Polypharmacy in patients with epilepsy: A nationally representative cross-sectional study.
- Terman SW University of Michigan Department of Neurology, Ann Arbor, MI 48109, USA; University of Michigan Institute for Healthcare Policy and Innovation, Ann Arbor, MI 48109, USA. Electronic address: sterman@umich.edu.
- Aubert CE University of Michigan Institute for Healthcare Policy and Innovation, Ann Arbor, MI 48109, USA; Department of General Internal Medicine, Bern University Hospital, University of Bern, Bern, Switzerland; Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland; Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI 48109, USA. Electronic address: caroleelodie.aubert@insel.ch.
- Hill CE University of Michigan Department of Neurology, Ann Arbor, MI 48109, USA; University of Michigan Institute for Healthcare Policy and Innovation, Ann Arbor, MI 48109, USA. Electronic address: chloehi@med.umich.edu.
- Maust DT University of Michigan Institute for Healthcare Policy and Innovation, Ann Arbor, MI 48109, USA; Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI 48109, USA; University of Michigan Department of Psychiatry, Ann Arbor, MI 48109, USA. Electronic address: maustd@umich.edu.
- Betjemann JP University of California San Francisco, Weill Institute for Neurosciences, San Francisco, USA. Electronic address: John.Betjemann@ucsf.edu.
- Boyd CM Johns Hopkins University, Center on Aging and Health, Baltimore, MD 21205, USA. Electronic address: cyboyd@jhmi.edu.
- Burke JF University of Michigan Department of Neurology, Ann Arbor, MI 48109, USA; University of Michigan Institute for Healthcare Policy and Innovation, Ann Arbor, MI 48109, USA. Electronic address: jamesbur@med.umich.edu.
- 2020-07-07
Published in:
- Epilepsy & behavior : E&B. - 2020
English
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.
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.
- Language
-
- English
- Open access status
- hybrid
- Identifiers
-
- DOI 10.1016/j.yebeh.2020.107261
- PMID 32629416
- Persistent URL
- https://sonar.ch/global/documents/127824
Statistics
Document views: 26
File downloads:
- Full-text: 0