Volume : 13, Issue : 07, July – 2026
Title:
OBSERVATIONAL STUDY ON DRUG-RELATED PROBLEMS ASSOCIATED WITH ANTIEPILEPTIC DRUGS IN A TERTIARY CARE HOSPITAL
Authors :
Vaibhav Kattimani, Venkatesh Chawan, Shivukumar Dudhani, MD Khaja Imad Uddin, Brahmadi Shankar Reddy*
Abstract :
Background: Epilepsy is a common neurological disorder requiring long-term antiepileptic drug (AED) therapy. Drug-related problems (DRPs), including drug-drug interactions and medication non-adherence, may adversely affect seizure control and treatment outcomes. Limited data are available regarding the pattern of DRPs associated with AED use in Indian tertiary care settings.
Objectives: To evaluate the prescription pattern of antiepileptic drugs, identify and categorize drug-related problems associated with AED therapy, and assess the impact of medication adherence on seizure control among epilepsy patients.
Materials and Methods: A prospective observational study was conducted in the Department of Neurology at Gulbarga Institute of Medical Sciences (GIMS) Hospital, Kalaburagi, over a period of six months from March 2025 to August 2025. A total of 102 patients receiving AED therapy were enrolled. Drug-related problems were identified using the Hepler-Strand classification, and medication adherence was assessed using the Modified Morisky Medication Adherence Scale (MMAS-8).
Results: Generalized seizures were the most common seizure type, accounting for 81.3% of cases, while focal seizures constituted 18.6%. Phenytoin (38.5%) was the most frequently prescribed AED, followed by levetiracetam (28.6%). A total of 130 drug-related problems were identified, with drug-drug interactions (51.5%) and non-adherence (45.4%) being the most prevalent. Among 173 identified drug-drug interactions, 70.4% were classified as major. Phenytoin accounted for 72.3% of all identified interactions. Assessment of medication adherence revealed that 59% of patients had low adherence, 22% had moderate adherence, and 19.1% had high adherence. Sociocultural beliefs, forgetfulness, and financial constraints were the leading causes of non-adherence. Patients with high adherence demonstrated better seizure control, with 71.5% achieving seizure freedom.
Conclusion: Drug-drug interactions and medication non-adherence were the most common DRPs associated with AED therapy. Improved medication adherence was strongly associated with better seizure control. Integration of clinical pharmacy services may help identify DRPs, enhance adherence, and optimize therapeutic outcomes among epilepsy patients.
Keywords: Epilepsy, Antiepileptic Drugs, Drug-Related Problems, Medication Adherence, Drug-Drug Interactions.
Cite This Article:
Please cite this article in press Brahmadi Shankar Reddy et al., Observational Study On Drug-Related Problems Associated With Antiepileptic Drugs In A Tertiary Care Hospital, Indo Am. J. P. Sci, 2026; 13(07).
REFERENCES:
[1] Fisher RS, Cross JH, French JA, Higurashi N, Hirsch E, Jansen FE, Lagae L, Moshe SL, Peltola J, Roulet Perez E, Scheffer IE, Zuberi SM. Operational classification of seizure types by the International League Against Epilepsy: Position Paper of the ILAE Commission for Classification and Terminology. Epilepsia. 2017;58(4):522-530.
[2] Fisher RS, Acevedo C, Arzimanoglou A, Bogacz A, Cross JH, Elger CE, Engel J Jr, Forsgren L, French JA, Glynn M, Hesdorffer DC, Lee BI, Mathern GW, Moshe SL, Perucca E, Scheffer IE, Tomson T, Watanabe M, Wiebe S. A practical clinical definition of epilepsy. Epilepsia. 2014;55(4):475-482.
[3] World Health Organization. Epilepsy [Internet]. Geneva: World Health Organization; 2023 [cited 2025 Sep 14]. Available from: https://www.who.int/news-room/fact-sheets/detail/epilepsy
[4] Wahab A. Difficulties in treatment and management of epilepsy and challenges in new drug development. Pharmaceuticals (Basel). 2010;3(7):2090-2110.
[5] India State-Level Disease Burden Initiative Neurological Disorders Collaborators. The burden of neurological disorders across the states of India: the Global Burden of Disease Study 1990-2019. Lancet Glob Health. 2021;9(8):e1129-e1144.
[6] GBD 2016 Epilepsy Collaborators. Global, regional, and national burden of epilepsy, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet Neurol. 2019;18(4):357-375.
[7] Thomas SV, Sarma PS, Alexander M, Pandit L, Shekhar L, Trivedi C, Vengamma B. Economic burden of epilepsy in India. Epilepsia. 2001;42(8):1052-1060.
[8] Amudhan S, Gururaj G, Satishchandra P. Epilepsy in India II: Impact, burden, and need for a multisectoral public health response. Ann Indian Acad Neurol. 2015;18(4):369-381.
[9] Mukhyaprana SK, Devipriya S, Thirumalaippan M. Study of adverse drug reactions associated with antiepileptic drugs: a pharmacovigilance study using spontaneous reporting system. Int J Basic Clin Pharmacol. 2021;10(9):1125-1129.
[10] Faught E. Adherence to antiepilepsy drug therapy. Epilepsy Behav. 2012;25(3):297-302.
[11] Koshy S. Role of pharmacists in the management of patients with epilepsy. Int J Pharm Pract. 2012;20(1):65-68.
[12] Kaculini CM, Tate-Looney AJ, Seifi A. The history of epilepsy: From ancient mystery to modern misconception. Cureus. 2021;13(3):e13922.
[13] Singh AP, Ahmad F, Subramanian N, Prasad V, Mahesh NK. Medication adherence of epilepsy patients – a hospital based cross sectional study in New Delhi, India. J Evid Based Med Healthc. 2018;5(47):3288-3292.
[14] Anuradha MT, Anju PG, Anuja J, Arya BR, Aswathy MA, Devika B, et al. Prescription pattern of antiepileptic drugs in a tertiary care hospital. Int J Epilepsy. 2020;7(2):76-81.
[15] Gupta K, Singh P, Singh G, Kaushal S. A prospective observational study to assess compliance and factors influencing compliance with antiepileptic drugs among patients with epilepsy. Int J Basic Clin Pharmacol. 2019;8(8):1838-1843.
[16] Joshi R, Tripathi M, Gupta P, Gulati S, Dwivedi R, Ramakrishnan L, et al. Prescription pattern of antiepileptic drugs in a tertiary care center of India. Ann Indian Acad Neurol. 2020;23(3):313-319.
[17] Osman T, Jaralla M, Biad T, Abd M, Aouda Z, Hashem K, Shlaka A, Bzaiea A. Unveiling the Hidden Burden: Medication-Related Problems in Epilepsy and Their Impact on Seizure Control and Quality of Life. J Neonatal Surg. 2025;14(5):62-73.
[18] Chowdhury S, Phani AK, Das P, Ahammed Z, Kayasthagir PK, Hassanuzzaman M. Adherence to Antiepileptic Drugs and Seizure Control Among Patients with Epilepsy. Chattogram Maa-O-Shishu Hosp Med Coll J. 2020;19(1):68-73