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Impact of New-Generation Agents on Antiepileptic Drug Prescribing Patterns in a Residential ICF-MR Facility

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Objective: Describe the impact of newer antiepileptic drugs (AEDs) on prescribing practices in a large, residential intermediate-care facility for the mentally retarded (ICF-MR), with onsite clinical pharmacist support services, over a 15-year period.

Design: All residents at the facility receiving AEDs for management of seizure disorder were included in this retrospective assessment. Number and type of AEDs used per individual were recorded and analyzed over the 15-year interval. Current prescribing practices were evaluated regarding rational polytherapy prescribing trends.

Setting: 400-bed residential ICF-MR for the severe to profoundly mentally retarded.

Patients/Participants: All individuals residing at the ICF-MR facility receiving AED therapy for a seizure disorder. Residents were primarily in the severe to profound range of developmental disability, with multiple medical comorbidities.

Interventions: Clinical pharmacists actively participate in all treatment teams and monthly neurology clinic to promote and encourage rational pharmacotherapy.

Main Outcome Measures: Prescribing trends related to AED therapy were followed over a 15-year period. Comparisons were made regarding monotherapy and polytherapy at multiple-year intervals, with specific emphasis on how the newer generation AEDs have affected use of older medications.

Results: Overall trend from 1988 suggests more monotherapy and less use of barbiturates. Introduction of a new generation of AEDs has not affected the overall trend toward one- or two-drug regimens over the period in review.

Conclusion: The relative stability of the number of AEDs per resident during the introduction of a new generation of AEDs suggests that as new drugs are added, ineffective or problem-prone drugs are discontinued.
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Keywords: Antiepileptic drugs; Intermediate care facility for the mentally retarded; Monotherapy; Polytherapy; Seizure disorder

Document Type: Research Article

Publication date: 01 June 2004

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  • The Consultant Pharmacist® is the official peer-reviewed journal of the American Society of Consultant Pharmacists. It is dedicated exclusively to the medication needs of the elderly in all settings, including adult day care, ambulatory care, assisted living, community, hospice, and nursing facilities. This award-winning journal is a member benefit of ASCP. Individuals who are not members and wish to receive The Consultant Pharmacist® will want to consider joining ASCP.
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