Question

After the birth of her son, Ilona maintains a healthy lifestyle. Given the change of circumstances, she and her husband decide to work towards a second child. She discusses the situation with her doctor, and they decide to switch her to another anti-epileptic medication as monotherapy. Her doctor warns her though that any rash should be report immediately after prescribing her the new monotherapy.

d. Explain how you would switch her to another drug, and which drug was prescribed. Justify your selection of the drug.

Answer 1

As per the information given,Mrs.Ilona has a male child,and she and her husband decides to work towards having a second child.When she discussed the same with the doctor,they decided to switch her to a new antiepileptic drug (AED)as a monotheraphy.

Mrs.Ilona is allready on some antiepileptic drug(AED) and she is planning to get concieved,hence we have to consider that few antiepileptic drugs has a adverse effect of increasing the risk of infertility(AED's have the potential to change the balance of reproductive harmones in the body).

The risk of fetal malformation is increased by AED theraphy,in particular valproate exposure.The other drugs such as Phenytoin,carbamazepine,phenobarbital,and topiramate have also been associated with higher incidence rate of fetal malformation.The polytheraphy with more than one AED's is a precipitating factor for fetal malforamtion.Certain AED's causes decrease in the serum folate level which is associated with neuarl tube defects.So the choice of Antiepileptic drug for the treatment of epilepsy in a women of child bearing age should be carefully made.

The drug which prescribed as monotheraphy in this patient is Tab.Levetiracetam(Levipil).

Tab.Levetiracetam taken in monotheraphy is a safer alternative to other Antiepileptic drugs for women with epilepsy in child bearing age.It is realtively free of teratogenic side effects.

Tab.levetiracetam has been associated with skin rashes.Serious skin reactions such as Steven Johnson syndrome and Toxic epidermal necrolysis(TEN)may occur, which is a medical emergency,hence patient should be warned to inform any occurance of maculopapular rashes following the consumption of the drug.