levetiracetam and HIV-Infections

Antiepileptic medication use in noncancer hospice/palliative care patients is not well defined. The authors report the case of a human immunodeficiency virus (HIV) patient under hospice care with increased seizure frequency. The patient is a 22-year-old female with advanced HIV disease complicated by tonic-clonic seizures, hypoalbuminemia, gastroesophageal reflux disease (GERD), and gastritis. During an admission to the hospice inpatient unit, she developed increasing seizure frequency while receiving oral phenytoin. After collaboration between the clinical pharmacist and the hospice treating physician, they simplified her medication regimen, discontinued the phenytoin, and initiated oral levetiracetam. After these adjustments to her medication regimen, the patient's seizure frequency decreased significantly. This case illustrates the challenges of anticonvulsant use in advanced disease, including drug-drug interactions, impaired pharmacokinetics parameters, and increased risk of adverse effects. The importance of continuously monitoring patients for adverse drug events and assessing patient specific factors to help guide medication selection are also highlighted.

Topics: Anti-Retroviral Agents; Anticonvulsants; Drug Interactions; Female; HIV Infections; Hospice Care; Humans; Levetiracetam; Piracetam; Seizures; Young Adult

In the treatment of seizures and epilepsy associated with central nervous system (CNS) infections, drug-drug interactions may significantly and unexpectedly impact outcome not only of epilepsy but also of the infectious disorders in both emergent and chronic care situations. A case is described in whom, the administration of the antimicrobial agent, meropenem presumably reduced serum valproate concentrations resulting in impaired seizure control. Other situations are reviewed in which interactions between antiepileptic drugs (AEDs) and antimicrobial agents may be of clinical significance. These include: (1) seizure management in individuals with neurocysticercosis, (2) management of seizures in patients with lobar tuberculomas, (3) management of seizures due to cerebral abscess, and (4) management of seizures in HIV-seropositive individuals.

Topics: Aged; Anti-Infective Agents; Anticonvulsants; Brain Abscess; Drug Interactions; Epilepsy; Female; Heart Block; HIV Infections; Humans; Levetiracetam; Neurocysticercosis; Piracetam; Valproic Acid

Topics: Anticonvulsants; Drug Industry; Drug Interactions; HIV Infections; HIV Protease Inhibitors; Humans; Levetiracetam; Lopinavir; Piracetam; Pyrimidinones; United States; United States Food and Drug Administration