Why the study?
Comorbidity between epilepsy and heart diseases is frequent.
What are the effects of cardiovascular drugs on seizures and their drug-drug interactions with antiseizure medications in patients with cardiac diseases and epilepsy?
What are the effects of cardiovascular drugs on seizures and their drug-drug interactions with antiseizure medications in patients with cardiac diseases and epilepsy?
Treatment of patients with epilepsy and vascular comorbidities requires careful consideration of the pro- or anticonvulsant properties of cardiovascular drugs and their potential for drug-drug interactions with antiseizure medications.
May warrant caution selecting cardiovascular drugs for epilepsy patients with cardiac disease; leaves open need for confirmatory trials.
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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Zaccara et al. (2020) studied this question.
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