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Clinically important drug interactions in epilepsy: general features and interactions between antiepileptic drugs.
Lancet Neurol 2003; 2(6):347-56LN

Abstract

There are two types of interactions between drugs, pharmacokinetic and pharmacodynamic. For antiepileptic drugs (AEDs), pharmacokinetic interactions are the most notable type, but pharmacodynamic interactions involving reciprocal potentiation of pharmacological effects at the site of action are also important. By far the most important pharmacokinetic interactions are those involving cytochrome P450 isoenzymes in hepatic metabolism. Among old generation AEDs, carbamazepine, phenytoin, phenobarbital, and primidone induce the activity of several enzymes involved in drug metabolism, leading to decreased plasma concentration and reduced pharmacological effect of drugs, which are substrates of the same enzymes (eg, tiagabine, valproic acid, lamotrigine, and topiramate). In contrast, the new AEDs gabapentin, lamotrigine, levetiracetam, tiagabine, topiramate, vigabatrin, and zonisamide do not induce the metabolism of other AEDs. Interactions involving enzyme inhibition include the increase in plasma concentrations of lamotrigine and phenobarbital caused by valproic acid. Among AEDs, the least potential interaction is associated with gabapentin and levetiracetam.

Authors+Show Affiliations

Department of Clinical and Experimental Epilepsy, Institute of Neurology, University College London, London, UK. p.patsalos@ion.ucl.ac.ukNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't
Review

Language

eng

PubMed ID

12849151

Citation

Patsalos, Philip N., and Emilio Perucca. "Clinically Important Drug Interactions in Epilepsy: General Features and Interactions Between Antiepileptic Drugs." The Lancet. Neurology, vol. 2, no. 6, 2003, pp. 347-56.
Patsalos PN, Perucca E. Clinically important drug interactions in epilepsy: general features and interactions between antiepileptic drugs. Lancet Neurol. 2003;2(6):347-56.
Patsalos, P. N., & Perucca, E. (2003). Clinically important drug interactions in epilepsy: general features and interactions between antiepileptic drugs. The Lancet. Neurology, 2(6), pp. 347-56.
Patsalos PN, Perucca E. Clinically Important Drug Interactions in Epilepsy: General Features and Interactions Between Antiepileptic Drugs. Lancet Neurol. 2003;2(6):347-56. PubMed PMID: 12849151.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Clinically important drug interactions in epilepsy: general features and interactions between antiepileptic drugs. AU - Patsalos,Philip N, AU - Perucca,Emilio, PY - 2003/7/10/pubmed PY - 2004/11/4/medline PY - 2003/7/10/entrez SP - 347 EP - 56 JF - The Lancet. Neurology JO - Lancet Neurol VL - 2 IS - 6 N2 - There are two types of interactions between drugs, pharmacokinetic and pharmacodynamic. For antiepileptic drugs (AEDs), pharmacokinetic interactions are the most notable type, but pharmacodynamic interactions involving reciprocal potentiation of pharmacological effects at the site of action are also important. By far the most important pharmacokinetic interactions are those involving cytochrome P450 isoenzymes in hepatic metabolism. Among old generation AEDs, carbamazepine, phenytoin, phenobarbital, and primidone induce the activity of several enzymes involved in drug metabolism, leading to decreased plasma concentration and reduced pharmacological effect of drugs, which are substrates of the same enzymes (eg, tiagabine, valproic acid, lamotrigine, and topiramate). In contrast, the new AEDs gabapentin, lamotrigine, levetiracetam, tiagabine, topiramate, vigabatrin, and zonisamide do not induce the metabolism of other AEDs. Interactions involving enzyme inhibition include the increase in plasma concentrations of lamotrigine and phenobarbital caused by valproic acid. Among AEDs, the least potential interaction is associated with gabapentin and levetiracetam. SN - 1474-4422 UR - https://www.unboundmedicine.com/medline/citation/12849151/Clinically_important_drug_interactions_in_epilepsy:_general_features_and_interactions_between_antiepileptic_drugs_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1474442203004095 DB - PRIME DP - Unbound Medicine ER -