may require a lamotrigine dosage rease of about 50% to maintain unchanged lamotrigine serum concentrations . Coadministration of raltegravir or atazanavir and lamotrigine may not require lamotrigine dosage adjustment . Coadministration of raltegravir and midazolam may not require midazolam dosage adjustment . Patients may be counseled that it is unclear Fisetin whether dosage adjustment is necessary when other AEDs and ARVs are combined . It may be important to avoid EI AEDs in people on ARV regimens that lude PIs or NNRTIs, as pharmacokinetic interactions may result in virologic failure, which has clinical implications for disease progression and development of ARV resistance. If such regimens are required for seizure control, patients may be monitored through pharmacokinetic assessments to ensure efficacy of the ARV regimen .
CLINICAL CONTEXT A retrospective cohort study and numerous pharmacokinetic studies indicate that EI AEDs interact with ARVs. The optimal choice of epilepsy treatment in patients with HIV should reflect an accounting for the metabolic and inhibitory/ inducing profiles of coadministered FGFR Signaling Pathway drugs. Clinicians who prescribe ARVs and AEDs are encouraged to refer to the Department of Health and Human Services treatment guidelines for HIV/AIDS, which provide specific recommendations for the management of possible drug–drug interactions with AED ARV combinations . For newer ARV agents, minimal data exist on drug interactions with AEDs. RECOMMENDATIONS FOR FUTURE RESEARCH Future research regarding AED ARV interactions is needed.
Special priority should be given to the study of first line AED ARV combinations used in lowand middle ome countries where second line agents may not be available. AUTHOR CONTRIBUTIONS Dr. Birbeck: drafting/revising the manuscript, study concept or design, analysis or interpretation paraffin of data, acquisition of data, study supervision, obtaining funding. It is based on an assessment of current scientific and clinical information. It is not intended to lude all possible proper methods of care for a particular neurologic problem or all legitimate criteria for choosing to use a specific procedure. Neither is it intended to exclude any reasonable alternative methodologies. The AAN and ILAE recognize that specific patient care decisions are the prerogative of the patient and the physician caring for the patient, based on all of the circumstances involved.
The clinical context section is made available in order to place the evidence based guideline into perspective with current practice habits and challenges. No formal practice recommendations should be inferred. The American Academy of Neurology is committed to producing independent, critical and truthful clinical practice guidelines . Significant efforts are made to minimize the potential for conflicts of interest to influence the recommendations of this CPG. To the extent possible, the AAN keeps separate those who have a financial stake in the success or failure of the products appraised in the CPGs and the developers of the guidelines. Conflict of interest forms were obtained from all authors and reviewed by an oversight committee prior to project initiation. AAN limits the participation of authors with substantial conflicts of interest.