[Rational combination therapy in epilepsy. III. Possible associations between antiepileptic drugs]

Abstract

Introduction: As the foundation underlying rational combination therapy it is necessary to consider the mechanism of action of each antiepileptic drug, its spectrum, the safety and pharmacodynamic and pharmacokinetic interactions, and to select the association of antiepileptic drugs in accordance with these factors.

Development: This paper consists of three parts. In this third part we consider possible associations between antiepileptic drugs; we suggest associations that may be beneficial, others that must be kept under surveillance because their advantages can be offset by their drawbacks, and others that should be avoided because their disadvantages outweigh their possible advantages.

Conclusions: Until more is known about the aetiopathogenesis of epilepsy and we have markers of the cause of epilepsy in a particular patient it will not be possible to associate antiepileptic drugs according to their mechanisms of action. The absence of clinical trials only allows us to make suggestions about possible beneficial or harmful associations depending on the pharmacodynamic and pharmacokinetic characteristics of antiepileptic drugs, which can thus enhance their effectiveness and safety.