Rationale: Most antiseizure medications (ASMs) approved since 2000 have been scheduled under the Controlled Substances Act in the United States. This reflects findings of increased addictive potential among these drugs. We have undertaken a systematic literature review to examine what ASMs have been reported to result in substance use disorders (SUDs).
Methods:
A search of PubMed using the combined term “Anticonvulsants AND Substance Related Disorders” was made. A search of Embase using the combined term “Anticonvulsants AND Drug Dependence” was also performed. Finally we searched both databases using individual ASM names along with the term "substance related disorders.”
Inclusion criteria consisted of the following 1) Does the paper discuss an ASM that is currently prescribed to patients? 2) Does the paper discuss the ASM being used by the patient in a way that meets the DSM-V’s criteria for a substance use disorder?
Articles were excluded if intentional misuse of ASMs were related to suicide or attempt. Papers were also excluded that involved accidental overdose. Finally, articles which were not accessible in English were excluded.
Results: One hundred forty-four published articles met inclusion criteria. Of these 83% described misuse, dependence, or abuse of gabapentin, pregabalin, or both. Just under 5% implicated carbamazepine. One to three reports each were found involving phenytoin, alprazolam, diazepam, eslicarbazepine, phenobarbital, and fenfluramine.
Conclusions: The published literature on SUDs involving ASMs is mostly focused on the gabapentinoid class of medications. Carbamazepine was the remote second-most cited ASM involving SUDs. These results may be informative to prescribers and policymakers on the potential for misuse, dependence, and abuse among the ASMs.
Funding: None.