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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
Antiepileptic drug selection for people with HIV/AIDS: Evidence-based guidelines from the ILAE and AAN
Epilepsia, Volume 53, No. 1, Year 2012
Notification
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Description
A joint panel of the American Academy of Neurology (AAN) and the International League Against Epilepsy (ILAE) convened to develop guidelines for selection of antiepileptic drugs (AEDs) among people with HIV/AIDS. The literature was systematically reviewed to assess the global burden of relevant comorbid entities, to determine the number of patients who potentially utilize AEDs and antiretroviral agents (ARVs), and to address AED-ARV interactions. Key findings from this literature search included the following: AED-ARV administration may be indicated in up to 55% of people taking ARVs. Patients receiving phenytoin may require a lopinavir/ritonavir dosage increase of approximately 50% to maintain unchanged serum concentrations (Level C). Patients receiving valproic acid may require a zidovudine dosage reduction to maintain unchanged serum zidovudine concentrations (Level C). Coadministration of valproic acid and efavirenz may not require efavirenz dosage adjustment (Level C). Patients receiving ritonavir/atazanavir may require a lamotrigine dosage increase of approximately 50% to maintain unchanged lamotrigine serum concentrations (Level C). Coadministration of raltegravir/atazanavir and lamotrigine may not require lamotrigine dosage adjustment (Level C). Coadministration of raltegravir and midazolam may not require midazolam dosage adjustment (Level C). Patients may be counseled that it is unclear whether dosage adjustment is necessary when other AEDs and ARVs are combined (Level U). It may be important to avoid enzyme-inducing AEDs in people on ARV regimens that include protease inhibitors or nonnucleoside reverse transcriptase inhibitors because pharmacokinetic interactions may result in virologic failure, which has clinical implications for disease progression and development of ARV resistance. If such regimens are required for seizure control, patients may be monitored through pharmacokinetic assessments to ensure efficacy of the ARV regimen (Level C). © 2011 International League Against Epilepsy.
Authors & Co-Authors
Birbeck, Gretchen Lano
United States, East Lansing
Michigan State University
Zambia, Mazabuka
Chikankata Hospital
French, Jacqueline A.
United States, New York
Nyu Langone Health
Perucca, Emilio P.
Italy, Pavia
Università Degli Studi Di Pavia
Simpson, David M.
United States, New York
Icahn School of Medicine at Mount Sinai
Fraimow, H.
United States, Camden
Cooper University Hospital
George, Jomy M.
United States, Philadelphia
Philadelphia College of Pharmacy
Okulicz, Jason F.
United States, San Antonio
San Antonio Military Medical Center, Texas
Clifford, David B.
United States, St. Louis
Washington University in St. Louis
Hachad, H.
United States, Seattle
University of Washington
Statistics
Citations: 52
Authors: 9
Affiliations: 10
Identifiers
Doi:
10.1111/j.1528-1167.2011.03335.x
e-ISSN:
15281167
Research Areas
Infectious Diseases