Therapeutic Considerations of Antiseizure Medications-Drug Interactions and Medications that Lower Seizure Threshold

Video Transcription

Video Summary

The presentation delves into the management of interactions between anti-seizure medications (ASMs) and other drugs, emphasizing the importance of recognizing these interactions, particularly in the elderly and those with comorbidities. It distinguishes between pharmacokinetic (affecting drug levels through metabolism) and pharmacodynamic interactions (often harder to detect, involving receptor interaction). Key examples include interactions with pain, psychiatric, and sleep medications, which can produce sedative effects, as well as specific drugs like valproic acid affecting olanzapine and nortriptyline levels. The discussion highlights strategies for managing these interactions: adjusting dosages, considering alternative medications, and employing bridges like benzodiazepines during short-term treatment changes. The latter part addresses medications that lower seizure thresholds, such as certain antibiotics, antidepressants, and antipsychotics, advising on careful selection and management of these drugs to prevent exacerbation of seizures. The overarching theme is careful balancing of risks and benefits when choosing and managing medications for patients on ASMs.

Asset Subtitle

Presenter:
Michael Gelfand, MD, PhD, is an Associate Professor of Clinical Neurology at the University of Pennsylvania. He completed his fellowship in Epilepsy in 2015. He currently directs epilepsy clinical trials in the Penn Epilepsy Center, and since 2021 has been Director of Clinical Trials for the department of neurology. He also directs the outpatient practice of the Penn Epilepsy Center. He has contributed to 30+ epilepsy trials and has particular interests in rescue therapies, novel diagnostics, and medical and surgical management of drug-resistant epilepsy.

Keywords

anti-seizure medications

drug interactions

pharmacokinetics

elderly comorbidities

seizure threshold