Potentially Inappropriate Antiepileptic Drugs for Elderly Patients with Epilepsy

Mary Jo V Pugh, Joyce Cramer, Janice Knoefel, Andrea Charbonneau, Alan Mandell, Lewis Kazis, Dan Berlowitz

Research output: Contribution to journalArticle

59 Citations (Scopus)

Abstract

OBJECTIVES: To describe prescribing patterns for older veterans with epilepsy, determine whether disparity exists between these patterns and clinical recommendations, and describe those at greatest risk of receiving potentially inappropriate antiepileptic drugs (AEDs). DESIGN: Retrospective administrative database analysis. SETTING: All outpatient facilities within the Department of Veterans Affairs (VA). PARTICIPANTS: All veterans aged 65 and older who had epilepsy diagnosed before the end of fiscal year 1999 (FY99) and who received AEDs from the VA in FY99 (N = 21,435). MEASUREMENTS: National VA pharmacy data were used to determine the AED regimen based on the AEDs patients received during the year. Administrative data were used to describe demographic variables and to gauge disease severity and epilepsy onset. RESULTS: Approximately 17% of patients received phenobarbital and 54% phenytoin. Patients classified as having newly diagnosed disease were less likely to receive phenobarbital monotherapy and combination therapy and more likely to receive gabapentin or lamotrigine monotherapy (x2=288.90, P<.001). Logistic regression analyses indicated that, for all patients, those with more severe disease were less likely to receive phenobarbital monotherapy than other monotherapy and phenobarbital combinations than other combinations. Those who received specialty consultation were less likely to receive phenytoin monotherapy than AED monotherapy, which is consistent with clinical recommendations. CONCLUSION: Most older veterans received potentially inappropriate AED therapy. Hence, the standard of care for older patients with epilepsy should be reevaluated, although the vast use of phenytoin in this population suggests that change in practice patterns may be difficult.

Original languageEnglish (US)
Pages (from-to)417-422
Number of pages6
JournalJournal of the American Geriatrics Society
Volume52
Issue number3
DOIs
StatePublished - Mar 2004
Externally publishedYes

Fingerprint

Veterans
Anticonvulsants
Epilepsy
Phenobarbital
Phenytoin
Standard of Care
Outpatients
Referral and Consultation
Logistic Models
Regression Analysis
Demography
Databases
Drug Therapy
Population

Keywords

  • Adverse effects
  • Drug therapy
  • Epilepsy
  • Geriatrics
  • Quality of care

ASJC Scopus subject areas

  • Geriatrics and Gerontology

Cite this

Pugh, M. J. V., Cramer, J., Knoefel, J., Charbonneau, A., Mandell, A., Kazis, L., & Berlowitz, D. (2004). Potentially Inappropriate Antiepileptic Drugs for Elderly Patients with Epilepsy. Journal of the American Geriatrics Society, 52(3), 417-422. https://doi.org/10.1111/j.1532-5415.2004.52115.x

Potentially Inappropriate Antiepileptic Drugs for Elderly Patients with Epilepsy. / Pugh, Mary Jo V; Cramer, Joyce; Knoefel, Janice; Charbonneau, Andrea; Mandell, Alan; Kazis, Lewis; Berlowitz, Dan.

In: Journal of the American Geriatrics Society, Vol. 52, No. 3, 03.2004, p. 417-422.

Research output: Contribution to journalArticle

Pugh, MJV, Cramer, J, Knoefel, J, Charbonneau, A, Mandell, A, Kazis, L & Berlowitz, D 2004, 'Potentially Inappropriate Antiepileptic Drugs for Elderly Patients with Epilepsy', Journal of the American Geriatrics Society, vol. 52, no. 3, pp. 417-422. https://doi.org/10.1111/j.1532-5415.2004.52115.x
Pugh, Mary Jo V ; Cramer, Joyce ; Knoefel, Janice ; Charbonneau, Andrea ; Mandell, Alan ; Kazis, Lewis ; Berlowitz, Dan. / Potentially Inappropriate Antiepileptic Drugs for Elderly Patients with Epilepsy. In: Journal of the American Geriatrics Society. 2004 ; Vol. 52, No. 3. pp. 417-422.
@article{2c7633ee7d634060b187ba41645119d8,
title = "Potentially Inappropriate Antiepileptic Drugs for Elderly Patients with Epilepsy",
abstract = "OBJECTIVES: To describe prescribing patterns for older veterans with epilepsy, determine whether disparity exists between these patterns and clinical recommendations, and describe those at greatest risk of receiving potentially inappropriate antiepileptic drugs (AEDs). DESIGN: Retrospective administrative database analysis. SETTING: All outpatient facilities within the Department of Veterans Affairs (VA). PARTICIPANTS: All veterans aged 65 and older who had epilepsy diagnosed before the end of fiscal year 1999 (FY99) and who received AEDs from the VA in FY99 (N = 21,435). MEASUREMENTS: National VA pharmacy data were used to determine the AED regimen based on the AEDs patients received during the year. Administrative data were used to describe demographic variables and to gauge disease severity and epilepsy onset. RESULTS: Approximately 17{\%} of patients received phenobarbital and 54{\%} phenytoin. Patients classified as having newly diagnosed disease were less likely to receive phenobarbital monotherapy and combination therapy and more likely to receive gabapentin or lamotrigine monotherapy (x2=288.90, P<.001). Logistic regression analyses indicated that, for all patients, those with more severe disease were less likely to receive phenobarbital monotherapy than other monotherapy and phenobarbital combinations than other combinations. Those who received specialty consultation were less likely to receive phenytoin monotherapy than AED monotherapy, which is consistent with clinical recommendations. CONCLUSION: Most older veterans received potentially inappropriate AED therapy. Hence, the standard of care for older patients with epilepsy should be reevaluated, although the vast use of phenytoin in this population suggests that change in practice patterns may be difficult.",
keywords = "Adverse effects, Drug therapy, Epilepsy, Geriatrics, Quality of care",
author = "Pugh, {Mary Jo V} and Joyce Cramer and Janice Knoefel and Andrea Charbonneau and Alan Mandell and Lewis Kazis and Dan Berlowitz",
year = "2004",
month = "3",
doi = "10.1111/j.1532-5415.2004.52115.x",
language = "English (US)",
volume = "52",
pages = "417--422",
journal = "Journal of the American Geriatrics Society",
issn = "0002-8614",
publisher = "Wiley-Blackwell",
number = "3",

}

TY - JOUR

T1 - Potentially Inappropriate Antiepileptic Drugs for Elderly Patients with Epilepsy

AU - Pugh, Mary Jo V

AU - Cramer, Joyce

AU - Knoefel, Janice

AU - Charbonneau, Andrea

AU - Mandell, Alan

AU - Kazis, Lewis

AU - Berlowitz, Dan

PY - 2004/3

Y1 - 2004/3

N2 - OBJECTIVES: To describe prescribing patterns for older veterans with epilepsy, determine whether disparity exists between these patterns and clinical recommendations, and describe those at greatest risk of receiving potentially inappropriate antiepileptic drugs (AEDs). DESIGN: Retrospective administrative database analysis. SETTING: All outpatient facilities within the Department of Veterans Affairs (VA). PARTICIPANTS: All veterans aged 65 and older who had epilepsy diagnosed before the end of fiscal year 1999 (FY99) and who received AEDs from the VA in FY99 (N = 21,435). MEASUREMENTS: National VA pharmacy data were used to determine the AED regimen based on the AEDs patients received during the year. Administrative data were used to describe demographic variables and to gauge disease severity and epilepsy onset. RESULTS: Approximately 17% of patients received phenobarbital and 54% phenytoin. Patients classified as having newly diagnosed disease were less likely to receive phenobarbital monotherapy and combination therapy and more likely to receive gabapentin or lamotrigine monotherapy (x2=288.90, P<.001). Logistic regression analyses indicated that, for all patients, those with more severe disease were less likely to receive phenobarbital monotherapy than other monotherapy and phenobarbital combinations than other combinations. Those who received specialty consultation were less likely to receive phenytoin monotherapy than AED monotherapy, which is consistent with clinical recommendations. CONCLUSION: Most older veterans received potentially inappropriate AED therapy. Hence, the standard of care for older patients with epilepsy should be reevaluated, although the vast use of phenytoin in this population suggests that change in practice patterns may be difficult.

AB - OBJECTIVES: To describe prescribing patterns for older veterans with epilepsy, determine whether disparity exists between these patterns and clinical recommendations, and describe those at greatest risk of receiving potentially inappropriate antiepileptic drugs (AEDs). DESIGN: Retrospective administrative database analysis. SETTING: All outpatient facilities within the Department of Veterans Affairs (VA). PARTICIPANTS: All veterans aged 65 and older who had epilepsy diagnosed before the end of fiscal year 1999 (FY99) and who received AEDs from the VA in FY99 (N = 21,435). MEASUREMENTS: National VA pharmacy data were used to determine the AED regimen based on the AEDs patients received during the year. Administrative data were used to describe demographic variables and to gauge disease severity and epilepsy onset. RESULTS: Approximately 17% of patients received phenobarbital and 54% phenytoin. Patients classified as having newly diagnosed disease were less likely to receive phenobarbital monotherapy and combination therapy and more likely to receive gabapentin or lamotrigine monotherapy (x2=288.90, P<.001). Logistic regression analyses indicated that, for all patients, those with more severe disease were less likely to receive phenobarbital monotherapy than other monotherapy and phenobarbital combinations than other combinations. Those who received specialty consultation were less likely to receive phenytoin monotherapy than AED monotherapy, which is consistent with clinical recommendations. CONCLUSION: Most older veterans received potentially inappropriate AED therapy. Hence, the standard of care for older patients with epilepsy should be reevaluated, although the vast use of phenytoin in this population suggests that change in practice patterns may be difficult.

KW - Adverse effects

KW - Drug therapy

KW - Epilepsy

KW - Geriatrics

KW - Quality of care

UR - http://www.scopus.com/inward/record.url?scp=1542615066&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=1542615066&partnerID=8YFLogxK

U2 - 10.1111/j.1532-5415.2004.52115.x

DO - 10.1111/j.1532-5415.2004.52115.x

M3 - Article

C2 - 14962158

AN - SCOPUS:1542615066

VL - 52

SP - 417

EP - 422

JO - Journal of the American Geriatrics Society

JF - Journal of the American Geriatrics Society

SN - 0002-8614

IS - 3

ER -