title: Choosing an antiepileptic. Selecting drugs for older patients with epilepsy.
abstract: After age 65, the incidence of epilepsy increases rapidly. Approximately 1.5% of Medicare recipients and 10% of nursing home residents are being treated with antiepileptic drugs (AEDs). The most commonly used AED is phenytoin, a first generation agent. Appropriate drug selection in this population is complicated by the fact that multiple comorbidity is commonplace. Most older patients receive a number of drugs in addition to AEDs. The average nursing home patient receives six additional medications. Age-related issues affecting the choice of an AED include changes in protein binding, decreases in hepatic and renal clearance, and alterations in gastrointestinal absorption. AEDs that do not have drug-drug interactions, are not metabolized by the liver, and are readily absorbed may be better suited for the elderly. This paper reviews the present knowledge base and attempts to develop a more rational approach to AED selection for the elderly.
authors.affiliation: University of Minnesota, and MINCEP Epilepsy Care, Minneapolis, USA.
authors.forename: Ilo E
authors.initials: IE
authors.lastname: Leppik
mesh_terms: D000367:Age Factors; D000368:Aged; D000927:Anticonvulsants / Q000627:therapeutic use*; D004347:Drug Interactions; D004827:Epilepsy / Q000188:drug therapy*; D015577:Geriatric Assessment; D006304:Health Status; D006801:Humans; D017410:Practice Guidelines as Topic; D012307:Risk Factors
chemical_list: D000927:Anticonvulsants