Overnight Switching Research Articles

Overnight switch from levetiracetam to brivaracetam. Safety and tolerability.

Brivaracetam is a newer antiseizure medication than levetiracetam. It has a more selective action on the synaptic vesicle glycoprotein 2A binding site, and it seems to provide a more favorable neuropsychiatric profile. The aim of this study was to assess the safety and tolerability of an overnight switch from levetiracetam to brivaracetam. This was a retrospective descriptive study including patients with epilepsy treated with levetiracetam, who switched due to inefficacy or previous adverse events (AEs). In total, forty-one patients were included (mean age 40.9±17.8years, women 48.8%). Focal epilepsy represented 75.6% (n=31) of patients (structural cause [n=25], unknown cause [n=6]). Four patients had idiopathic generalized epilepsy, two had developmental and epileptic encephalopathy and four patients were unclassified. The reason to start brivaracetam was inefficacy in 53.7% (n=22), AEs in 65.9% (25/27 neuropsychiatric) and both in 19.5% (n=8). Brivaracetam-related AEs were reported in 24.4%. Neuropsychological AEs associated with the previous use of levetiracetam improved in 76% of patients. Treatment was discontinued in 19.5% patients. Patients' reported seizure frequency improved, worsened and remained stable in 26.8%, 12.2%, and 61.0% of the cases, respectively. An overnight switching to brivaracetam is safe and well tolerated. This treatment can improve levetiracetam-related neuropsychiatric AEs.

Overnight switching from levetiracetam to brivaracetam

Overnight switching from levetiracetam to brivaracetam

Overnight switching from oxcarbazepine to eslicarbazepine acetate: an observational study.

There are clinical situations where it might be appropriate to switch patients from immediate-release oxcarbazepine (OXC) to eslicarbazepine acetate (ESL). We investigated the effects of transitioning patients overnight from OXC to ESL. A retrospective, single-center study was conducted in which patients with drug-resistant focal epilepsy on a stable dose of immediate-release OXC for at least 4weeks were switched overnight to ESL. Patients were switched because they experienced persistent seizures with OXC but were unable to tolerate increased OXC dosing due to adverse events. Tolerability was assessed using the Adverse Events Profile (AEP), quality of life was assessed using the Quality of Life in Epilepsy Inventory 10 (QOLIE-10), and alertness was assessed as reaction time using a subtest of the Test Battery for Attention Performance version 2.3. Assessments were performed immediately prior to and 5days after switching from OXC to ESL (days 0 and 5, respectively). The analysis included 21 patients (12 women, 9 men; mean age 36years). After switching from OXC to ESL, there were significant improvements in mean scores for AEP (P<.001), QOLIE-10 (P=.001), and alertness (P<.05). Adverse Events Profile total scores improved for 21/21 (100.0%) patients, QOLIE-10 total scores improved for 17/21 (81.0%) patients, and alertness scores improved for 16/21 (76.2%) patients. In this short-term, single-center study, an overnight switch from twice-daily OXC to once-daily ESL in patients with drug-resistant focal epilepsies resulted in improvements in side effects, quality of life, and alertness.

Pramipexole-induced antecollis in patients with Parkinson's disease: Two cases and literature review.

Antecollis is considered to be relatively rare in Parkinson's disease (PD). Few cases of dopamine agonist-induce antecollis in PD have been reported. We described literature review of 12 PD patients including our 2 cases with pramipexole (PPX)-induced antecollis. The patients were predominantly Japanese, women and above 3 of Hoehn and Yahr stage. PPX-induced antecollis in PD was considered a type of dystonia of flexor neck muscle, and was improved soon after cessation or reduction of PPX. Our two cases improved their antecollis by overnight changing from PPX to ropinirole without deteriorating motor functions. Overnight switching of DA was considered useful as one option in the treatment of antecollis.

Comparison of ropinirole controlled‐ and immediate‐release in Japanese patients with advanced Parkinson's disease

AbstractBackgroundIn Japan, ropinirole controlled‐release tabletsrecently became available for Parkinson's disease.AimWe compared the efficacy and safety of ropinirole controlled‐release with ropinirole immediate‐release.MethodsWe carried out a phase III clinical trial (randomized, double‐blind, double‐dummy), in which controlled‐release (n = 156) or immediate‐release (n = 146) was given to Japanese patients with advanced Parkinson's disease under L‐dopa treatment. First, we assessed the non‐inferiority of ropinirole controlled‐release to immediate‐release at week 24 by measuring change from week 0 in total score of the Unified Parkinson's Disease Rating Scale Part III. Then, during weeks 26–32, we evaluated the safety and efficacy of patients’ switching from ropinirole immediate‐release to controlled‐release, and a subset of patients continued on ropinirole controlled‐release though week 54.ResultsThe change in the Unified Parkinson's Disease Rating Scale Part III total score at week 24 was −10.8 for the controlled‐release group and −11.1 for the immediate‐release group (adjusted mean difference: 0.34, two‐sided 95% confidence interval −1.41 to 2.09), and the upper limit of the confidence interval was less than the predefined margin of 2.5, showing the non‐inferiority of ropinirole controlled‐release to immediate‐release. The efficacy did not change after overnight switching from ropinirole immediate‐release to controlled‐release, and lasted until week 54. Adverse events were comparable between the two groups during the whole study period.ConclusionsAs adjunctive therapy to L‐dopa, ropinirole controlled‐release improved motor symptoms in Japanese patients with advanced Parkinson's disease. The overnight switch from immediate‐release to controlled‐release did not result in any unexpected adverse event.

Success rate, efficacy, and safety/tolerability of overnight switching from immediate‐ to extended‐release pramipexole in advanced Parkinson's disease

For Parkinson's disease (PD), an extended-release (ER) pramipexole formulation taken once daily, has shown efficacy, safety, and tolerability resembling those of immediate-release (IR) pramipexole taken three times daily. The present study assessed, in advanced PD, the success of an overnight switch from adjunctive IR to ER. Levodopa users experiencing motor fluctuations were randomized to adjunctive double-blind (DB) placebo, IR, or ER. Amongst completers of ≥18weeks, ER recipients were kept on DB ER, whilst IR recipients were switched overnight to DB ER at unchanged daily dosage. After a DB week, switch success was assessed. During the next 5weeks, all patients underwent ER titration to optimal open-label maintenance dosage. One week post-switch, 86.2% of 123 IR-to-ER and 83.8% of 105 ER-to-ER patients had ≤15% (or ≤3-point, for pre-switch scores ≤20) increase on UPDRS Parts II+III, and 77.9% (of 122) and 70.2% (of 104) had ≤1-h increase in daily OFF-time. At 32weeks, the groups showed comparable improvements from DB baseline (pramipexole inception), including, on UPDRS II+III, adjusted mean (SE) changes of -14.8 (1.5) for IR-to-ER and -13.3 (1.6) for ER-to-ER. Rates of premature discontinuation owing to adverse events were 6.5% for IR-to-ER and 4.9% for ER-to-ER. By OFF-time and UPDRS criteria, majorities of patients with advanced PD were successfully switched overnight from pramipexole IR to ER at unchanged daily dosage. During subsequent maintenance, pramipexole showed sustained efficacy, safety, and tolerability, regardless of formulation (IR or ER) in the preceding DB trial.

Efficacy, safety, and tolerability of overnight switching from immediate‐ to once daily extended‐release pramipexole in early Parkinson's disease

The aim of this article is to test the feasibility, in early Parkinson's disease (PD), of an overnight switch from immediate-release (IR) pramipexole to a new once-daily extended-release (ER) formulation. Nonfluctuating patients on pramipexole IR three-times daily, alone or with levodopa, for early PD were randomly switched overnight to double-blind IR three-times daily (N = 52) or ER once-daily (N = 104) at initially unchanged daily dosage. Successful switching (defined as no worsening >15% of baseline UPDRS II+III score and no drug-related adverse event withdrawal) was assessed at 9 weeks, after optional dosage adjustments (primary endpoint), and at 4 weeks, before adjustment. Other secondary endpoints included adjusted mean changes from baseline in UPDRS scores and proportion of responders based on Clinical or Patient Global Impression (CGI/PGI). Absolute difference between percentage of successful switch to ER versus IR was tested for ER noninferiority, defined as a 95% confidence-interval lower bound not exceeding -15%. At 9 weeks, 84.5% of the ER group had been successfully switched, versus 94.2% for IR. Noninferiority was not demonstrated, with a difference of -9.76% (95% CI: [-18.81%, +1.66%]). At 4 weeks, 81.6% of the ER group had been successfully switched, versus 92.3% for IR, a difference of -10.75% (95% CI: [-20.51%, +1.48%]). UPDRS changes and CGI/PGI analyses showed no differences between the groups. Both formulations were safe and well tolerated. Pramipexole ER was not equivalent to IR, but the difference was marginal. The fact that >80% of the patients successfully switched overnight at unchanged dosage shows that this practice was feasible in most patients.

Clinical feasibility of immediate overnight switching from slow-release carbamazepine to oxcarbazepine in Korean patients with refractory partial epilepsy

We assessed the clinical variables predicting the feasibility of immediate overnight switching from slow-release carbamazepine to oxcarbazepine in Korean patients with refractory partial epilepsy. Thirty patients aged 15 years or older with refractory partial epilepsy, who had been treated with slow-release carbamazepine as monotherapy or in combination therapy, were switched overnight from slow-release carbamazepine (mean dose at switching, 900 mg/day) to oxcarbazepine. Of these 30 patients, 29 (96.7%) had been treated with a slow-release formulation of carbamazepine. The proportion of patients with polytherapy was 85.3%. Overall, 9 of 30 (30%) switched patients experienced clinically significant adverse events until 2 weeks after switching, including 2 with seizure aggravation. The only clinical variable related to the failure of overnight switching was the number of seizures at baseline.

Overnight switching from ergot-derived dopamine agonists to pramipexole in patients with Parkinson’s disease: An open preliminary trial in Japan

The aim of this study was to evaluate the safety and tolerability of overnight switching from ergot-derived dopamine agonists such as cabergoline to equivalent doses of pramipexole in patients with Parkinson's disease. The safety of overnight switching to pramipexole from cabergoline, which has a long plasma half-life and may cause dopaminergic excess after switchover, has not been established. Twenty-two consecutive patients with Parkinson's disease were included, 18 of them on cabergoline treatment. Patients were assessed with the Unified Parkinson's Disease Rating Scale (UPDRS) given just prior to switching as well as after 2, 4, 8, and 12 weeks of treatment. Eight patients (36.4%) experienced adverse events, of whom two were withdrawn from the study. Generally, however, significant improvement in the UPDRS was obtained after 2 weeks and improvement was maintained up to 12 weeks of treatment. Therefore, our study showed that overnight switching from ergot-derived dopamine agonists including cabergoline to dose-equivalent pramipexole was safe when associated with good patient compliance.

Overnight Transition from Carbamazepine to Oxcarbazepine in Children and Adolescents

To evaluate our clinical experience in pediatric patients who were rapidly switched from carbamazepine to oxcarbazepine at full therapeutic doses. Retrospective medical record review. Children's hospital. Twenty six patients (mean age 9.8 yrs, range 5-21 yrs) with childhood epilepsy who were converted from carbamazepine to oxcarbazepine overnight between January 2003 and December 2005. Data collection included patient demographics, seizure type, epilepsy syndrome, seizure frequency, and adverse events. Dose conversion ratios for switching from carbamazepine to oxcarbazepine ranged from 1:1-1.5. The transition was well tolerated, with only three patients experiencing an adverse event (rash). Among the other 23 patients, seizure frequency decreased in 12 (52%), increased in two (9%), and remained unchanged in nine (39%). Overnight switching from carbamazepine to oxcarbazepine may be a useful option for pediatric patients who cannot tolerate or whose condition is unresponsive to carbamazepine.

An overnight switch to ropinirole therapy in patients with Parkinson's disease. Short communication.

Patients with Parkinson's disease (n = 68) switched from pergolide or bromocriptine to ropinirole overnight (dose equivalence ratios 1:6 and 10:6, respectively). The activities of daily living score for the Unified Parkinson's Disease Rating Scale (UPDRS) was significantly improved 4 weeks after the bromocriptine-ropinirole switch. All other UPDRS scores, including that for the side-effect component, were not significantly different after either switch. Overnight switching may be a safe therapeutic approach that may reduce hospitalisation and related socio-economic costs.