1
|
Chen Y, Chen J, Zhuang X, Chen X, Zeng J, Wang R, Miao J. Risk factors of elevated blood ammonia level in epilepsy patients treated with lamotrigine. Medicine (Baltimore) 2022; 101:e29780. [PMID: 35776999 PMCID: PMC9239605 DOI: 10.1097/md.0000000000029780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
AbstractThe aim of this study was to explore the effect of lamotrigine (LTG) on blood ammonia level in patients with epilepsy and identify risk factors affecting blood ammonia level. This study included 91 epilepsy patients who were treated with LTG at Department of Neurology, Zhongshan Hospital, Xiamen University from January 2011 to April 2016, and were followed up for 3 years. Blood samples were taken during the interictal state and analyzed for blood LTG and ammonia levels. Total of 46.1% of the samples exceeded the median blood ammonia level, and 2.1% of patients had hyperammonemia. Blood ammonia level was positively correlated with LTG blood concentration. LTG combined with valproic acid therapy, seizure within 1 year, and elevated neutrophils affected blood ammonia level. Blood ammonia level was significantly correlated with plasma concentration of LTG. LTG combined with valproic acid therapy, seizure within 1 year, and elevated neutrophils may be risk factors for elevated blood ammonia level in epilepsy patients treated with LTG.
Collapse
Affiliation(s)
- Yiqian Chen
- Department of Neurology, Zhongshan Hospital, Xiamen University, Xiamen, China
| | - Jingzhen Chen
- Department of Neurology, Zhongshan Hospital, Xiamen University, Xiamen, China
| | - Xiaorong Zhuang
- Department of Neurology, Zhongshan Hospital, Xiamen University, Xiamen, China
| | - Xingyu Chen
- Department of Neurology, Zhongshan Hospital, Xiamen University, Xiamen, China
| | - Jianqi Zeng
- Department of Neurology, Zhongshan Hospital, Xiamen University, Xiamen, China
| | - Ru Wang
- Department of Neurology, Weinan Central Hospital, Weinan, China
| | - Jiayin Miao
- Department of Neurology, Zhongshan Hospital, Xiamen University, Xiamen, China
- *Correspondence: Jiayin Miao, Department of Neurology, Zhongshan Hospital, Xiamen University, Xiamen 361004, China (e-mail )
| |
Collapse
|
2
|
Nguyen T, Liu X, Abuhashem W, Bussing R, Winterstein AG. Quality of Evidence Supporting Major Psychotropic Drug‐Drug Interaction Warnings: A Systematic Literature Review. Pharmacotherapy 2020; 40:455-468. [DOI: 10.1002/phar.2382] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Trinh Nguyen
- Department of Pharmaceutical Outcomes and Policy College of Pharmacy University of Florida Gainesville Florida
| | - Xinyue Liu
- Department of Pharmacoepidemiology Merck & Co. Inc West Point Pennsylvania
| | - Wafa Abuhashem
- Department of Pharmaceutical Outcomes and Policy College of Pharmacy University of Florida Gainesville Florida
| | - Regina Bussing
- Department of Psychiatry College of Medicine University of Florida Gainesville Florida
| | - Almut G. Winterstein
- Department of Pharmaceutical Outcomes and Policy College of Pharmacy University of Florida Gainesville Florida
- Center for Drug Evaluation and Safety University of Florida Gainesville Florida
- Department of Epidemiology College of Public Health and Health Professionals and College of Medicine University of Florida Gainesville Florida
| |
Collapse
|
3
|
Kim H, Kim DW, Lee ST, Byun JI, Seo JG, No YJ, Kang KW, Kim D, Kim KT, Cho YW, Yang KI. Antiepileptic Drug Selection According to Seizure Type in Adult Patients with Epilepsy. J Clin Neurol 2020; 16:547-555. [PMID: 33029959 PMCID: PMC7541973 DOI: 10.3988/jcn.2020.16.4.547] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 06/03/2020] [Accepted: 06/05/2020] [Indexed: 12/14/2022] Open
Abstract
Epilepsy is a common neurological disorder that is mainly treated using antiepileptic drugs. Several antiepileptic drugs such as phenobarbital, phenytoin, primidone, and ethosuximide were developed in the early 20th century. More than 10 types of antiepileptic drugs have been developed since the 1990s, and there are now more than 20 antiepileptic drugs in active clinical use. The choice of antiepileptic drugs is based on the clinical features of the seizure types, electroencephalogram findings, epileptic syndrome, and drug stability. Currently there are 19 antiepileptic drugs approved by the Korean Food and Drug Administration, 18 of which (with the exclusion of brivaracetam) are covered by the National Health Insurance Service in Korea. We reviewed the selection of antiepileptic drugs according to the classification of epileptic seizures.
Collapse
Affiliation(s)
- Hyeyun Kim
- Department of Neurology, Catholic Kwandong University College of Medicine, International St. Mary's Hospital, Incheon, Korea
| | - Dong Wook Kim
- Department of Neurology, Konkuk University School of Medicine, Seoul, Korea
| | - Soon Tae Lee
- Department of Neurology, Seoul National University Hospital, Seoul, Korea
| | - Jung Ick Byun
- Department of Neurology, Kyunghee University Hospital at Gangdong, Seoul, Korea
| | - Jong Geun Seo
- Department of Neurology, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Young Joo No
- Department of Neurology, Samsung Noble County, Yongin, Korea
| | - Kyung Wook Kang
- Department of Neurology, Chonnam National University Hospital, Chonnam National University School of Medicine, Gwangju, Korea
| | - Daeyoung Kim
- Department of Neurology, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, Korea
| | - Keun Tae Kim
- Department of Neurology, Keimyung University, School of Medicine, Daegu, Korea
| | - Yong Won Cho
- Department of Neurology, Keimyung University, School of Medicine, Daegu, Korea.
| | - Kwang Ik Yang
- Department of Neurology, Soonchunhyang University College of Medicine, Cheonan Hospital, Cheonan, Korea.
| | | |
Collapse
|
4
|
Measurement of side effects of anti-epileptic drugs (AEDs) in adults with intellectual disability: A systematic review. Seizure 2017; 51:61-73. [DOI: 10.1016/j.seizure.2017.07.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Revised: 07/13/2017] [Accepted: 07/19/2017] [Indexed: 12/28/2022] Open
|
5
|
Greenberg RG, Melloni C, Wu H, Gonzalez D, Ku L, Hill KD, Hornik CP, Zheng N, Jiang W, Cohen-Wolkowiez M, Guptill JT. Therapeutic Index Estimation of Antiepileptic Drugs: A Systematic Literature Review Approach. Clin Neuropharmacol 2016; 39:232-40. [PMID: 27428884 PMCID: PMC5026556 DOI: 10.1097/wnf.0000000000000172] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Our study aimed to determine whether data obtained from the medical literature can be used to estimate the therapeutic index of 5 antiepileptic drugs (AEDs): carbamazepine, lamotrigine, phenobarbital, phenytoin, and valproate. METHODS We performed a literature search using PubMed and EMBASE to collect published safety, efficacy, and therapeutic monitoring data for 5 AEDs and extracted all relevant information into a drug- and study-specific drug database. For each AED, we summarized (1) type, severity, and incidence of toxicity-related adverse events and toxicity-associated range of drug doses or concentrations; (2) effective versus toxic concentration and dose (therapeutic range); and (3) therapeutic drug monitoring practices. We defined therapeutic index as the ratio of the minimum toxic concentration to the minimum effective concentration. RESULTS We reviewed a total of 810 full-text articles and extracted data from 163. The literature suggests that the therapeutic index of phenytoin is 2. The therapeutic indices of phenobarbital and valproate exceed 2. There were insufficient data to precisely quantify the therapeutic indices of carbamazepine and lamotrigine. CONCLUSIONS For some drugs, this approach offers a low-cost method of therapeutic index estimation. Our results can serve as preliminary data for future trials and as guidance for US Food and Drug Administration decision making regarding narrow therapeutic index classification.
Collapse
Affiliation(s)
| | | | - Huali Wu
- Duke Clinical Research Institute, Durham, NC
| | - Daniel Gonzalez
- Division of Pharmacotherapy and Experimental Therapeutics, UNC Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, NC
| | - Lawrence Ku
- Duke Clinical Research Institute, Durham, NC
| | | | | | - Nan Zheng
- Office of Generic Drugs, US Food and Drug Administration, Silver Spring, MD
| | - Wenlei Jiang
- Office of Generic Drugs, US Food and Drug Administration, Silver Spring, MD
| | | | | |
Collapse
|
6
|
Egunsola O, Sammons HM, Whitehouse WP. Monotherapy or polytherapy for childhood epilepsies? Arch Dis Child 2016; 101:356-8. [PMID: 26672103 DOI: 10.1136/archdischild-2015-309466] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2015] [Accepted: 11/15/2015] [Indexed: 11/04/2022]
Affiliation(s)
- Oluwaseun Egunsola
- Academic Division of Child Health, University of Nottingham, Derbyshire Children's Hospital, Derby, UK
| | - Helen M Sammons
- Academic Division of Child Health, University of Nottingham, Derbyshire Children's Hospital, Derby, UK
| | - William P Whitehouse
- School of Medicine, University of Nottingham, Nottingham, UK Department of Paediatric Neurology, Nottingham Children's Hospital, Nottingham University Hospitals' NHS Trust, Nottingham, UK
| |
Collapse
|
7
|
Affiliation(s)
- Kyoung Heo
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
- Epilepsy Research Institute, Yonsei University College of Medicine, Seoul, Korea
| |
Collapse
|
8
|
Czuczwar SJ, Kaplanski J, Swiderska-Dziewit G, Gergont A, Kroczka S, Kacinski M. Pharmacodynamic interactions between antiepileptic drugs: preclinical data based on isobolography. Expert Opin Drug Metab Toxicol 2010; 5:131-6. [PMID: 19210232 DOI: 10.1517/17425250802677826] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND At least 20 - 30% of epileptic patients do not sufficiently respond to monotherapy. Some of them can benefit from drug combinations; hence, animal data may provide some useful novel clues for rational polytherapy. OBJECTIVE To review combinations of antiepileptic drugs, evaluated with the help of isobolographic analysis, in terms of their efficacy and adverse effects. METHODS A literature search, on the basis of experimental studies, with no time limit was carried out. RESULTS/CONCLUSION Preclinical data indicate that a synergy occurred for the combinations of valproate + phenytoin, valproate + ethosuximide, lamotrigine + valproate, gabapentin + valproate, gabapentin + carbamazepine, topiramate + carbamazepine, topiramate + valproate, topiramate + oxcarbazepine, levetiracetam + topiramate, levetiracetam + oxcarbazepine, oxcarbazepine + gabapentin, tiagabine + gabapentin and lamotrigine + topiramate. On the other hand, lamotrigine combined with carbamazepine or oxcarbazepine resulted in a clear-cut antagonism. Interestingly, a combination of oxcarbazepine + clonazepam produced variable responses, including synergy, additivity or antagonism, depending on the dose ratio of these drugs. In no case did pharmacokinetic factors contribute to the final analysis of the effects of drug combinations. Pharmacokinetic factors can contribute to the final effect of drug combinations,such as when stiripentol is added to valproate, or clobazam is added to valproate. It may be concluded that the rational treatment of drug-resistant epilepsy needs to consider the results of preclinical studies.
Collapse
|
9
|
Abstract
The newer antiepileptic drugs (AEDs) provide more therapeutic options and overall improved safety and tolerability for patients. To provide the best care, physicians must be familiar with the latest tolerability and safety data. This is particularly true in children, given there are relatively fewer studies examining the effects of AEDs in children compared with adults. Since we now have significant paediatric literature on each of these agents, we provide a comprehensive and current literature review of the newer AEDs, focusing on safety and tolerability data in children and adolescents. Because the safety profiles in children differ from those in adults, familiarity with this literature is important for child neurologists and other paediatric caregivers. We have organized the data by organ system for each AED for easier reference.
Collapse
Affiliation(s)
- Dean P Sarco
- Department of Neurology, Division of Epilepsy and Clinical Neurophysiology, Children's Hospital Boston, Boston, Massachusetts, USA.
| | | |
Collapse
|
10
|
Moeller JJ, Rahey SR, Sadler RM. Lamotrigine-valproic acid combination therapy for medically refractory epilepsy. Epilepsia 2009; 50:475-9. [DOI: 10.1111/j.1528-1167.2008.01866.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
11
|
Knoester PD, Deckers CLP, Termeer EH, Boendermaker AJ, Kotsopoulos IAW, de Krom MCTFM, Keyser T, Renier WO, Hekster YA, Severens HL. A cost-effectiveness decision model for antiepileptic drug treatment in newly diagnosed epilepsy patients. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2007; 10:173-82. [PMID: 17532810 DOI: 10.1111/j.1524-4733.2007.00167.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
OBJECTIVE To establish cost-effectiveness of antiepileptic drug (AED) treatment strategies of newly diagnosed patients with epilepsy. METHODS A decision analysis was carried out comparing effectiveness and treatment cost of six treatment strategies comprising carbamazepine (CBZ), lamotrigine (LTG), and valproate (VPA) as first-line and second-line drugs. Three outcome groups were defined: complete success, partial success, and failure. Data on seizure control and failure due to adverse effects were derived from the literature. Data on resource use and costs were collected for each outcome group by means of a patient survey. RESULTS Cost data were obtained from 71 patients. Cost increased from complete success to failure outcome groups. The probability of obtaining complete success varied from 64% (VPA-CBZ strategy) to 74% (LTG-VPA strategy). The strategy LTG-VPA was more effective than the least expensive strategy CBZ-VPA, but at higher costs per additional effectively treated patient. Probabilistic sensitivity analysis confirmed these findings to be robust. Subsequent analysis showed that changing inclusion criteria used in the selection of the studies from the literature had a major effect on cost-effectiveness ratios of the various strategies. The probability that LTG first-line therapy is the most cost-effective option remains small, even defining a high cost-effectiveness threshold. Nevertheless, LTG second-line strategies can be cost-effective depending on the willingness to pay for patient improvement. CONCLUSIONS Only a few studies satisfied our inclusion criteria for employment in our decision model. Our model supports the use of conventional AEDs as first-line options for patients with newly diagnosed epilepsy. LTG second-line therapy is likely to be the most cost-effective option in case society is willing to pay more than Euro 6000 for an additional successfully treated patient. This study also illustrates that, with the data presently available, the outcome of decision analysis for AED treatment choice depends on the inclusion criteria used to select trials. Prospective real-life studies are needed in which first- and second-line treatment strategies are compared with respect to both effectiveness and costs.
Collapse
|
12
|
Luszczki JJ, Ratnaraj N, Patsalos PN, Czuczwar SJ. Isobolographic analysis of interactions between loreclezole and conventional antiepileptic drugs in the mouse maximal electroshock-induced seizure model. Naunyn Schmiedebergs Arch Pharmacol 2006; 373:169-81. [PMID: 16604339 DOI: 10.1007/s00210-006-0055-4] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2005] [Accepted: 02/22/2006] [Indexed: 11/26/2022]
Abstract
This study examined the interaction characteristics between loreclezole (LCZ) and various conventional antiepileptic drugs (phenytoin--PHT, carbamazepine--CBZ, valproate--VPA and phenobarbital--PB) in the mouse maximal electroshock (MES)-induced seizure model using isobolographic analysis. Drug-related adverse effects were ascertained by use of the chimney test (motor impairment) and the step-through passive avoidance task (learning and retrieval). It was observed that the combination of LCZ with VPA or PB, at the fixed ratio of 1:1, was supra-additive (synergistic) and the combination of LCZ with CBZ, at all fixed ratios tested (1:3, 1:1 and 3:1), was supra-additive against electroconvulsions. The remaining combinations evaluated, i.e., LCZ with PB or VPA at fixed ratios of 1:3 and 3:1, as well as all fixed-ratio combinations between LCZ and PHT, were additive in the MES test in mice. Pharmacokinetic characterization revealed that LCZ significantly increased both free plasma and brain concentrations of CBZ and PHT, but was without effect on PB. Moreover, a bi-directional pharmacokinetic interaction between LCZ and VPA was observed in that while LCZ increased free plasma, but not total brain VPA concentrations, VPA increased the total brain, but not free plasma LCZ concentrations. Adverse-effect testing revealed that for all antiepileptic drug combinations neither motor performance nor long-term memory was altered. Of the drug combinations investigated, only that of LCZ and PB at the fixed ratio of 1:1 was not associated with any pharmacokinetic interactions, and thus it may be concluded that the supra-additive (synergistic) isobolographic interaction was pharmacodynamic in nature. Furthermore, the fact that LCZ and PB have similar mechanisms of action would suggest that drugs with similar mechanisms of action may provide rational polytherapy regimens.
Collapse
Affiliation(s)
- Jarogniew J Luszczki
- Department of Pathophysiology, Medical University of Lublin, Jaczewskiego 8, 20-090, Lublin, Poland.
| | | | | | | |
Collapse
|
13
|
Luszczki JJ, Czuczwar SJ. Three-dimensional isobolographic analysis of interactions between lamotrigine and clonazepam in maximal electroshock-induced seizures in mice. Naunyn Schmiedebergs Arch Pharmacol 2004; 370:369-80. [PMID: 15526110 DOI: 10.1007/s00210-004-0983-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2004] [Accepted: 08/29/2004] [Indexed: 10/26/2022]
Abstract
The anticonvulsant effects of lamotrigine (LTG) and clonazepam (CZP) and combinations thereof against maximal electroshock (MES)-induced seizures in mice were investigated using three-dimensional (3D) isobolographic analysis. With this method, the doses of fixed-ratio combinations of the drugs (1:3, 1:1 and 3:1) that elicited 16, 50 and 84% of the maximum anticonvulsant effect were determined. Additionally, to evaluate the characteristics of interactions observed with 3D isobolography, the brain concentrations of both drugs were verified pharmacokinetically. The 3D isobolographic analysis showed that LTG and CZP combined at the fixed ratios of 3:1 and 1:1 interacted synergistically in the MES test for all anticonvulsant effects between 16% and 84% of maximum. In contrast, the combination of LTG and CZP at the fixed ratio of 1:3 showed only pure additivity for all estimated effects in 3D isobolography. Moreover, none of the examined antiepileptic drugs altered the brain concentrations of the coadministered drug, so the observed interactions in the MES test are of a pharmacodynamic nature. The 3D isobolographic findings suggest that in epilepsy therapy, increased efficacy of seizure control (synergistic interaction) might be achieved by using LTG and CZP in combination. In this study, some important problems and assumptions related to statistical analysis of data in 3D isobolography are discussed.
Collapse
Affiliation(s)
- Jarogniew J Luszczki
- Department of Pathophysiology, Skubiszewski Medical University of Lublin, Jaczewskiego 8, 20-950 Lublin, Poland.
| | | |
Collapse
|
14
|
Fakhoury TA, Hammer AE, Vuong A, Messenheimer JA. Efficacy and tolerability of conversion to monotherapy with lamotrigine compared with valproate and carbamazepine in patients with epilepsy. Epilepsy Behav 2004; 5:532-8. [PMID: 15256191 DOI: 10.1016/j.yebeh.2004.04.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2004] [Revised: 04/14/2004] [Accepted: 04/16/2004] [Indexed: 11/21/2022]
Abstract
OBJECTIVE This randomized, open-label study was designed to compare the efficacy and tolerability of lamotrigine monotherapy with those of valproate and carbamazepine monotherapy in patients with epilepsy whose seizures were uncontrolled on their prestudy antiepileptic drug monotherapy. METHODS Patients meeting eligibility criteria were randomized 2:1 to lamotrigine:carbamazepine or lamotrigine:valproate. The treatment phase was divided into a 4-week dose-escalation phase (Weeks 1-4), during which lamotrigine, carbamazepine, or valproate was added to patient's prestudy monotherapy; an 8-week add-on phase (Weeks 5-12), during which patients were stabilized on both the study medication and their prestudy antiepileptic therapy; an 8-week withdrawal phase (Weeks 13-20), during which prestudy antiepileptic therapy could be withdrawn if clinically appropriate; and an 8-week monotherapy phase (Weeks 21-28), during which patients could be treated with study medication as monotherapy. RESULTS The numbers of patients randomized to the carbamazepine and valproate arms of the study were 144 (98 lamotrigine, 46 carbamazepine) and 158 (105 lamotrigine, 53 valproate), respectively. Successful monotherapy sustained for at least 7 weeks was achieved in comparable percentages of patients in the lamotrigine group (56%) and the carbamazepine group (54%) and in more patients in the lamotrigine group (49%) than the valproate group (40%). Among monotherapy completers, the percentage of patients with zero seizures during the monotherapy phase was comparable for lamotrigine (41%) and carbamazepine (30%) and significantly higher (P<0.05) with lamotrigine (32%) than with valproate (11%). No differences between treatments were observed with respect to time to treatment failure or time to first seizure. Lamotrigine was also better tolerated than carbamazepine or valproate. CONCLUSION Lamotrigine monotherapy was as effective as and better tolerated than carbamazepine or valproate monotherapy in patients whose seizures were uncontrolled on their prestudy antiepileptic drug monotherapy.
Collapse
Affiliation(s)
- Toufic A Fakhoury
- Department of Neurology, University of Kentucky, Albert Chandler Medical Center L-445, Lexington, KY, USA.
| | | | | | | |
Collapse
|
15
|
Luszczki JJ, Czuczwar M, Kis J, Krysa J, Pasztelan I, Swiader M, Czuczwar SJ. Interactions of lamotrigine with topiramate and first-generation antiepileptic drugs in the maximal electroshock test in mice: an isobolographic analysis. Epilepsia 2003; 44:1003-13. [PMID: 12887431 DOI: 10.1046/j.1528-1157.2003.10003.x] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE The study investigated the types of interactions between lamotrigine (LTG) and first-generation antiepileptic drugs (AEDs) or topiramate (TPM) with isobolographic analysis. METHODS Anticonvulsant and adverse-effect profiles of combinations of LTG with other AEDs, at fixed ratios of 1:3, 1:1, and 3:1, were evaluated in the maximal electroshock (MES)-induced seizures and the chimney test (motor performance) in mice, which allowed the determination of benefit indices (BIs) for individual combinations. RESULTS Combinations of LTG with TPM or valproate (VPA), at fixed ratios of 1:1, were significantly supraadditive (synergistic) in the MES test and, simultaneously, subadditive (antagonistic) in the chimney test, showing the best profile for AED combinations. In contrast, combinations between LTG and carbamazepine (CBZ), in terms of antiseizure protection against MES, were subadditive (antagonistic) and additive in the chimney test, resulting in unfavorable AED combinations. Moreover, the combination of LTG with phenobarbital (PB), at a fixed ratio of 1:1, despite synergy in the MES test, also was synergistic in the chimney test, resulting in a modest BI for AED combination. LTG combined with phenytoin was additive in both the MES and chimney tests in mice. The remaining combinations, at fixed ratios not mentioned earlier, also showed an average BI for AED combinations. Furthermore, LTG combined with all studied AEDs did not affect long-term memory in mice. None of the AEDs influenced the free plasma level of LTG, whereas LTG slightly reduced the free plasma concentration of PB. CONCLUSIONS Interactions between LTG and TPM or LTG and VPA at a fixed ratio of 1:1 might be profitable from a preclinical point of view, displaying the most optimal BI.
Collapse
Affiliation(s)
- Jarogniew J Luszczki
- Departments of Pathophysiology, Medical University Isotope Laboratory, Institute of Agricultural Medicine, Jaczewskiego, Lublin, Poland
| | | | | | | | | | | | | |
Collapse
|
16
|
Maganti R, Gidal BE, Shaw R, Rutecki P. Concomitant use of divalproex sodium and lamotrigine in developmentally disabled patients with epilepsy: a retrospective evaluation of efficacy and tolerability. Epilepsy Behav 2002; 3:275-279. [PMID: 12662609 DOI: 10.1016/s1525-5050(02)00028-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Objective. Epilepsy in institutionalized severe developmentally disabled patients poses a therapeutic challenge. Frequently these patients have multiple seizure (sz) types that are often intractable. Both divalproex sodium (VPA) and lamotrigine (LTG) have demonstrated efficacy. We sought to examine the efficacy of this specific combination in a group of institutionalized, developmentally disabled patients with epilepsy.Methods. Medical and pharmacy records of all patients with developmental disabilities and intractable seizures were reviewed to identify those who had received VPA and LTG. This retrospective evaluation was structured with respect to time frame and outcome measure. Phase 1 consisted of baseline monotherapy with VPA. Phase 2 consisted of titration/dose escalation. Phase 3 was treatment observation period with the combination of both. Seizure frequency and adverse effect data were obtained from nursing or residential staff records. Primary outcome measures were change in seizure frequency between Phases 1 and 3. Additional measures were percentage of patients seizure-free and those with >75% reduction in seizures. A Wilcoxan signed rank test was used for statistical analysis.Results. Of 293 patients, 25 (12M/13F, 31.7+/-10.2 years) had VPA monotherapy following which LTG was added. Mean doses of VPA and LTG were 1474+/-728 and 165+/-111mg/day, respectively. Baseline seizure frequency ranged from 1 to 25 per month. Mean seizure frequency significantly decreased (6.5+/-vs2.0+/-4.0seizures/month, P<0.001). Sixty-four percent of these patients had >/=75% reduction in seizures 28% became seizure-free.Conclusions. The combination of VPA and LTG appears efficacious in this group of developmentally disabled patients with intractable seizures. Rash, which has been associated with this combination, was notably absent and this may reflect the slower titration schedule used.
Collapse
Affiliation(s)
- Rama Maganti
- Department of Neurology, University of Wisconsin, 53705, Madison, WI, USA
| | | | | | | |
Collapse
|
17
|
Abstract
Polytherapy with antiepileptic drugs is not popular mainly because it is thought to be associated with more adverse effects and to contribute relatively little in terms of efficacy compared with monotherapy. However, there are two reasons to question this assumption: certain combinations are more effective than others and, therefore, generalisations about the poor effectiveness of polytherapy cannot be made; and the total drug load, i.e. the total amount of drug exposure for a certain indication, is usually higher in polytherapy, which may explain the higher toxicity seen during such treatment. In this article, the available literature on the effectiveness of first-line monotherapy, alternative monotherapy and second-line polytherapy is reviewed. There is no conclusive evidence in favour for choosing either alternative monotherapy or polytherapy when first-line monotherapy fails. Therefore, a pragmatic approach is recommended until an evidence-based choice can be made.
Collapse
Affiliation(s)
- Charles L P Deckers
- Nijmegen Epilepsy Research Group, University Medical Center Nijmegen, The Netherlands.
| |
Collapse
|
18
|
Pharmacoepidemiology and drug safety. Pharmacoepidemiol Drug Saf 2001; 10:173-88. [PMID: 11499857 DOI: 10.1002/pds.547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
|