[Rational anti-epileptic polytherapy. Drug interactions and choice of treatment]

Following twenty years of antiepileptic biotherapy, monotherapy superseded this when it was shown to be equally effective, have fewer problems of drug interactions and the patients were more likely to actually take their drugs. However, the development of the so-called new antiepileptic drugs gives rational biotherapy a new chance.

In this article we discuss the basis of reasoned polytherapy and some of the possible interactions between antiepileptic and other drugs.

When polytherapy is considered, antiepileptic drugs with different modes of action and profiles of adverse effects should be used. Some epileptic patients may attain control of their seizures with rational polytherapy. The drug reactions between the antiepileptic drugs themselves and with other drugs are frequent but not usually of clinical importance. We discuss some of the more relevant interactions. Choice of the initial antiepileptic drug is based on various factors, basically the type of seizure, age of the patient, epileptic syndrome, possibility of pregnancy, family and job considerations.