Highlights
- •2/3 of 827 stroke subjects received enzyme-inducing antiepileptic drugs (AEDs).
- •Phenytoin was the most commonly used AED.
- •Potential interactions between AEDs and other prescribed medications were found.
- •AEDs prescription in stroke patients should be changed, to account for interactions.
Abstract
Background
Stroke prevention is an important socio-economic aim. Epilepsy and antiepileptic drugs
(AEDs), roughly divided into enzyme-inducers and non-enzyme-inducers, have been associated
with increased risk of stroke.
Methods
A retrospective review of patients admitted with a diagnosis of anytime stroke and
taking at least one AED was performed. A subgroup of subjects admitted for acute strokes
was separately studied. Potential interactions between AEDs and other consumed medications
were identified using MicroMedex and Lexi-Interact.
Results
The study included 827 patients, 59% of them using 5–10 medications. Two thirds of
the patients received at least one enzyme-inducer AED, with phenytoin being the most
commonly used AED (38% of the patients). Among the subgroup of 82 patients admitted
for stroke, 61% were prescribed AEDs after the stroke. More patients had large vessel
and embolic strokes among these than among the patients that had strokes while on
AEDs. Statins, antiplatelet drugs, antidiabetics and calcium channel blockers (CCBs)
were the most frequently used non-AED drugs, by 56, 55, 30 and 28%, respectively.
The most common combinations between AEDs and non-AED medications bearing risk for
potential major interactions were those of AEDs with statins, warfarin, calcium channel
blockers and anti-depressants.
Conclusions
A change in the AEDs prescription practice in stroke patients should be implemented,
to avoid interactions with major groups of other medications prescribed to these patients.
Keywords
Abbreviations:
AED (antiepileptic drug), EIAED (enzyme-inducer AED), NEIAED (non-EIAED), CCB (calcium-channel blocker), NOAC (non-vitamin K antagonist oral anticoagulant), DDI (drug-drug interaction)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: September 22, 2018
Accepted:
September 21,
2018
Received in revised form:
August 11,
2018
Received:
February 17,
2018
Identification
Copyright
© 2018 Elsevier B.V. All rights reserved.
