Abstract
ObjectiveEpilepsy management especially in developing country is challenging. Seizures recurrence can be caused by both drug and non-drug related problems such as inadequate antiepileptic regimens, adverse drug reaction and poor adherence. Patient treatment satisfaction also affects the treatment out comes by improving medication adherence. This study aimed to assess drug therapy problems (DTPs) and treatment satisfaction among ambulatory epileptic patients at Tikur Anbessa Specialized Hospital.MethodsA prospective cross-sectional study was conducted on 291 epileptic patients. Data was collected through patient interview and medical charts review. DTPs were identified based on the standard treatment guidelines and Micromedex® was used as drug interaction checker. Cipolle DTPs classification was used to classify the DTPs and Treatment Satisfaction with Medicine Questionnaire (SATMED-Q) was used to assess treatment satisfaction. Binary logistic regressions were utilized to identify the associated factors.ResultsPhenobarbital 195 (67%) and phenytoin 97 (33.3%) were the most frequently prescribed antiepileptic medications as monotherapy or combination therapy. Only 54 (18.6%) of the study participants had controlled seizure. DTP was found in 205(70.4%) of the study participants. From 352 DTPs identified, adverse drug reaction 146 (41.5%) was the leading DTPs followed by ineffective drugs 98 (27.8%) drug interaction 45 (12.8%) and inappropriate dose 42(11.9%). Headache, depression and epigastric pain were frequently reported adverse drug reaction. Among the study participants 167 (57.3%) were adherent to their medications. The number of medications taken by the patients had significant association with occurrence of DTPs, whereas source of medication and seizure free periods were found to have significant association with poor adherence. The global patient satisfaction was (67.4%) and lower satisfaction rate was found with regard to impact on daily activities (62.0%), treatment effectiveness (64.7%) and medical care (65.9%).ConclusionPrevalence of DTPs among ambulatory epileptic patients was high and about half of the patients were nona-dherent for their medication. The overall treatment satisfaction of the patients was suboptimal.
Highlights
Epilepsy is a neurologic disorder characterized by an enduring predisposition to generate epileptic seizures [1]
drug therapy problems (DTPs) were identified based on the standard treatment guidelines and Micromedex® was used as drug interaction checker
From 352 DTPs identified, adverse drug reaction 146 (41.5%) was the leading DTPs followed by ineffective drugs 98 (27.8%) drug interaction 45 (12.8%) and inappropriate dose 42(11.9%)
Summary
Epilepsy is a neurologic disorder characterized by an enduring predisposition to generate epileptic seizures [1]. The ultimate goal is to prevent seizure episode without side effects and having an optimal quality of life [2]. The management should be individualized to eliminate or reduce seizure frequency, while avoiding drug-related harms and complications [3, 4]. About 90% of epileptic patients in developing countries are not receiving appropriate treatment due to cultural attitudes, lack of prioritization, poor health care system and inadequate supply of antiepileptic drugs (AEDs) [5]. Complexity of medical problems and co-medications given with AEDs can increase drug-related problems (DRPs) & drug interactions, which can affect seizure control and toxicity [6]. Enzyme-inducing AEDs such as carbamazepine (CBZ) may accelerate the metabolism of many drugs including antiretroviral, anti-tuberculosis (anti-TB), and hormonal contraceptives thereby reducing their concentration by up to 50% [7]
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