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PubMed1979

Teratogenic risks of antiepileptic drugs in respect to the type of epilepsy.

The incidence of malformations and/or miscarriage-stillbirths was unequivocally higher in offsprings born to mothers with secondary generalized epilepsy or complex partial seizures. Although it was difficult to separate the possible role played by antiepileptic drugs from that of predisposed severity of epilepsy, the teratogenic risks due to medication appeared to be more plausible. Polypharmacy and overdose regimen should be avoided by all means especially during the earlier period of pregnancy.

Abnormalities, Drug-Induced↗

PubMed1988

Rational treatment of refractory epilepsy in childhood.

A multifaceted study on childhood refractory epilepsy disclosed an insufficient classification of epilepsies and epileptic seizures, and inappropriate polypharmacy as the most important factors preventing appropriate therapy. By means of an adjustment of AEDs based on the accurate classification of epilepsies and epileptic seizures, the number of AEDs could be reduced in 37.5% and monotherapy was successful in 13.8% of refractory cases. Most of the latter were those of partial epilepsy and generalized epilepsy with the monoseizure type. The exacerbation of seizures due to AEDs was also mentioned as one of the important side effects of AEDs.

Adolescent↗

PubMed1990

Factors that preclude the successful use of monopharmacy in the medical treatment of patients with epilepsy.

A neurologist conducted research efforts for more than 12 years as a step toward the establishment of monotherapy for epilepsy. Of 406 patients with epilepsy, seizures could be controlled for more than one year in 72% and for more than 3 years in 54%. Monotherapy was given to 57% of all the patients with a success rate of 54%. Factors that were found likely to interfere with a reduction in antiepileptic drug therapy to one drug modality included: symptomatic etiology, prolonged duration of illness, low age at onset and secondary generalized epilepsy with a large number of seizures in combination, for generalized epilepsies; symptomatic etiology, prolonged duration of illness, low age at onset, other than occipital lobe origin, complex partial seizure with secondary generalization, temporal lobe epilepsy with associated automatisms, elementary sensorimotor seizure and high frequency of seizures, for partial epilepsies. In addition to these factors relevant to the nature of epilepsies, other factors apparently unrelated to the disease process, e.g., liability of polypharmacy to produce side effects precluding dosage elevation, patient's rejection to reduce drug and the inability of a physician to treat the patient properly for want of information, were also recognized to exist.

Adult↗

PubMed1991

Teratogenicity of antiepileptic drugs: is the prevention possible?

To assess the relative contribution of antiepileptic drugs (AEDs) toward the occurrence of congenital malformation, two prospective studies (previous and present) were compared. In the present subjects of 145 cases, the total daily dose of AEDs (drug score) in each case was decreased as much as possible, and polypharmacy was changed to monopharmacy before conception where it was possible. The incidence of malformations significantly decreased from 13.5% to 6.2% (p = 0.031) by the change in drug regimen. The drug score, number of AEDs, maternal age at delivery, seizure type, and etiology of epilepsy were statistically different between the two study groups. Even after the correction of the data by the last three factors, the difference in the incidence of malformation did not disappear, while it disappeared if data were corrected either by the drug score or number of AEDs. These results suggest that the possibility of prevention of AED related malformations is possible by an improvement in AED therapy.

Abnormalities, Drug-Induced↗

PubMed1997

Modifying psychotropic drug prescription patterns: a follow-up survey.

Cross-sectional surveys of prescription patterns of psychotropic drugs provide a quick, global estimation of the appropriateness of psychopharmacotherapy. Recurrent inadequacies in prescribing for psychiatric patients include polypharmacy, high doses of antipsychotics (APS), the use of multiple APS simultaneously, and the administration of these drugs in multiple divided doses. Faulty prescribing patterns are difficult to amend. Following a survey in a rehabilitation facility for chronic psychiatric patients, a systematic education program and other measures were introduced to improve prescribing habits. Two years later the survey was repeated. Significant improvements were detected in the following areas: reductions in the doses of APS and antiparkinsonian (AP) drugs, reductions in the number of patients placed on these drugs, and reductions in the percentage of patients receiving multiple antipsychotics simultaneously. Despite these reductions in doses of psychotropic agents, patients' rehabilitative potential was not compromised.

Antiparkinson Agents↗

PubMed2006

Effects of switching from conventional antipsychotics to risperidone in Japanese patients with chronic schizophrenia.

Atypical antipsychotics are rapidly evolving to become the standard pharmacotherapy in schizophrenia; however, the trend of switching to such drugs is not necessarily progressing quickly in East Asia. This might be due to the scarcity of evidence for the efficacy of switching from conventional to atypical antipsychotics, which prompted the authors to examine effects of switching from conventional antipsychotics to an atypical drug, risperidone, in Japanese patients. Fifty patients with chronic schizophrenia completed the study in which combination therapy with other antipsychotics was allowed if monotherapy with risperidone was not tolerated. Symptoms were assessed with the brief psychiatric rating scale (BPRS). Switching to monotherapy was achieved in 34 patients (68%). The number of antipsychotics prescribed to each patient was reduced (from 2.1 to 1.4 drugs; P < 0.001) and the use of antiparkinsonian drugs decreased (P < 0.001). The mean BPRS score was also reduced 6 months after initiation of the switch (P < 0.001). Failure in switching to monotherapy was associated with higher dosage of antipsychotics at baseline. Switching from conventional antipsychotics to risperidone reduced schizophrenia symptoms, antiparkinsonian medication, and polypharmacy. However, a portion of patients, particularly those who receive an excessive dosage of antipsychotics, might not tolerate such switching.

Adult↗

PubMed1986

Factors which influence the effectiveness of treatment of epilepsy.

Despite recent advances in the management of epilepsy, some patients continue to have seizures which defy therapeutic intervention. To examine factors which may influence the successful application of therapy a survey was carried out of 103 patients, with a previous diagnosis of epilepsy, who had a seizure for which an ambulance was called. It was evident that anticonvulsants are not always used to their maximum potential or under optimal conditions. Problems which were identified in treatment included the widespread use of polypharmacy. Patients contributed to failure of seizure control by lack of compliance with therapy (29 patients) and by excessive alcohol consumption (19 patients).

Alcohol Drinking↗

PubMed2005

Trends in health service use for women in Australia with diabetes.

OBJECTIVE: To describe the health, health service use and use of recommended guidelines for care for women in Australia with diabetes. METHODS: Analysis of survey data 1996-99 from the Australian Longitudinal Study on Women's Health, linked with Medicare data for 1997-2001. Participants were 12,338 mid-age women aged 45-50 years in 1996 (1.9% with diabetes) and 10,421 older women aged 70-75 years at Survey 1 in 1996 (8.1% with diabetes). The outcome measures were number of general practice and specialist visits and use of glycosylated haemoglobin (HbAlc), lipids and microalbuminuria tests. RESULTS: Women with diabetes at Survey 1, and those diagnosed by Survey 2, were more likely to have hypertension, heart disease and eyesight problems, have high rates of polypharmacy (four or more medications: mid age 32%, older 64%) and more consultations with general practitioners and specialists than women without diabetes. During 1997-2001, there was a trend for a greater percentage of women with diabetes to have an HbA1c test at least annually (mid age 44%-52%, older age 46%-58%). Rates of testing microalbuminuria and lipids also increased but were far from conforming to guidelines. Having more frequent consultations with a general practitioner was significantly associated with having all three recommended tests. CONCLUSIONS: There is an increasing use of services by women with diabetes, in part due to an increase in compliance with guidelines for the management of diabetes. IMPLICATIONS: Linked health and administrative data provide a means to monitor health service utilisation, adherence to principles for best practice care and issues of equity in care.

Adolescent↗

PubMed1975

Behavioural effects of anti-epileptic drugs.

There is increasing evidence that various types of behavioural disturbance, other than those described for phenytoin, for example, may occur from the use of anti-epileptic medication, and it has been suggested that these disturbances may not always be reversible. There are suspicions also that certain groups of patients--especially those with structural brain damage--are particularly susceptible. These and other factors relevant to the study of the effects of anti-epileptic drugs on behaviour are comprehensively reviewed. It is concluded that the psycho-pharmacology of anti-epileptic drugs is unsatisfactory at present because of inadequate and unsophisticated reporting of behavioural change and because of the common problem of polypharmacy, and that more accurate observations are needed on less heterogeneous groups of patients that have been described in the past.

Anti-Anxiety Agents↗

PubMed2005

Treatment of behavioural symptoms and dementia in Parkinson's disease.

Behavioural symptoms such as anxiety, depression and psychosis are common in Parkinson's disease (PD), and dementia occurs in about 90% of the patients. These symptoms can be more disabling than the motor dysfunction and they negatively impact quality of life, increase caregiver distress and are more frequently associated with nursing home placement. Depression can be treated with counselling and pharmacotherapy. Tricyclic antidepressants or selective serotonin reuptake inhibitors are widely used, but there is still need for controlled clinical trials. Management of psychosis in PD is complex and includes elimination of identifiable risk factors, reduction of polypharmacy and administration of atypical neuroleptics, which can alleviate psychotic symptoms without worsening motor functions. Clozapine is the best documented atypical neuroleptic shown to be effective against psychosis in PD patients. Cholinesterase inhibitors may prove additional benefit in psychotic PD patients. Recent evidence from small double-blind and open-label trials suggests that cholinesterase inhibitors may be effective in the treatment of dementia associated with PD.

Antipsychotic Agents↗

PubMed2004

Lasers alleviate acne.

Propionibacterium acnes (P. acnes) and sebaceous glands are involved in the pathogenesis of acne. Although often effective, traditional therapies can have drawbacks, such as photosensitivity, other toxicities, polypharmacy and frequent dosing. Lasers have been studied to seek a solution that may overcome these disadvantages. Lasers and other light therapies target the wavelengths of the porphyrins in P. acnes to induce thermal damage that causes the bacterium's destruction. Pulsed-dye laser (PDL) or a system of light pulses and heat with wavelengths between 430 and 1100 nm are both efficacious. The 1450-nm diode laser targets sebaceous glands and is also effective. Topical indocyanine green (ICG) photodynamic therapy (PDT), using the near-infrared (NIR) laser, targets either P. acnes or sebaceous glands. ICG-PDT has fewer adverse effects than aminolevulinic acid-PDT. Lasers are still a relatively new therapy for acne and may be best used in an adjuvant role.

Journal Article↗

PubMedDate not supplied

Persistence and adherence of medications for chronic overactive bladder/urinary incontinence in the california medicaid program.

OBJECTIVES: To investigate persistence and adherence of medication treatment in chronic overactive bladder/urinary incontinence (OAB/UI) patients, and to evaluate OAB/UI-related comorbidity events associated with persistence. METHODS: Pharmaceutical outcomes research with a health-care provider perspective was conducted on a California Medicaid (Medi-Cal) chronic OAB/UI population. The primary end point was medication possession ratio (MPR), which was used to measure refill adherence. Secondary end points measuring persistence patterns included discontinuation of OAB drug therapy (medication-uncovered interval > 30 days) and time to discontinuation (period from the index date until the first discontinuation date). Significant factors on nonpersistence were found by using a Cox Proportional Hazards model. Factors contributing to nonadherence (MPR < 0.8) and the relationship between OAB/UI comorbidity events and persistence were examined by logistic regressions. RESULTS: Of 2496 eligible patients, 36.9% had only one OAB/UI prescription. The mean MPR was 0.34 (SD 0.21) and the median was 0.3, indicating that on average only about one-third of period of time since medication initiation was covered by the therapy. Only 122 patients exhibited > 80% adherence during the 6-month follow-up-period. Significant predictors of higher persistence included: white ethnicity, previous hospitalization length, starting with tolterodine or oxybutynin extended-release, and previous use of topical drugs or antipsychotics. Nevertheless, previous depression or urinary tract infection (UTI) diagnosis, polypharmacy, significantly increased the odds of early discontinuation. Treatment discontinuation increased the risk of UTI diagnosis by 37% in the post-treatment period (P = 0.03; OR 1.37; 95% CI 1.03-1.84), but had no significant effect on other OAB/UI-related comorbidities. CONCLUSIONS: For chronic OAB/UI patients identified in this study, both persistence and adherence with medication treatment were suboptimal. These results suggest that persistence and treatment discontinuation remains problematic for the OAB/UI population.

Benzhydryl Compounds↗

PubMed2006

Hypertension in older people: part 2.

There is overwhelming evidence that pharmacologic treatment of isolated systolic hypertension (ISH) (systolic blood pressure >or=140 mm Hg and diastolic blood pressure <90 mm Hg) reduces cardiovascular events and extends longevity in the elderly; in the very old (80 years or older), the evidence supports decreased incident stroke and heart failure, but is less convincing in terms of longevity. Thus, the inherent increased risk for ISH vascular events highlights the importance of its control. Importantly, ISH in the elderly, primarily related to large artery stiffness, remains more difficult to control than diastolic hypertension in the young, which is primarily related to increased peripheral vascular resistance. Appropriate lifestyle and pharmacologic intervention is indicated in individuals with systolic blood pressure >or=140 mm Hg in general and >or=130 mm Hg in persons with diabetes or chronic kidney disease. Lifestyle intervention may reduce the need for extensive antihypertensive therapy and minimize associated cardiovascular risk factors. To date, only a small percentage of older ISH patients are being treated to goal. Reaching target systolic blood pressure levels most often requires the use of polypharmacy that includes a diuretic and perhaps specific agents that target arterial stiffness and early wave reflection.

Aged↗

PubMedDate not supplied

Diagnosis and management of insomnia in dialysis patients.

Sleep-related complaints affect 50-80% of patients on dialysis. Sleep disorders impair quality of life significantly. Increasing evidence suggests that sleep disruption has a profound impact both on an individual and on a societal level. The etiology of sleep disorders is often multifactorial: biologic, social, and psychological factors play a role. This is especially true for insomnia, which is the most common sleep disorder in different populations, including patients on dialysis. Biochemical and metabolic changes, lifestyle factors, depression, anxiety, and other underlying sleep disorders can all have an effect on the development and persistence of sleep disruption, leading to chronic insomnia. Insomnia is defined as difficulty initiating or maintaining sleep, or having nonrestorative sleep. It is also associated with daytime consequences, such as sleepiness and fatigue, and impaired daytime functioning. In most cases, the diagnosis of insomnia is based on the patient's history, but in some patients objective assessment of sleep pattern may be necessary. Optimally the treatment of insomnia involves the combination of both pharmacologic and nonpharmacologic approaches. In some cases acute insomnia resolves spontaneously, but if left untreated, it may lead to chronic sleep problems. The treatment of chronic insomnia is often challenging. There are only a few studies specifically addressing the management of this sleep disorder in patients with chronic renal disease. Considering the polypharmacy and altered metabolism in this patient population, treatment trials are clearly needed. This article reviews the diagnosis of sleep disorders with a focus on insomnia in patients on dialysis.

Chronic Disease↗

PubMed1982

Anticonvulsant drugs and cognitive functions.

Thirty-five patients with epilepsy were seen before and 3 and 6 months following changes in their anticonvulsant regimes. Patients either underwent a reduction in the number of different drugs prescribed (n = 20) or had at least one drug changed to carbamazepine (n = 15). A third group of patients was seen at the same time intervals but remained on stable anticonvulsant therapy (n = 10). On each assessment session patients performed a series of specially designed tests of cognitive and motor functions, completed rating scales of mood, had a blood sample taken for the analysis of anticonvulsant serum levels, and had their seizure frequency for the previous 3 months documented. In addition, 24 patients had a routine EEG recording made. The overall results obtained suggested that a reduction in polypharmacy and the use of carbamazepine both had beneficial effects on cognitive functioning and mood.

Adult↗

PubMed1983

Reduction of two-drug therapy in intractable epilepsy.

The effects of reducing two-drug treatment to single-drug therapy were studied prospectively in 36 patients with intractable complex partial seizures. In 30 patients (83%) this was possible without an increase in seizure frequency. In six patients (17%) the number of seizures was higher during single-drug therapy. The slow transfer was not complicated by unwanted withdrawal effects. The plasma concentration of the single drug was raised if necessary until clinical drug toxicity was observed. An improvement in seizure control was surprisingly noted in 13 patients (36%). In two patients seizures were completely controlled. In one patient a seizure reduction of 87% was observed. The number of patients with clinical side effects was similar during two-drug and single-drug therapy. The number of side effects was lower during single-drug therapy. Reduction of polypharmacy may be beneficial for patients with intractable epilepsy.

Adult↗

PubMedDate not supplied

Intradose and circadian variation in circulating carbamazepine and its epoxide in epileptic patients: a consequence of autoinduction of metabolism.

Total and free carbamazepine (CBZ), and CBZ 10,11 epoxide (CBZ-E) concentrations were measured over 24 h in 19 patients receiving CBZ 400 mg b.i.d. either as monotherapy (n = 13) or combined with another anticonvulsant (n = 6). Differences in CBZ and CBZ-E disposition between day and night dosing were minor. Mean plasma CBZ concentrations were higher and CBZ-E/CBZ ratios were lower in the monotherapy patients. Variations in total and free plasma CBZ levels were comparable in the monotherapy and polypharmacy groups. Peak free and total CBZ concentrations coincided at approximately 4 h postdose. Free CBZ levels correlated significantly with total in each patient. The extent of variation in total plasma CBZ concentration during 24 h correlated significantly with antipyrine clearance in the monotherapy group. Circadian rhythms are unlikely to influence CBZ disposition to a clinically relevant extent. Measurement of peak and trough CBZ concentrations should improve the value of therapeutic drug monitoring. The diurnal variation in CBZ concentration appears related to the degree of autoinduction of metabolism and is substantial enough to warrant the development of a slow-release preparation of the drug.

Adolescent↗

PubMed1987

Treatment considerations in anticonvulsant monotherapy.

The long-standing practice of polypharmacy in treating epilepsy is giving way to use of monotherapy. Monotherapy can improve seizure control as well as reduce the risk of serious idiosyncratic reactions, dose-related side effects, and complex drug interactions. Monotherapy also offers improved compliance and cost-effectiveness. The basis of monotherapy is accurate diagnosis and assessment of the patient's seizure type(s), followed by selection of a single appropriate anticonvulsant drug. Many patients currently treated with multiple anticonvulsants can be successfully converted to monotherapy with a carefully monitored program in which troublesome and redundant drugs are gradually withdrawn from the therapeutic regimen.

Anticonvulsants↗