Managing Epilepsy: How Pharmacists Can Help

Choosing the correct medication to treat epilepsy is a multifaceted process. Pharmacists can have a huge impact on the patient’s therapeutic response as a valued member of the healthcare team. ¹

Medications used to treat seizures are called anti-epileptic drugs. Pharmacists review reams of information to ensure medication safety and suitability. The three primary concepts involved in this evaluation include:

1. Pharmacogenetics – the role of genetic differences on an individual’s response to a drug.
2. Pharmacokinetics – how a drug moves through the body.
3. Pharmacodynamics – an individual’s therapeutic response to a drug.

It is important to assess for drug interactions

When medications interact with one another it is called a drug-drug interaction. Medications can enhance the effects of another drug (agonize). They can also block the effects of another drug (antagonize).

Monitoring for kidney or liver function

Medications are either metabolized in the liver or kidneys. If an individual has impaired organ function or damage, it changes how the body responds to that drug. Some medications, like Carbamazepine and Phenytoin may have more of an impact than Gabapentin.

Medications that are metabolized in the liver have an affinity for certain enzymes:

• If a medication induces a particular enzyme, it can increase the body’s metabolism of it. The result is decreased serum concentration levels, or decreased effects.
• If a medication inhibits, it can decrease the body’s metabolism of it. The result is an increased serum concentration level. Individuals might experience increased side effects when this happens.

What to expect for the duration of treatment

The goals of treating seizures are:

1. Improve the patients quality of life; and,
2. Decrease seizure frequency.

An individual’s type of seizure and previous medical history dictate how long they must take anti-epileptic drug. Patients should only make changes to their medication as directed by their provider.

In general, there is no one size fits all approach to treating seizures. However, pharmacists can prevent medication-related issues by performing a comprehensive safety evaluation as a member of the healthcare team.

References:

1. Koshy S. Role of pharmacists in the management of patients with epilepsy. Int J Pharm Pract. 2012 Feb; 20 (1):65-8.