Utilization pattern of antiepileptic drugs and their adverse effects in tertiary healthcare and teaching hospital
Keywords:Anti-epileptic drugs, Adverse drug reaction, Utilisation pattern, WHO indicators
Background: Epilepsy is the most common neurological condition with 65 million cases of active epilepsy found worldwide. The incidence is approximately 0.3 - 0.5% in different world populations with a prevalence rate of five to ten per thousand people. The aim of the present study was to evaluate the prescriptions according to WHO/INRUD drug use indicators and to study the adverse effects to antiepileptic drugs (AEDs).
Methods: A cross sectional survey based observational study of 1year duration was conducted at tertiary healthcare hospital. Prescription data of patients (n=361) with Epilepsy from Neurology department was analysed using WHO indicators. The demographic data, type of seizures, AEDs prescribed and adverse drug reactions (ADRs) reported by the patients were recorded. Statistical analysis was done using Microsoft excel 2013.
Results: A total of 593 AEDs were prescribed to 361 patients. Average number of AEDs prescribed per prescription was 1.65±0.78 (S.D) with only 02% of newer AEDs. Generalized Tonic Clonic (GTC) was the most common seizure with 55.68%. Phenytoin (32%) was commonly prescribed followed by valproate for GTCS. Carbamazepine was commonly prescribed for partial seizures. Out of 15 ADR cases that has been recorded, phenytoin (73%) was associated with most ADRs followed by valproate (20%). 53% patients were on Monotherapy, 31% on dual drug therapy.
Conclusions: Older AEDs are still commonly prescribed drugs. Prescription of newer AEDs to be encouraged, as study revealed majority of adverse effects to drugs like phenytoin and valproate. Study concludes the need of creating awareness of reporting of adverse event to AEDs, in treating physician.
Lowenstein DH. Chapter 445, Seizure and epilepsy. Harrison’s principles of internal medicine, 19th ed. USA: McGraw Hill.2015:2542-2559.
Banerjee T K, Ray B K, Das S K. A longitudinal study of epilepsy in Kolkata, India. Epilepsia. December 2010;51(12): 2384-91.
Meyer AC, Dua T, Ma J, Saxena S, Birbeck G. Global disparities in the epilepsy treatment gap: a systematic review. Bull World Health Organization. 2010;88:260-6.
Cloyd JC, Remmel RP. Antiepileptic drug pharmacokinetics and interactions: impact on treatment of epilepsy. Pharmacotherapy: J Human Pharmacol Drug Therapy. 2000 Aug;20(8P2):139S-51S.
Foletti GB. Clinical utilization of new anti-epileptic agents. Rev Med Suisse Romande. 2000 Sep;120(9):703-7.
Shobhana M, Sumana S, Ramesh L, Satish Kumar M. Utilization pattern of antiepileptic drugs and their adverse effects in a teaching hospital. Asian J Pharmaceut Clin Res. 2010;3(1):55-9.
ArulKumaran K, Palanisamy S, Rajasekaran A. A Study on drug use evaluation of antiepileptic drugs at multispeciality tertiary care teaching hospital. Int J PharmTech Res. 2009;1(4):1541-7.
Chen LC, Chen YF, Yang LL, Chou MH, Lin MF. Drug utilization pattern of antiepileptic drugs and traditional Chinese medicines in a general hospital in Taiwan-a pharmaco-epidemiologic study. J Clin Pharm Therapeut. 2000 Apr;25(2):125-9.
Radhakrishnan K, Nayak SD, Kumar SP, Sarma PS. Profile of antiepileptic pharmacotherapy in a tertiary referral center in South India: a pharmacoepidemiologic and pharmacoeconomic study. Epilepsia. 1999 Feb;40(2):179-85.
Lammers MW, Hekster YA, Keyser A, Meinardi H, Renier WO, Van Lier H. Monotherapy or polytherapy for epilepsy revisited: a quantitative assessment. Epilepsia. 1995 May;36(5):440-6.
Haroon A, Tripathi M, Khanam R, Vohra D. Antiepileptic drugs prescription utilization behaviour and direct costs of treatment in a national hospital of India. Ann Indian Acad Neurol. 2012;15(4):289-93
Pal A. Drug utilization pattern of antiepileptic drugs: a pharmacoepidemiologic and pharmacovigilance study in a tertiary teaching hospital in India. Asian J Pharmaceut Clin Res. 2011;4(1):96-9.
World Health Organization. Social consequences and economic aspects: fact sheet N.166. Geneva: World Health Organization, 2001), (ILAE/IBE/WHO. “Out of the shadows”: global campaign against epilepsy. ILAE/IBE/WHO Annual Report, Geneva: World Health Organization, 1999.
Sigamani A, Roy AK, Yeragani VK, Kulkarni C. Profile of pharmacotherapy and pharmacoeconomics of epilepsy treatment at a tertiary care hospital. Ann Neurosci 2006;13:103-12.
Hanssens Y, Deleu D, Al Balushi K, Al Hashar A, Al-Zakwani I. Drug utilization pattern of anti-epileptic drugs: a pharmacoepidemiologic study in Oman. J Clin Pharm Ther. 2002 Oct;27(5):357-64.
Pathak S. Prescribing patterns of Anti-epileptic drug in different age group in India. J Drug Discovery Therapeut. 2013 Jul 21;1(07).
Murthy NV, Anusha B, Perumal P. A Study on trends in prescribing pattern of anti-epileptic drugs in teritiary care teaching hospital. Int J Che Pharmace Sci. 2012;3(2):25-30.
Malerba A. Patterns of prescription of antiepileptic drugs in patients with refractory epilepsy at tertiary referral centres in Italy. Available at: http ://pharmacy. oregonstate. Edu /drug_ policy /sites/default /files /pages/ dur_board /evaluations /articles/2011_05_aed_due.pdf. Accesses 4 November 2017.
Landmark CJ, Fossmark H, Larsson PG, Rytter E, Johannessen SI. Prescription patterns of antiepileptic drugs in patients with epilepsy in a nation-wide population. Epilepsy Res. 2011 Jun;95(1-2):51-9.
Elizabeth ST, Kia RA, Yagnik RM, Nagaraju K. Prescribing Pattern of Antiepileptic Drugs in Adults in a South Indian Tertiary care Hospital. Indian J Pharmacy Practice. 2012;5(1):52-6.
Wilbey J, Kainth A, Hawkins N, Epstein D, McIntosh H, McDaid C, et al. Clinical effectiveness, tolerability and cost-effectiveness of newer drugs for epilepsy in adults: a systematic review and economic evaluation. Health Technol Assess. 2005 Apr; 9(15):1-157.
Hui S. Pattern of antiepileptic drug usage in tertiary referral hospital in Singapore. Neurol J Southeast Asia. 1997;2:77-85.
Guidelines for the management of epilepsy in India. Indian epilepsy society. 2008. Available at: http://www.epilepsyindia.org/ies/GUIDELINES/Gemind_Combine.pdf. Accessed 18 October 2017.
Gupta V, Gupta DM, Gupta R. Intractable epilepsy. JK-Practioner. 2005;12(2):105-7.
Lous EK, Rosenfeld WE, Branley T. Antiepileptic drug monotherapy: the initial approach in epilepsy management. Curr Neuropharmacol. 2009 June;7(2):77-82.
Levetiracetam. Available at: website http://www. accessdata. fda. gov/ drugs at fda_ docs /label/ 2013 /021035 s089, 021505s030lbl.pdf. Accessed 10 October 2017.
French JA, Kanner AM, Bautista J. Efficacy and tolerability of the new antiepileptic drugs I: treatment of new onset epilepsy. Neurol. 2004a;62:1252-60.
French JA, Kanner AM, Bautista J, et al. Efficacy and tolerability of the new antiepileptic drugs II: treatment of refractory epilepsy. Neurol. 2004b; 62:1261-73.
Alsaadi T, Thieman C. Levetiracetam monotherapy for newly diagnosed epilepsy patients. Seizure. 2003;12(3):154-6.
Gambardella A, Labate A, Colosimo E, Ambrosio R, Quattrone A. Monotherapy for partial epilepsy: focus on levetiracetam. Neuropsychiatr Dis Treat. 2008;4(1):33-8.
Karceski S, Morrell MJ, Carpenter D. Treatment of epilepsy in adults: expert opinion. Epilepsy Behav. 2005;7:S1-S64.
MacNeil JS. Levetiracetam Effective Monotherapy for Epilepsy 2003. Available at: http://www.medscape .com/ view article /465702. Accesses 18 September 2017.
Glauser T, Ben‐Menachem E, Bourgeois B, Cnaan A, Guerreiro C, Kälviäinen R, et al. Updated ILAE evidence review of antiepileptic drug efficacy and effectiveness as initial monotherapy for epileptic seizures and syndromes. Epilepsia. 2013 Mar;54(3):551-63.
Werder SF, Preskorn SH. Managing polypharmacy: Walking the fine line between help and harm. Curr Psychiatry Online. 2003 Feb;2(2):24-36.
Lawthom C. Polytherapy and epilepsy: what is the role of polytherapy in the treatment of epilepsy?. Available at: website. http://rc.kfshrc.edu.sa/rcf/E_Library/Epilepsy/Polytherapy.pdf. Accesses 4 September 2017.
Hasan SS, Bahari MB, Babar ZU, Ganesan V. Antiepileptic drug utilisation and seizure outcome among paediatric patients in a Malaysian public hospital. Singapore Med J. 2010 Jan 1;51(1):21.
Desai JD. Epilepsy and cognition. J Pediatr Neurosci. 2008 Jan 1;3(1):16.