In this article we summarized the available evidence regarding the potential deleterious effects of long-term enzyme induction with AEDs. In a non-randomized study, patients with uncontrolled seizures had a slightly, non-significantly higher odds of remission if they remained on the same drug compared to switching to lamotrigine, levetiracetam or topiramate monotherapy 1.
J Neurol Neurosurg Psychiatry Double-blind treatment continued for another 84 days total double-blind treatment of days or until 1 of the 4 exit criteria described for the previous study occurred. Many of these have been integrated into everyday clinical practice, thereby providing a greater range of options for physicians and patients Brodie, You may or may not have a rash with these types of reactions.
Trileptal Drug Imprint
However, there is currently no robust evidence to support the contention that switching to non—enzyme-inducing AEDs in patients with previously uncontrolled seizures or side effects is possible without risking loss of efficacy or worsening tolerability. Pharmacoepidemiol Drug Saf The most significant of these can be classified into 3 general categories: None Open Label Primary Purpose: At any given time, the amount of drug-metabolizing enzyme is regulated by a zero order rate of enzyme production and a first-order rate of enzyme degradation.
Clin Cancer Res These findings could be explained by differences in induction profiles between the drugs, but it is also possible that some of these effects may be due to properties other than CYP induction.
In addition, there is a paucity of information on the effect of newer generation non—enzyme-inducing AEDs on sex steroid hormones. Further studies are needed to clarify the mechanisms of enzyme-inducing AED effects on bone and whether new-generation noninducing AEDs also impact bone metabolism.
This study directly compares the ability of these two drugs to induce the cytochrome P 3A4 enzyme, in healthy volunteers using a well defined biomarker reaction of a specific enzyme activity. The second placebo-controlled trial was conducted in 67 untreated patients 8 to 69 years of age with newly-diagnosed and recent-onset partial seizures. However, the study also suggested that death from CVD was even more common among patients taking oxcarbazepine or phenobarbital relative to those taking carbamazepine, which would not be expected if excess CVD were solely linked to CYP induction.
One placebo-controlled trial was conducted in patients 11 to 62 years of age with refractory partial seizures who had completed an inpatient evaluation for epilepsy surgery.
This dose dependence is seen not only with the older, traditional AEDs such as phenobarbital and carbamazepine, but also with newer agents such as topiramate. SHBG was significantly higher in the carbamazepine and phenytoin groups than in all other groups.
In these trials, no patients discontinued because of ataxia or gait disturbances in either treatment group. Information from the National Library of Medicine Choosing to participate in a study is an important personal decision. UCB Pharma supported the development of this project by bringing the authors together to discuss the format and content of the review. CYP enzyme induction can lead to accelerated metabolism of vitamin D to polar inactive metabolites.