Medications, epilepsy and climate change: Added layers of complexity.

Climate change-the global crisis with pervasive health impacts-has adverse consequences for people with epilepsy (PWE) who have low quality of life due to poor seizure control, socioeconomic disadvantages and comorbidities. This review focuses on the potential effects of climate change on the pharmacological characteristics of antiseizure medications (ASMs), antipsychotics and antidepressants. We note that findings particularly obtained from physicochemical stability studies have been demonstrated experimentally for some specific environmental conditions whereas studies for clinical outcome effects are very limited. Carbamazepine, valproate, phenytoin or lorazepam appear to be ASMs at risk of being affected by high temperature and/or humidity. Even the stability of blood samples needs to be considered during transportation to therapeutic drug monitoring units, particularly for the PWE living in low-income countries that are facing the most challenges of climate change effects attributed to low infrastructure and healthcare system capacity. We need more urgent research investigating drug responses of PWE regarding especially the effects of adverse weather events such as heatwaves on physicochemical stability or pharmacokinetics of drugs in a complex interaction with the vulnerabilities of individuals, accompanying neuropsychiatric disorders and geographical challenges. Then we will be able to develop pharmacological treatment strategies to improve the quality of life of PWE during adverse weather events.