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Drugs & Therapy Perspectives

, Volume 34, Issue 8, pp 368–371 | Cite as

Consider potential drug interactions when starting combination therapy with antiepileptic drugs

  • Adis Medical WritersEmail author
Drug Reactions and Interactions
  • 68 Downloads

Abstract

Alternative monotherapy and adjunctive therapy are both valid options following failure of initial monotherapy with an antiepileptic drug (AED). Depending on the cause of initial failure of AED monotherapy, one option may be favoured over the other. When proceeding with adjunctive therapy, considerations should include choosing an agent with a different mechanism of action to that of the existing antiepileptic drug and avoiding unfavourable pharmacokinetic interactions (e.g. those related to hepatic metabolism and enzyme induction).

Notes

Funding

The preparation of this review was not supported by any external funding.

Compliance with ethical standards

Conflict of interest

The article was adapted from CNS Drugs 2017; 31(10):835–44 [1] by employees of Adis/Springer, who are responsible for the article content and declare no conflicts of interest.

References

  1. 1.
    Abou-Khalil B. Selecting rational drug combinations in epilepsy. CNS Drugs. 2017;31(10):835–44.CrossRefGoogle Scholar
  2. 2.
    Beghi E, Gatti G, Tonini C, et al. Adjunctive therapy versus alternative monotherapy in patients with partial epilepsy failing on a single drug: a multicentre, randomised, pragmatic controlled trial. Epilepsy Res. 2003;57(1):1–13.CrossRefGoogle Scholar
  3. 3.
    Kwan P, Brodie MJ. Epilepsy after the first drug fails: substitution or add-on? Seizure. 2000;9(7):464–8.CrossRefGoogle Scholar
  4. 4.
    Millul A, Iudice A, Adami M, et al. Alternative monotherapy or add-on therapy in patients with epilepsy whose seizures do not respond to the first monotherapy: an Italian multicenter prospective observational study. Epilepsy Behav. 2013;28(3):494–500.CrossRefGoogle Scholar
  5. 5.
    Semah F, Thomas P, Coulbaut S, et al. Early add-on treatment vs alternative monotherapy in patients with partial epilepsy. Epileptic Disord. 2014;16(2):165–74.PubMedGoogle Scholar
  6. 6.
    Canevini MP, De Sarro G, Galimberti CA, et al. Relationship between adverse effects of antiepileptic drugs, number of coprescribed drugs, and drug load in a large cohort of consecutive patients with drug-refractory epilepsy. Epilepsia. 2010;51(5):797–804.CrossRefGoogle Scholar
  7. 7.
    Besag FM, Berry DJ, Pool F, et al. Carbamazepine toxicity with lamotrigine: pharmacokinetic or pharmacodynamic interaction? Epilepsia. 1998;39(2):183–7.CrossRefGoogle Scholar
  8. 8.
    Margolis JM, Chu BC, Wang ZJ, et al. Effectiveness of antiepileptic drug combination therapy for partial-onset seizures based on mechanisms of action. JAMA Neurol. 2014;71(8):985–93.CrossRefGoogle Scholar
  9. 9.
    Brodie MJ, Yuen AW, Group S. Lamotrigine substitution study: evidence for synergism with sodium valproate? Epilepsy Res. 1997;26(3):423–32.CrossRefGoogle Scholar
  10. 10.
    Pisani F, Oteri G, Russo MF, et al. The efficacy of valproate-lamotrigine comedication in refractory complex partial seizures: evidence for a pharmacodynamic interaction. Epilepsia. 1999;40(8):1141–6.CrossRefGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.SpringerAucklandNew Zealand

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