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Published on: May 16, 2019
Drug treatments in patients with cardiac diseases and epilepsy
Gaetano Zaccara1, Simona Lattanzi2, Massimo Cincotta3
1Regional Health Agency of Tuscany, Firenze, Italy.
Insights
Treating epilepsy patients with heart conditions is complex. Many cardiovascular drugs have antiseizure effects, but some can worsen seizures, and drug interactions are common.
Area of Science:
- Pharmacology
- Neurology
- Cardiology
Background:
- Epilepsy and cardiovascular diseases frequently occur together.
- Managing patients with both conditions presents significant therapeutic challenges.
Purpose of the Study:
- To review cardiovascular drugs for their effects on seizures and epilepsy.
- To identify potential drug-drug interactions between cardiovascular agents and antiepileptic drugs.
Main Methods:
- Systematic review of cardiovascular drugs based on the Anatomical Therapeutic Chemical (ATC) classification.
- Literature search for drug-drug interactions (DDIs) between cardiovascular drugs and antiepileptic medications (ASMs).
Main Results:
- Numerous cardiovascular drugs, including antihypertensives, diuretics, and calcium channel blockers, demonstrated antiseizure properties in preclinical and clinical studies.
- Certain cardiovascular agents, such as reserpine and high-dose propranolol, were found to be proconvulsant.
- Significant DDIs were identified between enzyme-inducing ASMs and specific cardiovascular drugs like ivabradine, ranolazine, and certain calcium channel blockers.
Conclusions:
- The treatment of epilepsy in patients with vascular comorbidities is intricate.
- A thorough understanding of the pharmacological profiles of cardiovascular drugs and their interactions with ASMs is crucial for safe and effective patient management.
Objective:
Comorbidity between epilepsy and heart diseases is frequent.
Methods:
All drugs classified within the group of drugs for cardiovascular system according to the Anatomical Therapeutic Chemical (ATC) classification system were reviewed for their effects on seizures or epilepsy.
Results:
Several agents showed antiseizure properties in animal models of seizures and/or in patients with epilepsy and only few were proconvulsant. Drugs with anticonvulsant effects include mecamylamine and guanfacine (antihypertensive drugs), indapamide, amiloride, furosemide and bumetanide (diuretics), fasudil (peripheral vasodilator), bioflavonoids (vasoprotective drug), propranolol (beta blocking agent), isradipine, nimodipine, verapamil and diltiazem (calcium channel blockers: CCBs), fosinopril and zofenopril (agents acting on the renin-angiotensin system), several statins, and fenofibrate (lipid-modifying agents). Drugs with proconvulsant properties in experimental models or in patients include reserpine, buflomedil, naftidrofuryl, and clonidine and propranolol at high doses. Drug-drug interactions (DDI) between antiseizure medications (ASMs) and drugs for cardiovascular system were also searched in two leading publicly accessible drug compendia. The most important DDIs occur between enzyme-inducing (EI) ASMs and ivabradine, ranolazine, macitenan and between EI-ASMs and the CCBs felodipine, nicardipine, nisoldipine, and verapamil. Simvastatin and atorvastatin are the lipid-modifying agents with more DDIs with EI-ASMs. Several pharmacodynamic interactions have been also documented.
Discussion And Conclusions:
Available data show that the treatment of patients with epilepsy and vascular comorbidities is challenging and requires the appropriate knowledge of pharmacological properties of drugs and drug interactions.
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