13. Antiepileptic Drug Interactions

  1. John W. Miller MD, PhD Director, UW Regional Epilepsy Center, Professor of Neurology and Neurological Surgery3 and
  2. Howard P. Goodkin MD, PhD The Shure Professor of Neurology and Pediatrics, Director, Division of Pediatric Neurology4
  1. Philip N. Patsalos1,2

Published Online: 10 JAN 2014

DOI: 10.1002/9781118456989.ch13

Epilepsy

Epilepsy

How to Cite

Patsalos, P. N. (2014) Antiepileptic Drug Interactions, in Epilepsy (eds J. W. Miller and H. P. Goodkin), John Wiley & Sons, Oxford. doi: 10.1002/9781118456989.ch13

Editor Information

  1. 3

    University of Washington, Seattle, WA, USA

  2. 4

    Department of Neurology, University of Virginia, Charlottesville, VA, USA

Author Information

  1. 1

    Department of Clinical and Experimental Epilepsy, UCL-Institute of Neurology, London, UK

  2. 2

    Epilepsy Society, Chalfont Centre for Epilepsy, Chalfont St Peter, Buckinghamshire, UK

Publication History

  1. Published Online: 10 JAN 2014
  2. Published Print: 14 FEB 2014

ISBN Information

Print ISBN: 9781118456941

Online ISBN: 9781118456989

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Keywords:

  • antiepileptic drugs;
  • pharmacokinetic interactions;
  • pharmacodynamic interactions;
  • therapeutic drug monitoring;
  • phenytoin;
  • carbamazepine;
  • valproate;
  • levetiracetam;
  • lamotrigine;
  • perampanel;
  • topiramate

Summary

Antiepileptic drugs (AEDs) are the mainstay of epilepsy treatment. They are usually prescribed for prolonged periods, even a lifetime, and often in polytherapy and also in combination with other drugs for the management of other medical conditions. The propensity for drug interactions is substantial, and clinically important interactions often occur. Carbamazepine, phenytoin, phenobarbital, and primidone are potent inducers of hepatic enzymes and decrease the plasma concentration of not only other AEDs but also many antimicrobials, antineoplastics, cardiovascular, and psychotropic drugs as well as oral contraceptive steroids. Valproic acid and stiripentol are potent inhibitors of hepatic enzymes and increase plasma concentrations. Concomitant medication may additionally affect the pharmacokinetics of AEDs. In contrast, the new AEDs gabapentin, lacosamide, lamotrigine, levetiracetam, perampanel, tiagabine, topiramate, vigabatrin, and zonisamide neither induce nor inhibit the metabolism of other drugs. Among AEDs, the lowest propensity to interact is associated with gabapentin, pregabalin, vigabatrin, and levetiracetam.