative trial is available. Positive small series and case reports have been reported for lamotrigine, gabapentin and topiramate.ConclusionSo far, data of anticonvulsants in demented patients with behavioral disturbances are not convincing. Controlled clinical trials using specific, valid and psychometrically sound instruments of newer anticonvulsants with a better tolerability profile are mandatory to verify whether they can contribute as treatment option in this indication.

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Safety and efficacy of anticonvulsants in elderly patients with psychiatric disorders: oxcarbazepine, topiramate and gabapentin

Cited by 20 publications

References 106 publications

Gabapentin and pregabalin to treat aggressivity in dementia: a systematic review and illustrative case report

Gabapentin and pregabalin to treat aggressivity in dementia: a systematic review and illustrative case report

Alzheimer's Disease: Diagnosis and Treatment Across the Spectrum of Disease Severity

Anticonvulsants in the treatment of aggression in the demented elderly: an update

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