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Background: Levetiracetam is widely used in post-stroke epilepsy. However, it is suspected to possess P-glycoprotein (P-gp) induction properties, and therefore, a potentially significant interaction with direct oral anticoagulants (DOACs). We aimed to search for ischemic stroke signals with levetiracetam and the DOACs., Methods: In this retrospective pharmacovigilance study, we used the FAERS database to identify ischemic stroke events associated with DOACs and concomitant use of levetiracetam. We evaluated disproportionate reporting by the adjusted reporting odds ratio (adjROR) and the lower bound of the shrinkage 95% confidence interval. When shrinkage is positive, an increased risk of a specific adverse event occurrence is emphasized over the sum of the individual risks when these same drugs are used separately., Results: We identified 1841 (1.5%), 3731 (5.3%), 338 (4.9%), and 1723 (1.3%) ischemic stroke reports with apixaban, dabigatran, edoxaban, and rivaroxaban, respectively. The adjROR of the interaction effect was 3.57 (95% CI 2.81-4.58) between DOACs and levetiracetam. The shrinkage analysis detected an interaction between each of the DOACs and levetiracetam. The logistic model and shrinkage analysis failed to detect an interaction when queried for hemorrhagic stroke. A significant signal in the classical enzyme inducer, carbamazepine, strengthened our results (adjROR; 8.47, 95% CI 5.37-13.36)., Conclusions: Our study shows a strong signal for the levetiracetam interaction with the DOACs. Our findings suggest implementation of a drug monitoring strategy., (© 2023. The Author(s), under exclusive licence to Springer Nature Switzerland AG.)

The blood-brain barrier (BBB) prevents drugs' permeability into the brain and limits the management of brain diseases. Intranasal delivery is a convenient route of drug administration that can bypass the BBB and lead to a direct delivery of the drug to the brain. Indeed, drug accumulation in the brain following intranasal application of a drug solution, or of a drug encapsulated in specialized delivery systems (DDSs), has been reported in numerous scientific publications. We aimed to analyze the available quantitative data on drug delivery to the brain via the nasal route and to reveal the efficiency of brain drug delivery and targeting by different types of nasally-administered DDSs. We searched for scientific publications published in 1970-2014 that reported delivery of drugs or model compounds to the brain via intranasal and parenteral routes, and contained quantitative data that were sufficient for calculation of brain targeting efficiency. We identified 73 publications (that reported data on 82 compounds) that matched the search criteria and analyzed their experimental settings, formulation types, analytical methods, and the claimed efficiencies of drug brain targeting: drug targeting efficiency (%DTE) and nose-to-brain direct transport (%DTP). Outcomes of this analysis indicate that efficiency of brain delivery by the nasal route differs widely between the studies, and does not correlate with the drug's physicochemical properties. Particle- and gel-based DDSs offer limited advantage for brain drug delivery in comparison to the intranasal administration of drug solution. Nevertheless, incorporation of specialized reagents (e.g., absorption enhancers, mucoadhesive compounds, targeting residues) can increase the efficiency of drug delivery to the brain via the nasal route. More elaborate and detailed methodological and analytical characterizations and standardized reporting of the experimental outcomes are required for reliable quantification of drug targeting to the brain by the nasal route. Quantitative analysis of these data will facilitate the development of DDSs with high brain targeting efficiency., (Copyright © 2014 Elsevier B.V. All rights reserved.)

Dehydroepiandrosterone (DHEA), pregnenolone (P) and their sulfate derivatives are neuroactive neurosteroids synthesized endogenously in the brain and in steroidogenic organs and influence or are influenced by a variety of physiological processes. Since parturition is followed by a rapid drop in estrogen levels in serum and brain it may be hypothesized that the drastic drop in the brain exposure to estrogens may cause a disturbance in the neurosteroid-to-neurosteroid-sulfate equilibrium with clinical relevance. In order to develop a rat animal model for human postpartum rapid estrogen decline conditions, the present study investigated effects of sudden withdrawal of hyperphysiological estrogens levels on levels of DHEA, DHEAS, P and PS in peripheral blood and brain tissue as well as cortical sulfatase activity. Twenty-four 3-month-old female rats were ovarectomized followed by either no estrogen, high levels of estrogen alone, or followed by sudden withdrawal after high-administered estrogen levels. Results indicated elevated brain cortical DHEA-S and reduced cortical sulfatase in ovarectomized rats following sudden estrogen withdrawal. No significant alterations in DHEA, P or PS were noted. Study observations suggest the marked influence estrogen withdrawal states may have on cortical DHEA-S levels in particular, the precise mechanism of which remains unknown but which may be related to the paralleled decrease in sulfatase activity. This DHEA-S increase may lead to attenuated GABAergic tone and may be relevant to post-natal behavioral disturbances (e.g. depression, anxiety).