cardiovascular-agents and Epilepsy

Comorbidity between epilepsy and heart diseases is frequent.. All drugs classified within the group of drugs for cardiovascular system according to the Anatomical Therapeutic Chemical (ATC) classification system were reviewed for their effects on seizures or epilepsy.. Several agents showed antiseizure properties in animal models of seizures and/or in patients with epilepsy and only few were proconvulsant. Drugs with anticonvulsant effects include mecamylamine and guanfacine (antihypertensive drugs), indapamide, amiloride, furosemide and bumetanide (diuretics), fasudil (peripheral vasodilator), bioflavonoids (vasoprotective drug), propranolol (beta blocking agent), isradipine, nimodipine, verapamil and diltiazem (calcium channel blockers: CCBs), fosinopril and zofenopril (agents acting on the renin-angiotensin system), several statins, and fenofibrate (lipid-modifying agents). Drugs with proconvulsant properties in experimental models or in patients include reserpine, buflomedil, naftidrofuryl, and clonidine and propranolol at high doses. Drug-drug interactions (DDI) between antiseizure medications (ASMs) and drugs for cardiovascular system were also searched in two leading publicly accessible drug compendia. The most important DDIs occur between enzyme-inducing (EI) ASMs and ivabradine, ranolazine, macitenan and between EI-ASMs and the CCBs felodipine, nicardipine, nisoldipine, and verapamil. Simvastatin and atorvastatin are the lipid-modifying agents with more DDIs with EI-ASMs. Several pharmacodynamic interactions have been also documented.. Available data show that the treatment of patients with epilepsy and vascular comorbidities is challenging and requires the appropriate knowledge of pharmacological properties of drugs and drug interactions.

Topics: Animals; Anticonvulsants; Cardiovascular Agents; Drug Interactions; Epilepsy; Heart Diseases; Humans

Voltage-gated calcium channels underlie a plethora of physiological functions in the cardiovascular and nervous systems. Calcium channels are considered important targets for the treatment of conditions such as absence epilepsy and hypertension, and significant efforts are increasing to discover novel calcium-channel modulators for the treatment of pain. An overview of advances in the development of calcium-channel therapeutics in the areas of pain, epilepsy and disorders associated with cardiovascular function are discussed.

Topics: Animals; Calcium Channel Blockers; Calcium Channels; Calcium Channels, T-Type; Cardiovascular Agents; Epilepsy; Humans; Mice; Mice, Knockout; Pain

Despite their presence in many tissues and their potential implication in various disease states, low-voltage activated T-type calcium channels (T-channels) have only recently become targets of interest. Unfortunately, the lack of selective T-channel blockers has hampered further characterisation of these channels. The recent availability of cloned T-channels, the Ca(V)3 proteins, facilitates identification of novel T-channel blockers. Also, studies performed in knockout animals have fostered novel interest. Selective inhibition of T-channels may have clinical importance in cardiovascular diseases, some forms of epilepsy, sleep disorders, pain and possibly cancer. This review focuses on novel research approaches to discover potent and selective T-channel modulators. These molecules may be potential drugs for treating human diseases, as well as important tools to decipher the physiological role of these channels.

Topics: Analgesics; Animals; Anticonvulsants; Arachidonic Acids; Autistic Disorder; Calcium; Calcium Channel Blockers; Calcium Channels, T-Type; Cardiovascular Agents; Cardiovascular Diseases; Cations; Drug Design; Endocannabinoids; Epilepsy; Humans; Mice; Mice, Knockout; Polyunsaturated Alkamides; Scorpion Venoms; Sleep Disorders, Intrinsic

As epilepsy often is a chronic condition requiring prolonged therapy with anticonvulsants, patients being treated for epilepsy can be at risk when they are prescribed other drugs for concomitant diseases. Pharmacokinetic interactions can occur at each step of drug disposition (absorption, distribution, metabolism and elimination). Although such interactions may occur frequently with some drugs, only some will be clinically relevant. Alterations in the hepatic biotransformation of metabolised drugs due to hepatic isoenzyme induction or inhibition is of particular concern. The consequences of pharmacokinetic interactions are either accumulation of the drug leading to toxicity, or lowering of plasma concentrations resulting in reduced efficacy. Clinically relevant interactions depend on the structure, dosage and duration of administration of interacting agents, and on the individual's genetic make-up. In the past, drug interactions have been analysed empirically. At present, at least for interactions between drugs that are biotransformed in the liver, the risk should be predicted by considering the individual cytochrome P450 isoforms involved in the metabolism of coadministered drugs. Although drug-drug interactions can be predicted, their extent cannot be due to large interindividual variability. Even if nearly all drug combinations could be used with close clinical surveillance and blood concentration determinations, drugs that are not metabolised and are not highly protein bound, as are several of the new anticonvulsants, such as gabapentin, lamotrigine and vigabatrin, have a clear advantage in terms of a lower interaction potential.

Topics: Analgesics; Anti-Asthmatic Agents; Anti-Bacterial Agents; Anti-Infective Agents; Anticonvulsants; Antifungal Agents; Cardiovascular Agents; Contraceptives, Oral; Drug Interactions; Epilepsy; Humans; Psychotropic Drugs

Drug-induced seizures are a commonly encountered problem for physicians. In this article, drugs that cause seizures are discussed with regards to the incidence of seizures, associated clinical factors, risk factors, and special treatment considerations. This information should help physicians determine appropriate evaluation and treatment strategies when their patients experience a seizure while using drugs.

Topics: Analgesics; Anti-Bacterial Agents; Anticonvulsants; Antidepressive Agents; Antipsychotic Agents; Cardiovascular Agents; Epilepsy; Humans; Immunosuppressive Agents; Psychotropic Drugs; Substance-Related Disorders

Levetiracetam (LEV) monotherapy was investigated in 35 patients (pts) (16M/19F, 71.9+/-7.3 years of age) with late-onset post-stroke seizures (i.e. seizures occurring at least 2 weeks after an ischemic stroke) in a prospective open-label study. Overall, 27 pts (77.1%) achieved a condition of seizure freedom (defined as 1 year without seizures): 19 (54.3%) at a daily LEV dose of 1000mg, 7 (20.0%) at 1500mg, 1 (2.8%) at 2000mg. Four pts (11.4%) discontinued the drug because of intolerable side effects (drowsiness associated to gait disturbance in 1 pt, and aggressive behaviour in the remaining 3 pts); 3 pts were unresponsive at a dose of 3000mg, and 1 pt was lost at follow-up. These observations suggest that LEV exhibits safety and efficacy profiles which make it an optimal candidate as a first-choice drug against post-stroke seizures.

Topics: Aged; Aged, 80 and over; Aggression; Anticonvulsants; Brain Ischemia; Cardiovascular Agents; Drug Interactions; Epilepsy; Female; Fibrinolytic Agents; Gait Ataxia; Humans; Levetiracetam; Male; Middle Aged; Piracetam; Sleep Stages

Topics: Acoustic Stimulation; Adrenergic Uptake Inhibitors; Animals; Anticonvulsants; Atomoxetine Hydrochloride; Blood Pressure; Brugada Syndrome; Cardiovascular Agents; Disease Models, Animal; Epilepsy; Female; Heart Rate; Male; Mice, Inbred DBA; Respiration; Respiratory System Agents; Seizures

To examine the overall morbidity of patients who underwent surgery for congenital cardiac defect during childhood.. A congenital cardiac defect treated with surgery is seldom totally cured. The incidence of residua, sequelae, and comorbidity is quite high. The morbidity has not been thoroughly examined.. Medication was used as an indicator of morbidity. Data from the Finnish Research Registry of Paediatric Cardiac Surgery were linked to data from the medication registry of Finland's Social Insurance Institution. This study includes 5116 patients with a mean age of 33.5 (ranged from 14.7 to 64.8) years, who had undergone surgery for congenital cardiac defect between 1953 and 1989. The use of medicines among patients in 2004 was compared with 10232 age- and sex-matched control subjects.. The overall use of medicines was frequent; 62% of patients and 53% of controls had purchased at least one prescribed medicine (risk ratio: 1.2, 95% confidence interval: 1.1-1.2). The number of patients using cardiovascular medicines (17%) and anti-thrombotic agents (5%) was higher than that of control subjects (risk ratio: 2.2 and 8.4). In addition, the patients needed medicinal care for epilepsy (3%), asthma (7%), and psychiatric diseases (10%) more often than did controls (risk ratio: 2.2, 1.5, and 1.3, respectively).. Patients operated on for congenital cardiac defect had more chronic diseases and used more medicines than did controls.

Topics: Adolescent; Adult; Anti-Bacterial Agents; Asthma; Cardiac Surgical Procedures; Cardiovascular Agents; Cardiovascular Diseases; Child; Chronic Disease; Epilepsy; Follow-Up Studies; Heart Defects, Congenital; Humans; Mental Disorders; Middle Aged; Young Adult

Topics: Anticonvulsants; Cardiovascular Agents; Cardiovascular Diseases; Death, Sudden; Epilepsy; Female; Humans; Male; Middle Aged; Treatment Outcome

Polypharmacy (the prescription of more than one therapy for a single patient) and subcutaneous (s.c.) sumatriptan tolerability were prospectively studied in 12,339 migraineurs, each followed for up to 1 year. Inclusion/exclusion criteria were minimal and mirrored United States Imitrex labeling. Drug usage and compliance monitoring were automatically interfaced with prescription refill. Concomitant drugs were used by 79% of patients, with analgesics, antidepressants, and sedatives used most commonly. No adverse interactions between sumatriptan and neurological drugs were found, possibly reflecting relative inability of the former to cross the blood-brain barrier. No difference in cardiovascular adverse events was associated with oral contraceptive use, which was more common than expected. No other drug class influenced adverse event probability, although sample sizes for these comparisons was sometimes <400 patients. This study confirms the prevalence of polypharmacy in migraine, identifies the drugs used, and concludes that, on a population basis, the tolerability of s.c. sumatriptan, when used according to labeled instructions, is unaffected by these concomitant drugs.

Topics: Adolescent; Adrenergic beta-Antagonists; Adult; Aged; Aged, 80 and over; Analgesics, Opioid; Anti-Asthmatic Agents; Anti-Infective Agents; Anti-Inflammatory Agents, Non-Steroidal; Anticonvulsants; Antidepressive Agents; Cardiovascular Agents; Cohort Studies; Comorbidity; Contraceptives, Oral, Hormonal; Depression; Drug Evaluation; Drug Interactions; Drug Therapy, Combination; Epilepsy; Female; Humans; Hypnotics and Sedatives; Injections, Subcutaneous; Male; Methysergide; Middle Aged; Migraine Disorders; Patient Acceptance of Health Care; Prospective Studies; Serotonin Receptor Agonists; Smoking; Sumatriptan; Valproic Acid; Vasoconstrictor Agents

Topics: Cardiovascular Agents; Epilepsy; Humans; Muscle Relaxants, Central; Propionates

Topics: Cardiovascular Agents; Epilepsy; Heterocyclic Compounds; Muscle Relaxants, Central; Thiazines

Topics: Cardiovascular Agents; Epilepsy; Humans; Respiration, Artificial; Status Epilepticus; Succinylcholine

Topics: Cardiovascular Agents; Epilepsy; Humans; Muscle Relaxants, Central; Muscle Spasticity; Propionates

Topics: Anticonvulsants; Behavior; Cardiovascular Agents; Cerebral Palsy; Epilepsy; Meprobamate; Muscle Relaxants, Central; Personality Disorders

Topics: Belladonna Alkaloids; Cardiovascular Agents; Epilepsy; Ergot Alkaloids

Topics: Cardiovascular Agents; Epilepsy; Ergoloid Mesylates; Ergot Alkaloids

Topics: Anesthesia; Anesthesiology; Cardiovascular Agents; Epilepsy; Humans; Muscle Relaxants, Central

Topics: Cardiovascular Agents; Cerebrovascular Circulation; Electroencephalography; Epilepsy; Ergoloid Mesylates; Ergot Alkaloids; Humans; Injections, Intravenous; Procaine

Topics: Cardiovascular Agents; Convulsants; Epilepsy; Humans; Muscle Relaxants, Central

Topics: Anticonvulsants; Cardiovascular Agents; Epilepsy; Humans; Muscle Relaxants, Central