Prescription pattern of antiepileptic drugs in Southern Pakistan: A retrospective cohort study in tertiary care centres

Abstract

Epilepsy is the most occurring neurological disorder after stroke. Prevalence of epilepsy is about 9.99 per 1000 population in Pakistan. In recent years, about 14 new antiepileptic drugs (AEDs) have been marketed. Irrational drugs prescribing might decrease patient adherence with therapy and cause therapeutic failure. The aim of the current study was to evaluate the incidence of different types of epilepsy with syndromes and use of AEDs in patients with epilepsy in detail in a population, characterized by gender and age differences, with focus on exposure of AEDs, in Karachi-Pakistan. It reveals the results of a retrospective cohort study conducted during the period of June 2015 to May 2017 at General Neurology wards of different tertiary care hospitals of Karachi, Pakistan. Prescriptions (n = 90,356) were randomly collected along with the diagnostic data of patients with epilepsy. Variables included exposure of AEDs, polytherapy, age and gender differences, AEDs dosages and Non-AEDs in the same prescription. Total of 21 AEDs were utilized during the two-year study. Variations in the prescription pattern were noticed with respect to age and gender differences. Seventy-four percent of patients with epilepsy have utilized more than one AED. Levetiracetam (38%) was the most prescribed drug among all AEDs used in hospitals of Karachi, Pakistan. Valproic acid was still the most commonly utilized AED in children after inclusion its name in black box warning drug list. This study revealed the discrepancies related to dosages of commonly prescribed AEDs. The study indicates higher prevalence of irrational use of AEDs and the discrepancies in the dosing of mostly drugs. The achieved outcomes may provide sufficient basis for pharmacovigilance studies to health care authorities.