MS Speaks

Mult Scler Int. 2015;2015:317859.

Antiepileptic and Antidepressive Polypharmacy in Patients with Multiple Sclerosis

Beiske GA1, Holmøy T2, Beiske AG3, Johannessen SI4, Johannessen Landmark C5.

Author information:

1Department of Life Sciences and Health, Programme for Pharmacy, Oslo and Akershus University College, 0167 Oslo, Norway.
2Department of Neurology, Akershus University Hospital, 1478 Lørenskog, Norway ; Institute of Clinical Medicine, University of Oslo, 0316 Oslo, Norway.
3MS Rehabilitation Centre, 1487 Hakadal, Norway.
4The National Center for Epilepsy, Oslo University Hospital, Sandvika, 0424 Oslo, Norway ; Department of Pharmacology, Oslo University Hospital, 0424 Oslo, Norway.
5Department of Life Sciences and Health, Programme for Pharmacy, Oslo and Akershus University College, 0167 Oslo, Norway ; The National Center for Epilepsy, Oslo University Hospital, Sandvika, 0424 Oslo, Norway ; Department of Pharmacology, Oslo University Hospital, 0424 Oslo, Norway.

Objective

 Patients with multiple sclerosis (MS) are often suffering from neuropathic pain. Antiepileptic drugs (AEDs) and tricyclic antidepressants (TCAs) are commonly used and are susceptible to be involved in drug interactions. The aim of this retrospective study was to investigate the prevalence of use of antiepileptic and antidepressive drugs in MS patients and to discuss the theoretical potential for interactions.

Methods

 Review of the medical records from all patients treated at a dedicated MS rehabilitation centre in Norway between 2009 and 2012.

Results

 In total 1090 patients attended a rehabilitation stay during the study period. Of these, 342 (31%; 249 females) with mean age of 53 (±10) years and EDSS 4.8 (±1.7) used at least one AED (gabapentin 12.7%, pregabalin 7.7%, clonazepam 7.8%, and carbamazepine 2.6%) or amitriptyline (9.7%).

Polypharmacy was widespread (mean 5.4 drugs) with 60% using additional CNS-active drugs with a propensity to be involved in interactions. Age, gender, and EDSS scores did not differ significantly between those using and not using AED/amitriptyline.

Conclusion

 One-third of MS patients attending a rehabilitation stay receive AED/amitriptyline treatment. The high prevalence of polypharmacy and use of CNS-active drugs calls for awareness of especially pharmacodynamic interactions and possible excessive adverse effects.