 Many Women Treated Off Label With Antiepilepsy Drugs - pcos mentioned
OB/GYN News
August 1, 2001
Many Women Treated Off Label With Antiepilepsy Drugs.
Author/s: Nicholas Mulcahy
Contributing Writer
NEW YORK -- Burgeoning numbers of women are being treated off label with antiepilepsy drugs for conditions such a migraine headache, bipolar disorder, and pain, and ob.gyns. need to be aware of thc drugs' adverse effects on reproductive health, Dr. Martha J. Morrell said at press briefing sponsored by the Epileps) Foundation.
"Antiepilepsy drugs and epilepsy itself are associated with infertility and reproductive health disorders, such as polycystic ovarian syndrome, and affect sexuality in significant ways. Antiepilepsy drugs (AEDs) can also render oral contraceptives ineffective and are more strongly associated with birth defects than any other class of drugs," said Dr. Morrell of the Columbia Comprehensive Epilepsy Center at New York-Presbyterian Hospital, New York, and past chair of the Epilepsy Foundation.
The list of problems associated with AEDs extends beyond reproductive and sexuality issues and includes weight gain, unwelcome changes in facial and body hair, gum swelling, and acne.
The Epilepsy Foundation says that although there are an estimated 1 million women in the United States with epilepsy, the number of women being treated with AEDs is two to three times higher than the total number with epilepsy
* Pregnancy. AED use during pregnancy is associated with birth defects. "In a recent study in The New England Journal of Medicine, 23% of children born to mothers who were taking antiepileptic drugs had some kind of birth defect, either a major malformation or a minor anomaly, and this is associated with the use of the older agents," she said. One of the older agents, phenobarbital, has a 25% rate of related birth defects, according to new data from the North American Antiepileptic Drug Pregnancy Registry
"This is not the drug of choice to use during pregnancy," Dr. Morrell said.
The risk of birth defects is significantly reduced with single AED therapy versus polytherapy and with lower doses. Also, folic acid supplements have been shown to improve the likelihood of successful pregnancy outcomes in women raking these agents.
* Polycystic ovarian syndrome. Seven percent of all women suffer from PCOS. However, 30% of women with epilepsy have the condition, and 50% of women who use depakote have PCOS. Depakote is one of four older AEDs that predate the arrival of 11 such agents in the last decade.
"It's often hard to distinguish the effects of epilepsy from the effects of the medications used to manage seizures," Dr. Morrell noted. Thus, it is helpful for the physician to learn the side-effect profile of particular AEDs and remain watchful for adverse events.
"Research is showing that certain epilepsy treatments are less likely to cause reproductive problems or some of the other side effects such as weight gain," Dr. Morrell observed.
For instance, in a recent study by Dr. Morrell and his associates, a group of women on one of the newer AEDs reported more regular menstrual cycles with stable weight gain, compared with women who were prescribed one of the older AEDs.
* Birth control. Another distinguishing feature between certain older and newer AEDs involves failure rates with oral contraceptives. One class of AEDs known as liver-enzyme-inducing drugs breaks down estrogen and progesterone in the body, making them less effective in preventing pregnancy. Some of these older AEDs cause at least a 6% failure rate with oral contraceptives. Some of the newer AEDs do not affect the hormonal system and therefore do not interfere with oral contraceptives.
* Polytherapy. Side effects from AED therapy occur more often from multiple therapies or polytherapy than from monotherapy. The more common pattern of epilepsy treatment until the last 10 years, polytherapy continues to be used by physicians treating women with epilepsy and by psychiatrists treating bipolar disorder and other conditions, Dr. Morrell said.
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COPYRIGHT 2001 International Medical News Group
in association with The Gale Group and LookSmart. COPYRIGHT 2001 Gale Group
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