Transitional polytherapy: tricks of the trade for monotherapy to monotherapy AED conversions.

Current Neuropharmacology
William R GarnettThomas Bramley

Abstract

The goal of epilepsy therapy is to help patients achieve seizure freedom without adverse effects. While monotherapy is preferable in epilepsy treatment, many patients fail a first drug due to lack of efficacy or failure to tolerate an initial medication, necessitating an alteration in therapy. Sudden changes between monotherapies are rarely feasible and sometimes deleterious given potential hazards of acute seizure exacerbation or intolerable adverse effects. The preferred method for converting between monotherapies is transitional polytherapy, a process involving initiation of a new antiepileptic drug (AED) and adjusting it toward a target dose while maintaining or reducing the dose of the baseline medication. A fixed-dose titration strategy of maintaining the baseline drug dose while titrating the new medication is preferable when breakthrough seizures are occurring and no adverse effects are present. However, a flexible titration strategy involving reduction of the baseline drug dose to ensure adequate tolerability of the new adjunctive medication is preferred when patients are already experiencing adverse effects. This article reviews pharmacokinetic considerations pertinent for ensuring successful transitional polytherapy ...Continue Reading

Citations

Jun 5, 2012·Current Treatment Options in Neurology·Paul W Shepard, Erik K St Louis
May 1, 2012·AORN Journal·Rachael Kubiski
Mar 21, 2016·Pharmacological Research : the Official Journal of the Italian Pharmacological Society·Lia SantulliSalvatore Striano
Oct 13, 2011·ISRN Dentistry·Jôice Dias CorrêaTarcilia Aparecida Silva
Oct 13, 2017·The Annals of Pharmacotherapy·P Brittany VickeryAlicia Potter DeFalco
Feb 15, 2019·Journal of Oncology Practice·Britny G RogalaKelly M Gaertner

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