Prescription Patterns and Clinical use of Antiepileptic Drugs in a Tertiary Care ICU in Western India: A Prospective Cross‑Sectional Study

Abstract

Background: Epilepsy is a major chronic neurological disorder that requires long‑term treatment with antiepileptic drugs (AEDs), and inappropriate prescribing can worsen outcomes, increase adverse effects, and add to healthcare costs. Monitoring real‑world AED utilization in tertiary‑care settings is essential to promote rational pharmacotherapy and align practice with national and international guidelines.
Objective: To evaluate the prescribing patterns of AEDs in a tertiary‑care hospital, with emphasis on the use of newer versus conventional agents, the proportion of monotherapy and polytherapy, and the influence of documented comorbidities on prescribing trends.
Methods: A prospective, observational, cross‑sectional prescription audit was conducted over six months in a tertiary‑care hospital in Latur, Maharashtra, India.All prescriptions containing at least one AED for patients managed for epilepsy or seizure disorders during the study period were included.An anonymized, structured proforma was used to record indication, AEDs prescribed (name, route, regimen), number of AEDs per prescription (monotherapy vs polytherapy), presence of major comorbidities in aggregate categories, and any adverse drug reactions documented in the medical records. Data were analysed descriptively using frequencies and percentages.
Results: Seventy‑seven AED‑containing prescriptions were evaluated. Monotherapy was observed in 50 prescriptions (64.9%), while 27 (35.1%) involved polytherapy with two or more AEDs. Levetiracetam was the most frequently prescribed drug, appearing in 72 prescriptions (93.51%), and constituted the core of both single‑drug and combination regimens.Conventional agents were less commonly used: valproic acid in 20 prescriptions (25.97%), fosphenytoin in 9 (11.69%), and phenytoin in 7 (9.09%). No comorbidities were recorded in 49 prescriptions (72%); among those with documented comorbid conditions, hypertension (13%), type 2 diabetes mellitus (8%), and concurrent diabetes with hypertension (7%) were most frequent.Available demographic details suggested a male predominance and higher AED use in adults aged 18–40 years.
Conclusion: AED prescribing in this tertiary‑care hospital was characterized by a clear preference for monotherapy and a marked shift toward levetiracetam‑based regimens, with traditional agents used less often. These patterns suggest increasing reliance on newer AEDs with favourable safety and interaction profiles, but also highlight the need for better documentation of seizure type and comorbidities, and for regular prescription audits and clinical pharmacist involvement, to ensure sustained adherence to evidence‑based epilepsy treatment guidelines.