Use and costs of concomitant medicines in epileptic patients in Poland: A 12-month prospective multicentre study

Majkowska-Zwolińska, Beata; Jędrzejczak, Joanna; Majkowski, J

doi:10.1016/j.seizure.2011.06.015

Cited by 8 publications

(6 citation statements)

References 17 publications

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“…antidepressant, or antipsychotic [15]. Our study builds upon this prior work, and other work examining prevalence of concomitant medications taken alongside ASMs [14], because our study captured polypharmacy as more broadly defined in the medical literature, and identified particular dangerous medication combinations and drug-disease interactions that were not described in prior studies. Of course, many patients have legitimate indications for multiple CNS-acting medications, and in each situation, the neuropsychiatric benefits must be weighed against additive risk.…”

Section: Discussionmentioning

confidence: 99%

“…While patients with epilepsy likely experience a high burden of polypharmacy, the extent of the problem is poorly understood. Only limited data exist describing the frequency and composition of polypharmacy and central nervous system (CNS)-acting medications taken by patients with epilepsy beyond simply antiseizure medications (ASMs) [12][13][14][15]. However, certain knowledge gaps exist.…”

Section: Introductionmentioning

confidence: 99%

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Polypharmacy in patients with epilepsy: A nationally representative cross-sectional study

Terman

Aubert

Hill

et al. 2020

Epilepsy & Behavior

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Objective: The objective of the study was to characterize the prevalence of polypharmacy and central nervous system (CNS)-acting medications in patients with epilepsy, and particular types of medications. Methods: This was a retrospective cross-sectional study using data from the nationally representative National Health and Nutrition Examination Survey (NHANES). We included patients who reported taking at least one prescription medication in order to treat seizures or epilepsy during NHANES survey years 2013–2016. We assessed the number and types of drugs and predictors of total number of medications using a negative binomial regression. We then assessed prevalence of polypharmacy (≥5 medications), CNS polypharmacy (≥3 CNS-acting medications) and additional CNS-acting medications, and drugs that lower the seizure threshold (i.e., bupropion and tramadol), and extrapolated prevalence to estimated affected US population. Results: The NHANES contained 20,146 participants, of whom 135 reported taking ≥1 antiseizure medication (ASM) for seizures or epilepsy representing 2,399,520 US citizens using NHANES's sampling frame. Patients reported taking a mean 5.3 (95% confidence interval (CI): 4.3–6.3) prescription medications. Adjusting for race, sex, and uninsurance, both age and number of chronic conditions predicted increased number of medications (incident rate ratio (IRR) per decade: 1.16, 95% CI: 1.04–1.28; IRR per chronic condition: 1.19, 95% CI: 1.11–1.27). Polypharmacy was reported by 47% (95% CI: 38%–57%) of patients, CNS polypharmacy by 34% (23%–47%), benzodiazepine use by 21% (14%–30%), opioid use by 16% (11%–24%), benzodiazepine plus opioid use by 6% (3%–14%), and 6% (2%–15%) reported a drug that lowers the seizure threshold. Twelve percent (7%–20%) took an opioid with either a benzodiazepine or gabapentinoid. Conclusions: Polypharmacy is common in patients with epilepsy. Patients taking ASMs frequently reported also taking other CNS-acting medications (i.e., opioids, benzodiazepines, seizure threshold-lowering medications), and medication combinations with black box warnings. Central nervous system polypharmacy poses health risks. Future research is needed to explore drivers of polypharmacy and strategies to help mitigate potentially harmful prescription use in this high-risk population.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Polypharmacy in patients with epilepsy: A nationally representative cross-sectional study

Terman

Aubert

Hill

et al. 2020

Epilepsy & Behavior

View full text Add to dashboard Cite

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“…Majkowska-Zwolińska et al [19] analyzed the use and cost of concomitant medications in a similarly large group of epileptic patients in Poland (n = 772; mean age, 27.4 years). While the most common comedication classes in their study (drugs for nervous system and for cardiovascular disorders) were also most commonly used in our cohort of patients, the direct comparison is difficult due to different methodological approach.…”

Section: Tablementioning

confidence: 99%

Co-medication and potential drug interactions among patients with epilepsy

Bosak

Słowik

Iwańska

et al. 2019

Seizure

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This study aimed to analyze the extent of co-medication and to assess potential interactions between antiepileptic drugs (AEDs) and other drugs among patients with epilepsy. Methods: We studied 663 consecutive patients with epilepsy seen in tertiary outpatient clinic. Data on epilepsy and current treatment with AED(s) were collected from structured interview and medical records. Other medications used regularly were classified according to the Anatomical Therapeutic Chemical classification system. Possible drug interactions between AEDs and other drugs were analyzed with the use of IBM Micromedex® database. Results: Studied sample included 395 women; 54.5% of subjects were on monotherapy. Enzyme-inducing AED(s) were used by 127 patients (19.2%). Among 265 patients who used medications other than AEDs (40.0% of all subjects), potential major and moderate interactions between AEDs and other drugs were found in 80 patients (30.1%). Most prevalent major interactions included: ethinylestradiol/estradiol-valproate/oxcarbazepine/ carbamazepine, sertraline-carbamazepine, and simvastatin-carbamazepine. A total number of currently used medications (OR = 1.26 [1.07-1.48] per one additional medication; p = 0.005) and the use of enzyme-inducing AEDs (OR = 2.78 [1.51-5.12]; p < 0.001) were independent predictors of interactions between AEDs and other drugs. Conclusions: Co-medication is common (40%) among patients with epilepsy. Potential major or moderate interactions between AED(s) and other drugs are noted in 30.1% of patients exposed to at least one medication other than AED (12.1% of the entire cohort). The risk of potential interactions increases with the number of medications used chronically and with the use of hepatic enzyme-inducing AEDs.

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“…This is particularly important as the comorbidity of other somatic and mental diseases in patients with epilepsy is more frequent than in the general population (Tellez-Zenteno et al, 2005;Majkowska-Zwolińska et al, 2008). This results in comedication and potential interactions between different drugs (Patsalos et al, 2002, Majkowska-Zwolińska et al, 2011.…”

Section: Discussion and Recommendationsmentioning

confidence: 99%

Recommendations of the Polish Society of Epileptology for the treatment of epileptic seizure in adult patients in Poland: an update

Jędrzejczak

Majkowska-Zwolińska

Ryglewicz

et al. 2019

Journal of Epileptology

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… Constantly expand my medical knowledge and bring to the knowledge of the medical world all that I can invent and improve. (Excerpt of the oath of Polish medical schools' graduates, derived from the Hippocrates, 5 th century BC). SummaRy Introduction. In 2014, a group of Polish epilepsy experts published recommendations for antiepileptic drug (AED) use in adults with epilepsy. Selection of AEDs was based on the registration and reimbursement status in Poland, evidence of efficacy, and the personal views and experiences of the epilepsy practitioners. method. In 2018 previous recommendations were reviewed by the ad hoc group consisting of the authors of the original paper and additional epilepsy experts. As a result of joint work and reaching a consensus, an updated version of these recommendations has been prepared. Discussion and recommendations. This update focuses on the epileptic seizure type treatment recommendations for initial monotherapy and add-on treatment in adult patients. Some new relevant aspects of treatment with AEDs are addressed, including information on the safety of valproic acid (VPA) in women of childbearing potential.

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Use and costs of concomitant medicines in epileptic patients in Poland: A 12-month prospective multicentre study

Abstract: The results confirm that patients with epilepsy, regardless of age, take commonly CMs. Physicians should be more aware of this practice.

Cited by 8 publications

References 17 publications

Polypharmacy in patients with epilepsy: A nationally representative cross-sectional study

Polypharmacy in patients with epilepsy: A nationally representative cross-sectional study

Co-medication and potential drug interactions among patients with epilepsy

Recommendations of the Polish Society of Epileptology for the treatment of epileptic seizure in adult patients in Poland: an update

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