Medicine Reduction Examples

Sample 1

EPILEPSY MONITORING UNIT PROTOCOLS

Medication reduction to increase seizure yield: Medication reductions are tailored to the individual patient and to the specific goals of care.

  1. For patients with frequent (i.e. daily or near daily) seizures, initial monitoring is conducted without home medications being reduced.
  2. For patients admitted with signs or symptoms which may be side effects of prescribed medications, initial monitoring is also conducted without home medications being reduced.
  3. For all other patients on medications, particularly for those undergoing characterization of events and/or localization for pre-surgical evaluation, medications are generally reduced from admission in a sequential order at one-half to one-third of the dosage, as is reasonable, until the medication has been discontinued.

Sample 2

Epilepsy Monitoring Unit Protocols
AED Reduction to Maximize A Yield Of Monitoring

Each patient's plan has to be individualized according to their clinical scenario and specific goals of admission to the EMU.

An EMU attending is ultimately responsible to address an AED Reduction issues for all patients under their care.

All patients have to be counseled in detail about a likely necessity for and associated risks involved in AED reduction or discontinuation in the EMU.

Only in the case of well-known patients who are being re-admitted to the EMU AEDs may be reduced or rarely stopPed before their EMU admission.

Considering different referral sources and level of specific patients' instructions, it is necessary to verify and document when the patient took their last doze of each AED.

All patients in the EMU irrespective of AED regimen must have an IV in place and a written benzodiazepine rescue protocol.

Once in the EMU, it is generally preferred to reduce or stop an AED with a shorter half-life and/or one that can be easily loaded via IV.

Generally, it may be acceptable to stop one medication first day if the patient is on polytherapy. In patients on monotherapy, a reduction by 30-50% may be appropriate. Subsequent AED reduction should be customized according to the clinical development.

Carbamazepine is one AED whose fast reduction or abrupt discontinuation may lead to different seizures that are not habitual seizures of the patient.

In principle, the patients are restarted on their outpatient doses of AEDs if they are to be continued upon discharge.

The patient has to receive at least their daily dose of all AEDs before discharge unless otherwise specifically agreed by the patient and EMU attending.