Treating epilepsy patients with investigational anti-COVID-19 Drugs: Recommendations by the Israeli chapter of the ILAE

Dana Ekstein, Iris Noyman, Firas Fahoum, Moshe Herskovitz, Ilan Under, Bruria Ben Zeev, Sara Eyal

Research output: Contribution to journalArticlepeer-review

Abstract

The coronavirus disease-2019 (COVID-19) and its management in patients with epilepsy can be complex. Prescribers should consider potential effects of investigational anti-COVID-19 drugs on seizures, immunomodulation by anti-seizure medications (ASMs), changes in ASM pharmacokinetics, and the potential for drug-drug interactions (DDIs). The goal of the Board of the Israeli League Against Epilepsy (the Israeli Chapter of the International League Against Epilepsy, ILAE) was to outline the main principles of the pharmacological treatment of COVID-19 in patients with epilepsy. This guide was based on current literature, drug labels, and drug interaction resources. We summarized the available data related to the potential implications of anti-COVID-19 co-medication in patients treated with ASMs. Our recommendations refer to drug selection, dosing, and patient monitoring. Given the limited availability of data, some recommendations are based on general pharmacokinetic or pharmacodynamic principles and might apply to additional future drug combinations as novel treatments emerge. They do not replace evidence-based guidelines, should those become available. Awareness to drug characteristics that increase the risk of interactions can help adjust anti-COVID-19 and ASM treatment for patients with epilepsy.

Original languageEnglish
Pages (from-to)665-672
Number of pages8
JournalIsrael Medical Association Journal
Volume22
Issue number11
StatePublished - Nov 2020

Keywords

  • Anti-COVID-19 medications
  • Anti-epileptic drugs
  • Clinically-relevant drug-drug interactions
  • Cytochrome P450
  • Pharmacokinetics

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