TY - JOUR
T1 - Polypharmacy in patients with epilepsy
T2 - A nationally representative cross-sectional study
AU - Terman, Samuel W.
AU - Aubert, Carole E.
AU - Hill, Chloe E.
AU - Maust, Donovan T.
AU - Betjemann, John P.
AU - Boyd, Cynthia M.
AU - Burke, James F.
N1 - Publisher Copyright:
© 2020 The Authors
PY - 2020/10
Y1 - 2020/10
N2 - Objective: The objective of the study was to characterize the prevalence of polypharmacy and central nervous system (CNS)-acting medications in patients with epilepsy, and particular types of medications. Methods: This was a retrospective cross-sectional study using data from the nationally representative National Health and Nutrition Examination Survey (NHANES). We included patients who reported taking at least one prescription medication in order to treat seizures or epilepsy during NHANES survey years 2013–2016. We assessed the number and types of drugs and predictors of total number of medications using a negative binomial regression. We then assessed prevalence of polypharmacy (≥ 5 medications), CNS polypharmacy (≥ 3 CNS-acting medications) and additional CNS-acting medications, and drugs that lower the seizure threshold (i.e., bupropion and tramadol), and extrapolated prevalence to estimated affected US population. Results: The NHANES contained 20,146 participants, of whom 135 reported taking ≥ 1 antiseizure medication (ASM) for seizures or epilepsy representing 2,399,520 US citizens using NHANES's sampling frame. Patients reported taking a mean 5.3 (95% confidence interval (CI): 4.3–6.3) prescription medications. Adjusting for race, sex, and uninsurance, both age and number of chronic conditions predicted increased number of medications (incident rate ratio (IRR) per decade: 1.16, 95% CI: 1.04–1.28; IRR per chronic condition: 1.19, 95% CI: 1.11–1.27). Polypharmacy was reported by 47% (95% CI: 38%–57%) of patients, CNS polypharmacy by 34% (23%–47%), benzodiazepine use by 21% (14%–30%), opioid use by 16% (11%–24%), benzodiazepine plus opioid use by 6% (3%–14%), and 6% (2%–15%) reported a drug that lowers the seizure threshold. Twelve percent (7%–20%) took an opioid with either a benzodiazepine or gabapentinoid. Conclusions: Polypharmacy is common in patients with epilepsy. Patients taking ASMs frequently reported also taking other CNS-acting medications (i.e., opioids, benzodiazepines, seizure threshold-lowering medications), and medication combinations with black box warnings. Central nervous system polypharmacy poses health risks. Future research is needed to explore drivers of polypharmacy and strategies to help mitigate potentially harmful prescription use in this high-risk population.
AB - Objective: The objective of the study was to characterize the prevalence of polypharmacy and central nervous system (CNS)-acting medications in patients with epilepsy, and particular types of medications. Methods: This was a retrospective cross-sectional study using data from the nationally representative National Health and Nutrition Examination Survey (NHANES). We included patients who reported taking at least one prescription medication in order to treat seizures or epilepsy during NHANES survey years 2013–2016. We assessed the number and types of drugs and predictors of total number of medications using a negative binomial regression. We then assessed prevalence of polypharmacy (≥ 5 medications), CNS polypharmacy (≥ 3 CNS-acting medications) and additional CNS-acting medications, and drugs that lower the seizure threshold (i.e., bupropion and tramadol), and extrapolated prevalence to estimated affected US population. Results: The NHANES contained 20,146 participants, of whom 135 reported taking ≥ 1 antiseizure medication (ASM) for seizures or epilepsy representing 2,399,520 US citizens using NHANES's sampling frame. Patients reported taking a mean 5.3 (95% confidence interval (CI): 4.3–6.3) prescription medications. Adjusting for race, sex, and uninsurance, both age and number of chronic conditions predicted increased number of medications (incident rate ratio (IRR) per decade: 1.16, 95% CI: 1.04–1.28; IRR per chronic condition: 1.19, 95% CI: 1.11–1.27). Polypharmacy was reported by 47% (95% CI: 38%–57%) of patients, CNS polypharmacy by 34% (23%–47%), benzodiazepine use by 21% (14%–30%), opioid use by 16% (11%–24%), benzodiazepine plus opioid use by 6% (3%–14%), and 6% (2%–15%) reported a drug that lowers the seizure threshold. Twelve percent (7%–20%) took an opioid with either a benzodiazepine or gabapentinoid. Conclusions: Polypharmacy is common in patients with epilepsy. Patients taking ASMs frequently reported also taking other CNS-acting medications (i.e., opioids, benzodiazepines, seizure threshold-lowering medications), and medication combinations with black box warnings. Central nervous system polypharmacy poses health risks. Future research is needed to explore drivers of polypharmacy and strategies to help mitigate potentially harmful prescription use in this high-risk population.
KW - Epidemiology
KW - Epilepsy
KW - Opioids
KW - Polypharmacy
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U2 - 10.1016/j.yebeh.2020.107261
DO - 10.1016/j.yebeh.2020.107261
M3 - Article
C2 - 32629416
AN - SCOPUS:85087347109
SN - 1525-5050
VL - 111
JO - Epilepsy and Behavior
JF - Epilepsy and Behavior
M1 - 107261
ER -