Professional Documents
Culture Documents
Interactions
phenytoin
carbemazepine
phenobarbital
leviteracetam
oxcarbazepine
gabapentin
Absence Seizures
ethosuximide
Infantile Spasms
ACTH
vigabatrin
topiramate
valproate
lamotrigine
topiramate
zonisamide
benzodiazepines
Phenobarbital (Luminal)
Pharmacology
Adverse Effects
Idiosyncratic
Primidone (Mysoline)
Pharmacology
Adverse Effects
Similar to PB
Idiosyncratic
Rash, hepatitis
Acute initial toxicity
Drowsiness, dizziness, ataxia, nausea, vomiting
Dose-related
sedation, nystagmus, ataxia, vertigo
impotence, decreased libido
crystalluria
Tiagabine (Gabitril)
Pharmacology
Inhibits GABA reuptake
Protein binding: 95%
Metabolism: hepatic, nearly 100%, no induction
Adverse Effects
Neuropsychiatric: dizziness, fatigue, somnolence, nervousness,
Vigabatrin
Pharmacology
Adverse Effects
Notes
Phenytoin (Dilantin)
Pharmacology
Phenytoin (Dilantin)
Adverse Effects (cont)
Peripheral neuropathy
Gingival hyperplasia (20% adults, higher children)
Hirsutism, coarsening of facial features (5-10%)
Immunosuppression (5-10%): reduced IgA
Metabolic bone disease: osteomalacia, osteoporosis
Megaloblastic anemia (0.15-0.75%): folate deficiency
Aplastic anemia, leukopenia, thrombocytopenia, erythroid
hyperplasia, pancytopenia
Cardiac arrhythmias (rare)
Lupus-like syndrome (rare)
Carbamazepine (Tegretol)
Pharmacology
Adverse Effects
Idiosyncratic
Skin rashes (10-15%), Stevens-Johnson
Aplastic anemia (1/200,000) or agranulocytosis
Granulomatous hepatitis, cholangitis
Dose-related
CNS: dysequilibrium, drowsiness, nystagmus, dizziness, headache,
irritability, hyperactivity, impaired attention, memory
Anorexia, nausea, vomiting, Gl discomfort
Leukopenia, thrombocytopenia
Hyponatremia
Osteomalacia
Notes
Oxcarbazepine (Trileptal)
Pharmacology
Inhibits voltage-gated Na+ channels (binds to inactive form)
Adverse Effects
Idiosyncratic
Valproate (Depakote/Depakene)
Pharmacology
Adverse Effects
Idiosyncratic
Valproate (Depakote/Depakene)
Adverse Effects (cont)
Dose-related
Mental dulling, sedation: polytherapy, levels 100mcg/ml
Anorexia, nausea, vomiting, Gl distress, rare diarrhea
Weight gain
Hair loss
Tremor
Hyperammonemia / encephalopathy
Hepatic dysfunction
Thrombocytopenia, platelet defects, fibrinogen depletion, and
coagulopathy
Polycystic ovarian disease, menstrual irregularities
Teratogenicity
Notes
Drug of choice for childhood absence, JME
Useful in Lennox-Gastaut
Useful in bipolar disorder
Lamotrigine (Lamictal)
Pharmacology
Adverse Effects
Rash in 10-12%
Notes
Useful in Lennox-Gastaut, absence
Zonisamide (Zonegran)
Pharmacology
Adverse Effects
Idiosyncratic
Ethosuximide (Zarontin)
Pharmacology
Inhibits T-type Ca+ channels, modulating thalamic circuits
Protein binding: none
Metabolism: 80% hepatic, P450
Adverse Effects
Idiosyncratic
Gabapentin (Neurontin)
Pharmacology
Adverse Effects
Levetiracetam (Keppra)
Pharmacology
Mechanism unknown (K channel inhibition, synaptic vesicles)
Protein binding: <10%
Metabolism: ~25% by enzymatic hydrolysis of acetamide group,
not P450-dependent
minimal drug interactions
Adverse Effects
Somnolence and fatigue: not dose-related
Coordination difficulties: dizziness, ataxia, abnormal gait,
Behavioral abnormalities: agitation, hostility, anxiety, apathy,
Topiramate (Topamax)
Pharmacology
Adverse Effects
Dose-related
Notes
Felbamate (Felbatol)
Pharmacology
Adverse Effects
Notes
Used in Lennox-Gastaut
All older AEDs have been associated with neural tube defects;
mini-pill preparations are rendered LESS effective: need estrogencontaining OCP or alternative method
Interactions
Inducers: CBZ, dilantin, PB, primidone
channel blockers
VPA inhibits metabolism of toxic epoxide metabolite, increasing
toxicity