Changing trends in antiepileptic drug prescribing in girls of child-bearing potential

Arch Dis Child. 2009 Jun;94(6):443-7. doi: 10.1136/adc.2008.144386. Epub 2009 Mar 22.

Abstract

Objective: To characterize trends in prescribing carbamazepine (CBZ), sodium valproate (VPA) and lamotrigine (LTG) in adolescent females in the UK and to examine possible reasons for changing trends.

Design: Population-based observational study.

Setting: UK General Practice Research Database between 1 January 1993 and 31 December 2006.

Patients: 12-18-year-old subjects who were issued >or=1 CBZ, VPA or LTG prescription.

Main outcome measures: Prescribing prevalences stratified by age, gender and antiepileptic drug.

Results: 5417 patients (47.6% females) were prescribed 147 111 prescriptions for CBZ (34.5%), VPA (38.6%) or LTG (26.9%). The prevalence of LTG prescribing in females increased from 0.08 (95% CI 0.04 to 0.12) to 0.80 (95% CI 0.70 to 0.89) per 1000 female population. Conversely, the prevalence in females of CBZ and VPA prescribing significantly decreased from 1.00 (95% CI 0.85 to 1.15) to 0.51 (95% CI 0.44 to 0.58) and from 0.94 (95% CI 0.80 to 1.09) to 0.63 (95% CI 0.55 to 0.72), respectively. This 10-fold rise in LTG prescribing in females is much higher than the fivefold rise in males from 0.09 (95% CI 0.05 to 0.14) to 0.47 (95% CI 0.40 to 0.54) per 1000 male population.

Conclusion: The practice of prescribing antiepileptic drugs in adolescents has changed gradually over the last decade. More females aged 12-18 years are prescribed LTG than CBZ or VPA and the increase is much greater than for males. The increase in LTG prescribing mirrors a corresponding decrease in both VPA and CBZ. Concerns about potential problems to offspring appear to be affecting prescription trends in adolescent females of child-bearing potential.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Abnormalities, Drug-Induced / prevention & control
  • Adolescent
  • Anticonvulsants / adverse effects
  • Anticonvulsants / therapeutic use*
  • Carbamazepine / therapeutic use
  • Child
  • Contraceptive Agents / administration & dosage
  • Drug Interactions
  • Epilepsy / drug therapy*
  • Female
  • Humans
  • Lamotrigine
  • Practice Patterns, Physicians' / trends
  • Pregnancy
  • Triazines / therapeutic use
  • Valproic Acid / therapeutic use

Substances

  • Anticonvulsants
  • Contraceptive Agents
  • Triazines
  • Carbamazepine
  • Valproic Acid
  • Lamotrigine