Advertisement

Treatment with antiepileptic drugs in patients with stroke. A change in clinical practice may be required

Published:September 22, 2018DOI:https://doi.org/10.1016/j.jns.2018.09.026

      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

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Journal of the Neurological Sciences
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Zelano J.
        Poststroke epilepsy: update and future directions.
        Ther. Adv. Neurol. Disord. 2016; 9: 424-435
        • Rogawski M.A.
        • Loscher W.
        The neurobiology of antiepileptic drugs for the treatment of nonepileptic conditions.
        Nat. Med. 2004; 10: 685-692
        • Renoux C.
        • Dell'Aniello S.
        • Saarela O.
        • Filion K.B.
        • Boivin J.F.
        Antiepileptic drugs and the risk of ischaemic stroke and myocardial infarction: a population-based cohort study.
        BMJ Open. 2015; 5e008365
        • Mintzer S.
        • Skidmore C.T.
        • Abidin C.J.
        • et al.
        Effects of antiepileptic drugs on lipids, homocysteine, and C-reactive protein.
        Ann. Neurol. 2009; 65: 448-456
        • Patsalos P.N.
        • Perucca E.
        Clinically important drug interactions in epilepsy: interactions between antiepileptic drugs and other drugs.
        Lancet Neurol. 2003; 2: 473-481
        • Huang Y.H.
        • Chi N.F.
        • Kuan Y.C.
        • et al.
        Efficacy of phenytoin, valproic acid, carbamazepine and new antiepileptic drugs on control of late-onset post-stroke epilepsy in Taiwan.
        Eur. J. Neurol. 2015; 22: 1459-1468
        • Belcastro V.
        • D'Egidio C.
        • Striano P.
        • Verrotti A.
        Metabolic and endocrine effects of valproic acid chronic treatment.
        Epilepsy Res. 2013; 107: 1-8
        • Leker R.R.
        • Khoury S.T.
        • Rafaeli G.
        • Shwartz R.
        • Eichel R.
        • Tanne D.
        Prior use of statins improves outcome in patients with intracerebral hemorrhage: prospective data from the National Acute Stroke Israeli Surveys (NASIS).
        Stroke. 2009; 40: 2581-2584
        • Jaspers Focks J.
        • Brouwer M.A.
        • Wojdyla D.M.
        • et al.
        Polypharmacy and effects of apixaban versus warfarin in patients with atrial fibrillation: post hoc analysis of the ARISTOTLE trial.
        BMJ. 2016; 353i2868
        • Piccini J.P.
        • Hellkamp A.S.
        • Washam J.B.
        • et al.
        Polypharmacy and the Efficacy and Safety of Rivaroxaban Versus Warfarin in the Prevention of Stroke in Patients With Nonvalvular Atrial Fibrillation.
        Circulation. 2016; 133: 352-360
        • Stollberger C.
        • Finsterer J.
        Interactions between non-vitamin K oral anticoagulants and antiepileptic drugs.
        Epilepsy Res. 2016; 126: 98-101
        • Berman E.
        • Marom E.
        • Ekstein D.
        • Blatt I.
        • Eyal S.
        Utilization of antiepileptic drugs in Israel.
        Epilepsy Behav. 2016; 61: 82-85
        • Hamer H.M.
        • Dodel R.
        • Strzelczyk A.
        • et al.
        Prevalence, utilization, and costs of antiepileptic drugs for epilepsy in Germany--a nationwide population-based study in children and adults.
        J. Neurol. 2012; 259: 2376-2384
        • Rowan A.J.
        • Ramsay R.E.
        • Collins J.F.
        • et al.
        New onset geriatric epilepsy: a randomized study of gabapentin, lamotrigine, and carbamazepine.
        Neurology. 2005; 64: 1868-1873
        • Consoli D.
        • Bosco D.
        • Postorino P.
        • et al.
        Levetiracetam versus carbamazepine in patients with late poststroke seizures: a multicenter prospective randomized open-label study (EpIC Project).
        Cerebrovasc. Dis. 2012; 34: 282-289