Reports from the Field: Drug works better for elderly epileptics
Data pooled from more than 13 studies indicate that in elderly patients, lamotrigine is better tolerated than carbamazepine for treatment of epilepsy.
Roughly 25% of all new cases of epilepsy occur in people over age 60. Many physicians face a difficult choice when prescribing first-line anti-epileptic drugs for these older patients. Age-related changes in metabolism and the likelihood of patients receiving multiple medications for concurrent conditions make the choice of a drug treatment for epilepsy particularly hazardous. Also, elderly people, with generally slower metabolisms, are considerably more sensitive to drug side effects than younger people.
Fewer patients quit treatment
Lamotrigine, which can be prescribed as an add-on or monotherapy in adults with epilepsy, has a desirable pharmacological profile for use in the elderly, according to data presented at the Fourth European Congress on Epileptology in Florence, Italy. Lamotrigene has a long elimination half-life, is effective in all common seizure types, does not inhibit or induce hepatic metabolism, and does not cause central nervous system side effects such as drowsiness, confusion, or cognitive impairment, researchers note.
"We have shown conclusively that lamotrigine is both safe and well-tolerated in elderly patients, and these studies have shown that individuals treated with lamotrigine are twice as likely to continue treatment than patients who receive older anti-epileptic drugs such as carbamazepine," says Luigi Giorgi, MD, principal clinical research physician for Glaxo Wellcome in Research Triangle Park, NC. "Lamotrigine is a highly effective, safe, and well-tolerated drug for younger adults and the elderly alike."
The pooled data included 199 elderly patients and 596 adult patients under age 65 with newly diagnosed epilepsy receiving either lamotrigine or carbamazepine as a monotherapy. Both drugs were found to be highly effective in terms of seizure prevention, but lamotrigine was associated with significantly fewer adverse events than carbamazepine, and the incidence of drowsiness was approximately halved in the lamotrigine treatment group compared with the carbamazepine group. In addition, very few people withdrew from treatment with lamotrigine, whereas up to 42% of patients withdrew from carbamazepine treatment due to adverse events.
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