Utilisation and polypharmacy aspects of antiepileptic drugs in elderly versus younger patients with epilepsy: A pharmacoepidemiological study of CNS-active drugs in Norway, 2004-2015

Baftiu, Arton; Feet, Silje Andrea; Larsson, Pål G.; Burns, Margrete Larsen; Henning, Oliver; Sætre, Erik; Molden, Espen; Granås, Anne Gerd; Johannessen, Svein I.; Landmark, Cecilie Johannessen

doi:10.1016/j.eplepsyres.2017.11.001

Cited by 31 publications

(23 citation statements)

References 40 publications

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“…Some AEDs have been approved for indications other than epilepsy, such as neuropathic pain [22,102], and are also used for off-label treatment of neuropsychiatric symptoms of dementia [103,104]. However, a recent Cochrane Database System Review found valproate use to be ineffective for management of agitation in dementia and may lead to an increased risk of adverse effects [105].…”

Section: Prevalence and Indications Of Antiepilepticsmentioning

confidence: 99%

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Psychotropic Drug-Associated Pneumonia in Older Adults

2020

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The use of psychotropic drugs (antipsychotics, benzodiazepines and benzodiazepine-related drugs, and antidepressants) is common, with a prevalence estimates range of 19-29% among community dwelling older adults. These drugs are often prescribed for off-label use, including neuropsychiatric symptoms. The older adult population also has high rates of pneumonia and some of these cases may be associated with adverse drug events. In this narrative review, we summarize the findings from current observational studies on the association between psychotropic drug use and pneumonia in older adults. In addition to studies assessing the use of psychotropics, we included antiepileptic drugs, as they are also central nervous system-acting drugs, whose use is becoming more common in the aging population. The use of antipsychotics, benzodiazepine, and benzodiazepine-related drugs are associated with increased risk of pneumonia in older adults (≥ 65 years of age), and these findings are not limited to this age group. Minimal and conflicting evidence has been reported on the association between antidepressant drug use and pneumonia, but differences between study populations make it difficult to compare findings. Studies regarding antiepileptic drug use and risk of pneumonia in older persons are lacking, although an increased risk of pneumonia in antiepileptic drug users compared with non-users in persons with Alzheimer's disease has been reported. Tools such as the American Geriatric Society Beers Criteria and the STOPP/START criteria for potentially inappropriate medications aids prescribers to avoid these drugs in order to reduce the risk of adverse drug events. However, risk of pneumonia is not mentioned in the current criteria and more research on this topic is needed, especially in vulnerable populations, such as persons with dementia.

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Section: Prevalence and Indications Of Antiepilepticsmentioning

confidence: 99%

“…Thus, antidepressants and AEDs are commonly utilized among older adults. Some antidepressants and AEDs also have indications other than mental diseases or epilepsy, like neuropathic pain, a common ailment of the older adult population [22,23].…”

Section: Introductionmentioning

confidence: 99%

Psychotropic Drug-Associated Pneumonia in Older Adults

2020

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“…The use of GBP in Norway was shown to gradually increase from 2007 to 2015, 4,5 due to an increase in use in neuropathic pain. The use of GBP in Norway was shown to gradually increase from 2007 to 2015, 4,5 due to an increase in use in neuropathic pain.…”

Section: Use Of Gbp In Norwaymentioning

confidence: 99%

“…Data from the Norwegian prescription database show that the use of GBP increased by more than 30% from 2014 to 2017. The use of GBP in Norway was shown to gradually increase from 2007 to 2015, 4,5 due to an increase in use in neuropathic pain. 4 Increased use has also been demonstrated internationally, with a recent study from United Kingdom finding a large increase in the rate of patients newly treated with GBP from 2007 to 2017.…”

Section: Use Of Gbp In Norwaymentioning

confidence: 99%

Therapeutic drug monitoring of gabapentin in various indications

et al. 2019

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Objectives Gabapentin has been increasingly used in various indications in recent years. Despite variable pharmacokinetics, therapeutic drug monitoring (TDM) is scarcely described in other indications than epilepsy. The aim of the study was to investigate the use and pharmacokinetic variability of gabapentin in epilepsy and non‐epilepsy indications and to further evaluate the use of TDM in patients with restless legs syndrome (RLS). Materials & Methods Population‐based data from the Norwegian Prescription Database, retrospective TDM data from the section for Clinical Pharmacology, the National Center for Epilepsy, Norway, and prospective observational data on patients with RLS were used. Results The use of gabapentin increased by 30% from 2014 to 2017 (32 181 to 42 675 users). TDM data from 120 patients showed a 22‐fold pharmacokinetic variability in concentration/dose ratios, and this ratio was elevated in elderly patients (≥65 years). The majority of elderly used gabapentin for non‐epilepsy indications. In patients with RLS, intake in the evening/night only was common due to nocturnal symptoms, in contrast to regular dosing regimens in epilepsy. Thus, drug fasting concentrations do not reflect concentrations at the time of required therapeutic effect. TDM was still found useful in most patients to support dosage increase or evaluate adverse effects. Conclusion Due to extensive pharmacokinetic variability, TDM can benefit patients using gabapentin. Challenges with applying TDM in new indications such as RLS include different dosage regimens and consequently different interpretation of serum concentrations. Thus, TDM should be requested on clear clinical grounds and the service tailored according to the therapeutic indication.

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“…The major groupings of AEDs, can be defined as those which facilitate γ-aminobutyric acid transmission by various mechanisms; Those which block voltage-gated ion channels and thus reduce excitatory transmission; those whose mechanism of action is still open to debate. 4 Most AEDs, exert their antiepileptic effects via the Na + or the Ca 2+ channel or via GABAergic transmission. In chronic phase, the incidence of adverse effects with the new AEDs is low, but tocopheryl phosphate mixture and AEDs drugs that potentiate glutamatergic transmission, may elicit behavioral changes and cognition disorders.…”

Section: Introductionmentioning

confidence: 99%

Impact of antiepileptic drugs therapy on thyroid profile in epileptic patients of Punjab origin

Singh

Kaur

2019

Int J Basic Clin Pharmacol

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Background: Epilepsy requires lifelong therapy with antiepileptic drugs (AEDs) and having medical and psychological consequence. So, the present study was conducted to evaluate the role of different AEDs on thyroid profile in epileptic patients.Methods: 50 epileptic patients receiving AEDs for minimum 1 year were recruited as study group and 50 healthy subjects considered as control group. These subjects were recruited from general (rural or urban) community of Punjab. Fasting blood samples were drawn from patients and healthy subjects for the evaluation of triiodothyronine (T3), thyroxine (T4) and thyroid stimulating hormone (TSH) levels.Results: Significant increase in TSH levels were recorded in epileptic patients while no significant change was found in T3 and T4 epileptic patients treated with different AEDs with respect to healthy controls. Maximum increase in TSH was seen in phenytoin, treated epileptic patients and maximum fall in TSH was recorded in levetiracetam treated epileptic patients. Maximum increase in T3 and T4 levels was found in phenytoin while a maximum decrease was recorded T3 and T4 levels in carbamazepine treated epileptic patients in comparison to other drugs treated patients.Conclusions: Aforementioned observations suggested that epileptic patients treated with phenytoin, valproic acid, carbamazepine and levetiracetam for long time could cause initiation of subclinical hypothyroidism further could leads to overt hypothyroidism which in turn responsible for pathophysiology of various coronary heart disease. Routine screening of thyroid profile during chronic use of AEDs is recommended.

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Utilisation and polypharmacy aspects of antiepileptic drugs in elderly versus younger patients with epilepsy: A pharmacoepidemiological study of CNS-active drugs in Norway, 2004-2015

Cited by 31 publications

References 40 publications

Psychotropic Drug-Associated Pneumonia in Older Adults

Psychotropic Drug-Associated Pneumonia in Older Adults

Therapeutic drug monitoring of gabapentin in various indications

Impact of antiepileptic drugs therapy on thyroid profile in epileptic patients of Punjab origin

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