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

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: Anticoagulants; Antiepileptic drugs; Calcium channel blockers; Drug-drug interaction; Statins; Stroke.