Polypharmacy in elderly patients
- The information below is a hypothetical case example of a patient experiencing breakthrough adverse reactions once in a while who is on multiple medications which might be the reason for additional problem to patient.
- A 57-years female patient had a known history of Trigeminal Neuralgia left V2 (Maxillary nerve) for 2 years. She has been on multiple drugs like Ox-carbamazepine, Pregabalin and Dothiepin for past 2 years. She was asymptomatic for 1 year, again recurrence of pain while brushing teeth and eating.
- She recently had a compliant of slurring of speech and weakness of right upper limb, Echo report showed fast ventricular rate and possible embolic stroke. Drugs was changed and patient recovered.
- While again patient had compliant of headache, palpitation, while coughing, Patient was tachypneic.
Clinical findings
ECG showed AF with RVR.
Discussion
- Pregabalin is an anticonvulsant and is also used to treat neuropathic pain (pain caused by nerve damage). Since trigeminal neuralgia is a form of neuropathic pain, pregabalin is effective in controlling and reducing the intensity of the pain.
- Some AEDs (Ox-carbamazepine) are primarily developed for blocking neuronal ion channels, e.g., voltage-gated channels. Importantly, neuronal and cardiac ion channel isoforms are highly homologous. Thus, AEDs may not only affect neuronal electrical activity but may also act on cardiac ion channels, thereby causing cardiac arrhythmias.
- In elderly patients free of cardiovascular disease, exposure to gabapentin or to pregabalin or ox carbamazepine may be associated with an increased risk of AF.
- The drugs given for trigeminal neuralgia possibly would had caused Atrial Fibrillation for this patient.
- A radiofrequency ablation could be an effective option for this patient.
- Radiofrequency ablation (RFA) is a minimally invasive procedure used to treat trigeminal neuralgia (TN), a condition causing severe facial pain. During RFA, a needle is inserted near the trigeminal nerve, and a radiofrequency current is used to selectively damage the nerve fibers transmitting pain.
