Prescription Patterns of Antiepileptic Drugs and Co-prescribed Medications in Patients with Epilepsy in Kazakhstan (2021-2023)

Background/Objectives: Epilepsy is a major neurological disorder associated with significant comorbidity and treatment challenges. In low- and middle-income countries, access to newer antiseizure medications remains limited, and prescription patterns often rely on older agents. This study aimed to characterize national prescribing patterns of antiepileptic drugs (AEDs), assess monotherapy versus polytherapy use, and examine comorbid medication profiles among patients with epilepsy in Kazakhstan from 2021 to 2023. Methods: We conducted a retrospective observational study using de-identified electronic health record data from the Unified National Electronic Health System of Kazakhstan. All patients with an ICD-10 diagnosis of epilepsy (G40) and at least one AED prescription during 2021–2023 were included. Prescription frequencies, therapy type, and chronic polytherapy levels were analyzed. Non-AED medications were categorized using the WHO ATC classification, and the most common comorbid drugs were identified. Associations between therapy type, age, and comorbidity status were determined. Results: A total of 54,274 patients were identified (median age 42 years; IQR 31–57). Monotherapy predominated: 61.7% remained on monotherapy, 18.5% remained on polytherapy, and 19.8% had mixed exposure. Overall, 12.3% escalated from monotherapy to polytherapy and 11.3% de-escalated from polytherapy to monotherapy. Carbamazepine and valproic acid were most frequently prescribed (64.3% and 45.6% of patients, respectively). Lamotrigine (20.4%) and levetiracetam (15.2%) showed year-on-year increases, topiramate was stable (8.8%), and oxcarbazepine remained infrequent but rose from a low baseline (2.4%). Among those with chronic medication data (n=15,752), nervous-system drugs were common (70.1%), led by psycholeptics (49.7%); frequently dispensed agents included chlorpromazine (n=5,991), clozapine (n=1,875), and risperidone (n=1,642). Cardiovascular agents were recorded in 37.2% (acetylsalicylic acid n=4,056; atorvastatin n=2,235), and diabetes drugs in 12.1% (metformin n=1,430). Conclusions: AED prescribing in Kazakhstan is dominated by older broad-spectrum agents, with increasing uptake of lamotrigine and levetiracetam. High monotherapy rates align with guideline-concordant care, whereas escalation and de-escalation patterns reflect the dynamic management of refractory disease. The frequent use of psychotropic and cardiometabolic medicines highlights the need for integrated, multidisciplinary care and ongoing surveillance of prescribing to optimize safety and effectiveness.