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Titolo:
Choice and use of newer anticonvulsant drugs in older patients
Autore:
Willmore, LJ;
Indirizzi:
St Louis Univ, Sch Med, Dept Neurol, St Louis, MO 63104 USA St Louis UnivSt Louis MO USA 63104 , Dept Neurol, St Louis, MO 63104 USA
Titolo Testata:
DRUGS & AGING
fascicolo: 6, volume: 17, anno: 2000,
pagine: 441 - 452
SICI:
1170-229X(200012)17:6<441:CAUONA>2.0.ZU;2-6
Fonte:
ISI
Lingua:
ENG
Soggetto:
REFRACTORY PARTIAL EPILEPSY; NEWLY-DIAGNOSED EPILEPSY; PREVIOUSLY UNTREATED EPILEPSY; CONTROLLED CLINICAL-TRIAL; PLACEBO-CONTROLLED TRIAL; DOSE-RANGING TRIAL; DOUBLE-BLIND; PARTIAL SEIZURES; ELDERLY PATIENTS; CREATININE CLEARANCE;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Clinical Medicine
Life Sciences
Citazioni:
73
Recensione:
Indirizzi per estratti:
Indirizzo: Willmore, LJ St Louis Univ, Sch Med, Dept Neurol, 1402 S Grand Blvd M226, St Louis, MO 63104 USA St Louis Univ 1402 S Grand Blvd M226 St Louis MO USA63104 SA
Citazione:
L.J. Willmore, "Choice and use of newer anticonvulsant drugs in older patients", DRUG AGING, 17(6), 2000, pp. 441-452

Abstract

Epilepsy is common in the elderly. The incidence of epilepsy is age-dependent, with a peak during the first year of life and higher incidence in those older than 75 years. Cerebrovascular disease is a common cause of epilepsy in the elderly. Drug treatment of the elderly is a challenge because of pharmacokinetic changes with aging, including impaired drug protein binding or displacement of drug from protein binding sites, potentially causing drug toxicity as a result of increased free drug concentrations. With aging, hepatic mass and blood flow decline along with renal function. Established anticonvulsant drugs have adverse effects and drug interactions that can make treating the elderly difficult. Newly available anticonvulsants cause fewer drug-drugs interactions and less toxicity. Gabapentin is not metabolised, is not bound to protein, and has a favourable adverse effect profile and thus may be useful in the treatment of elderly patients. Lamotrigine reduced seizures between 20 and 30% in trials. Dose response was between 300mg per day and 500mg per day. This drug was well tolerated inopen-label trials. Rash occurred in younger patients. Oxcarbazepine is rapidly absorbed and is converted to a monohydroxy derivative. Use with hepatic enzyme-inducing drugs necessitates an increase in dose. This drug may be substituted for carbamazepine. Hyponatraemia has been reported and monitoring is suggested. Topiramate blocks voltage-dependent sustained repetitive firing and has aneffect on the gamma-aminobutyric acid (GABA) receptors. It affects glutamate responses and inhibits carbonic anhydrase. Topiramate has a dose response pattern up to 400mg per day. Cognitive effects limits its use in some patients. Nephrolithiasis has occurred with this drug. Tiagabine blocks GABA transporter proteins. Clearance is rapid and metabolism complete. Hepatic dysfunction prolongs clearance. The use of tiagabine has not been reported in the elderly. Zonisamide is rapidly absorbed and protein binding is 50%. Plasma half-life is 55 hours but is reduced to about 30 hours by hepatic enzyme-inducing drugs. Responder rate is 45%. Adverse effects include drowsiness, altered thinking and nephrolithiasis. Treatment of the elderly requires obligatory polypharmacy with potential drug interactions. Changes in body physiology alter absorption, binding, metabolism and elimination of drugs. Concomitant illness and sensitivity to drug effects narrow the therapeutic range and complicate pharmacokinetics in elderly patients. Newer anticonvulsant drugs have advantages that may outweigh risks and have therapeutic profiles that may aid in the treatment of this special population of patients.

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Documento generato il 04/12/20 alle ore 13:17:48