30JUN

Welcome To MJPPS

The editors welcome the submission of relevant articles for editorial consideration. Manuscripts should be addressed to editor@medjpps.com.
Mediterranean Journal of Pharmacy and Pharmaceutical Sciences
https://ppj.org.ly/article/doi/10.5281/zenodo.15118894

Mediterranean Journal of Pharmacy and Pharmaceutical Sciences

Original article

Association between antiepileptic drug side effects and medication adherence among Libyan epilepsy patients

Ensherah M. N. Ben Zekri, Nabila A. Rghebi, Rima F. Elmzughi

http://dx.doi.org/10.5281/zenodo.15118894 Mediterr J Pharm Pharm Sci, Ahead of Print, 2025
PDF
Downloads: 0
Views: 132

Abstract

Treatment adherence is a critical component of epilepsy management. Antiepileptic drug side effects affect adherence and may result in the discontinuation of medication. This study aimed to investigate the association between antiepileptic drug side effects and medication adherence among Libyan patients with epilepsy while identifying predictors of adherence. A cross-sectional study was conducted at Tripoli University Hospital involving 200 adult epilepsy patients. Adherence was assessed via a self-report tool dichotomized as adherent/ non-adherent if patients stopped medication due to side effects. Side effects were evaluated using the Side Effects of Antiepileptic Drugs questionnaire. Logistic regression analyzed predictors of adherence, including antiepileptic drug use, therapy regimen, and side-effect profiles, with p<0.05 declared association. The overall adherence rate was 87.0%. Higher adherence was observed in older age groups, 95.8% in patients aged 51-60, 89.4% in married patients, and 91.0% in university-educated patients. Patients on monotherapy and those seizure-free in the preceding month demonstrated better adherence (88.4% and 93.0%, respectively). Valproate users had notably low adherence (52.6%) while carbamazepine and phenytoin users showed higher adherence (89.7% and 91.7%, respectively). Cognitive complaints significantly reduced adherence (76.1% vs. 79.6%), as did aggressive behavior (58.3% adherence). Logistic regression identified two independent predictors: patients on old-generation antiepileptic drugs had 2.7 times higher adherence (AOR=2.702, 95% CI: 1.168-6.249; p=0.02) while cognitive side effects reduced adherence by 86.4% (AOR=0.136, 95% CI: 0.031-0.596; p=0.008). Cognitive side effects predict non-adherence, necessitating routine monitoring. Paradoxically, older antiepileptic drugs correlated with better adherence. Integrating patient-reported metrics and addressing cognitive impacts could optimize epilepsy care, highlighting gaps in side-effect management and advocating personalized strategies in clinical settings.

Keywords

Antiepileptic drug, cognitive complaint, epilepsy, medication adherence, side effects

References

  1. Beghi E (2020) The epidemiology of epilepsy. Neuroepidemiology. 54 (2): 185-191. doi: 10.1159/000503831
  2. Getnet A, Woldeyohannes SM, Bekana L, Mekonen T, Fekadu W, Menberu M, Yimer S, Assaye A, Belete A, Belete H (2016) Antiepileptic drug nonadherence and its predictors among people with epilepsy. Behavioural Neurology. 2016: 3189108. doi: 10.1155/2016/3189108
  3. Gurumurthy R, Chanda K, Sarma G (2017) An evaluation of factors affecting adherence to antiepileptic drugs in patients with epilepsy: a cross-sectional study. Singapore Medical Journal. 58 (2): 98-102. doi: 10.11622/smedj. 2016022
  4. DM IJff, Kinderen RJ, Vader CI, Majoie MHJM, Aldenkamp AP (2015) Subjectively perceived side-effects of anti-epileptic drugs in chronic refractory epilepsy. Advances in Pharmacoepidemiology & Drug Safety. 4 (4): 1-5. 1000186. doi: 10.4172/2167-1052.1000186
  5. Sherif (2016) Pharmacological review of vigabatrin. Pharmacy and Pharmacology International Journal. 4 (1): 00063. doi: 10.15406/ppij.2016.04.00063
  6. Sherif FM (2017) Role of the pharmacist in adverse drug reaction monitoring. Pharmacy and Pharmacology International Journal. 5 (5): 172. doi: 10.15406/ppij.2017.05.00133
  7. Perucca P, Gilliam FG (2012) Adverse effects of antiepileptic drugs. The Lancet. Neurology. 11 (9): 792-802. doi: 10.1016/S1474-4422(12)70153-9
  8. de Kinderen RJA, Evers SMAA, Rinkens R, Postulart D, Vader CI, Majoie MH, Aldenkamp AP (2014) Side-effects of antiepileptic drugs: The economic burden. Seizure. 23 (3): 184-190. doi: 10.1016/j.seizure.2013.11.009
  9. Walia KS, Khan EA, Ko DH, Raza SS, Khan YN (2004) Side effects of antiepileptics-a review. Pain Practice. 4 (3): 194-203. doi: 10.1111/j.1533-2500.2004.04304.x
  10. Witkin JM, Golani LK, Smith LJ (2021) New and emerging antiepileptic drug targets. In: Burger’s Medicinal Chemistry, Drug Discovery and Development, 8th Ed., John Wiley & Sons, Inc. doi: 10.1002/0471266949. Online ISBN: 9780471266945.
  11. Shams ME, Barakat EA (2010) Measuring the rate of therapeutic adherence among outpatients with T2DM in Egypt. Saudi Pharmaceutical Journal. 18 (4): 225-232. doi: 10.1016/j.jsps.2010.07.004
  12. Masroor Roudsari D, Mohammad Beigi E, Haghani H (2017) Effect of peer education on the medication adherence and the quality of life of hypertensive patients. Pharmacophore. 8 (3): 19-23. doi: Nil.
  13. Khalil A, Al-Amoudi AA, Almutairi MM, Abualola RA, Altaifi JA (2018) Adherence to anti-epileptic drugs and their determinant factors among adult patients with epilepsy. Pharmacophore. 9 (6): 41-48. doi: Nil.
  14. Paschal AM, Rush SE, Sadler T (2014) Factors associated with medication adherence in patients with epilepsy and recommendations for improvement‏. Epilepsy & Behavior. 31: 346-350. doi: 10.1016/j.yebeh.2013.10.002
  15. Sweileh WM, Ihbesheh MS, Jarar IS, Zyoud SH, Jamous RM, Morisky DE (2011) Self-reported medication adherence and treatment satisfaction in patients with epilepsy. Epilepsy & Behavior. 21 (3): 301-305. doi: 10.1016/ j.yebeh.2011.04.011
  16. Awan SA, Khawaja I, Babar M, Khan F (2022) Prevalence of non-adherence to antiepileptic drugs in patients with epilepsy presenting to emergency with fits. Cureus. 14 (7): e27072. doi: 10.7759/cureus.27072
  17. Beghi E, Beghi M, Cornaggia CM (2014) The use of recently approved antiepileptic drugs: use with caution, use in refractory patients or use as first-line indications? Expert Review of Neurotherapeutics. 11 (12): 1759-1767. doi: 10.1586/ern.11.169
  18. Bautista RED, Rundle-Gonzalez V (2012) Effects of antiepileptic drug characteristics on medication adherence. Epilepsy & Behavior. 23 (4): 437-441. doi: 10.1016/j.yebeh.2012.02.002
  19. Golpayegani M, Salari F and Gharagozli K (2019) Newer antiepileptic drugs discontinuation due to adverse effects: an observational study. Annals of Indian Academy of Neurology. 22 (1): 27-30. doi: 10.4103/aian.AIAN_25_18
  20. Martins HH, Alonso NB, Guilhoto LMFF, Guaranha MSB, Yacubian EMT (2009) Adherence to treatment in patients with juvenile myoclonic epilepsy: correlation with quality of life and adverse effects of medication. Journal of Epilepsy and Clinical Neurophysiology. 15 (4): 192-196. doi: 10.1590/S1676-26492009000400010
  21. Bayane YB, Senbeta BS (2023) Pattern of anti-epileptic medications non adherence and associated factors at ambulatory clinic of Jimma Medical Center, Southwestern Ethiopia: A prospective observational study. SAGE Open Medicine. 11: 20503121231160817. 1-9. doi: 10.1177/20503121231160817
  22. Tilahun M, Habte N, Mekonnen K, Srahbzu M, Ayelegne D (2020) Nonadherence to antiepileptic medications and its determinants among epileptic patients at the University of Gondar Referral Hospital, Gondar, Ethiopia, 2019: An institutional-based cross-sectional study. Neurology Research International. 2020: 8886828. doi: 10.1155/2020/ 8886828
  23. Elmuzghi RF (2023) Assessing the influential factors associated with medication non-adherence and self-care practices among type 2 diabetes mellitus patients in Tripoli, Libya. Sciences of Pharmacy. 2 (2): 104-116. doi: 10.58920/sciphar02020077
  24. Hasiso TY, Desse TA (2016) Adherence to treatment and factors affecting adherence of Epileptic patients at Yirgalem General Hospital, Southern Ethiopia: A prospective cross-sectional study. PLoS one. 11 (9): e0163040. doi: 10.1371/journal.pone.0163040
  25. Al-Faris EA, Abdulghani HM, Mahdi AH, Salih MA, Al-Kordi AG (2002) Compliance with appointments and medications in a pediatric neurology clinic at a University Hospital in Riyadh, Saudi Arabia. Saudi Medical Journal. 23 (8): 969-974. PMID: 12235472.
  26. El-Shazly M, Abdel-Fattah M, Zaki A, Bedwani R, Assad S, Tognoni G, Nicolucci A (2000) Health care for diabetic patients in developing countries: a case from Egypt. Public Health. 114 (4): 276-281. doi: 10.1038/sj.ph.1900666
  27. Munaf ZA, Mohammed SI (2024) Quality of life, adherence and knowledge of epileptic patients and the impact of a pharmacist‐led educational intervention: A review. Medicine Advances. 2: 29-42. doi: 10.1002/med4.55
  28. Seidenberg M, Pulsipher DT, Hermann B (2009) Association of epilepsy and comorbid conditions. Future Neurology. 4 (5): 663-668. doi: 10.2217/fnl.09.32
  29. Zhou Y, Kobau R, Pastula DM, Greenlund KJ (2024) Comorbidity among adults with epilepsy -United States, 2021-2022. Preventing Chronic Disease. 21: 240313. doi: 10.5888/pcd21.240313
  30. Gabr WM, Shams MEE (2015) Adherence to medication among outpatient adolescents with epilepsy. Saudi Pharmaceutical Journal. 23 (1): 33-40. doi: 10.1016/j.jsps.2014.05.003
  31. Aldenkamp AP, van Meel HF, Baker GA, Brooks J, Hendriks MPH (2002) The A-B neuropsychological assessment schedule (ABNAS): the relationship between patient-perceived drug related cognitive impairment and results of neuropsychological tests. Seizure. 11 (4): 231-237. doi: 10.1053/seiz.2002.0672 
  32. Bootsma HP, Ricker L, Hekster YA, Hulsman J, Lambrechts D, Majoie M, Schellekens A, de Krom M, Aldenkamp AP (2009) The impact of side effects on long-term retention in three new antiepileptic drugs. Seizure. 18 (5): 327-331. doi: 10.1016/j.seizure.2008.11.006
  33. Beghi E (2004) Efficacy and tolerability of the new antiepileptic drugs: comparison of two recent guidelines. The Lancet. Neurology. 3 (10): 618-621. doi: 10.1016/S1474-4422(04)00882-8
  34. Donahue MA, Akram H, Brooks JD, Modi AC, Veach J, Kukla A, Benard SW, Herman ST, Farrell K, Ficker DM, Zafar SF, Trescher WH, Sirsi D, Phillips DJ, Pellinen J, Buchhalter J, Moura L, Fureman BE; as the Epilepsy Learning Healthcare System (2025) Barriers to medication adherence in people living with epilepsy. Neurology: Clinical Practice. 15 (1): e200403 doi: 10.1212/CPJ.0000000000200403
  35. Shumet S, Wondie M, Ayano G, Asfaw H, Kassew T, Mesafint G (2022) Antiepileptic drug adherence and its associated factors among epilepsy patients on follow-ups at Amanuel Mental Specialized Hospital, Ethiopia. Ethiopian Journal of Health Sciences. 32 (5): 913-922. doi: 10.4314/ejhs.v32i5.6
  36. Chen B, Choi H, Hirsch LJ, Moeller J, Jayed A, Kato K, Legge A, Buchsbaum R, Detyniecki K (2015) Cosmetic side effects of antiepileptic drugs in adults with epilepsy. Epilepsy and Behavior. 42: 129-137. doi: 10.1016/j.yebeh. 2014.10.021
  37. Haag A, Strzelczyk A, Bauer S, Kühne S, Hamer HM, Rosenow F (2010) Quality of life and employment status are correlated with antiepileptic monotherapy versus polytherapy and not with use of “newer” versus “classic” drugs: results of the “Compliant 2006” survey in 907 patients. Epilepsy and Behavior. 19 (4): 618-622. doi: 10.1016/ j.yebeh2010.09.037
  38. Mansour M, Alkadi AE, Alnayif HA, Otannish (2022) Assessment of knowledge and awareness of community pharmacists toward epilepsy Mediterranean Journal of Pharmacy and Pharmaceutical Sciences. 2 (3): 17-23. doi: 10.5281/zenodo.7115139

Submitted date:
02/12/2025

Reviewed date:
03/24/2025

Accepted date:
04/28/2025

Publication date:
04/01/2025

67ebc4ada95395548d06ce73 medjpps Articles
Links & Downloads
2789-1895 (Electronic) 2958-3101 (Printed)
Mediterr J Pharm Pharm Sci ©2025 All rights reserved.

Mediterr J Pharm Pharm Sci

Share this page
Page Sections