Class
- Antiepileptic drug (AED)
Felbamate
Commonly Prescribed for
(FDA approved in bold)
- Complex partial seizures (adjunctive)
- Partial and generalized seizures associated with Lennox-Gastaut syndrome (children)
- Infantile spasms (West syndrome)
Felbamate
How the Drug Works
- The exact mechanism of action in epilepsy is unknown, but putative mechanisms include changes in binding at GABA and benzodiazepine receptors and blockade of NMDA-activated glutamate receptors
Felbamate
How Long Until It Works
- Seizures – 2 weeks
Felbamate
If It Works
- Seizures – goal is the decrease or remission of seizures. Continue as long as effective and well-tolerated
Felbamate
If It Doesn’t Work
- Increase to highest tolerated dose. If not effective discontinue
Felbamate
Best Augmenting Combos for Partial Response or Treatment-Resistance
- Epilepsy: generally used in combination with other agents for severe epilepsy
Felbamate
Tests
- Obtain liver function testing and CBC before starting, and monitor frequently – especially in the first months after initiating treatment
- Repeat liver function testing whenever new medications are added
Adverse Effects (AEs)
Felbamate
How Drug Causes AEs
- CNS AEs may be caused by binding changes at GABA, benzodiazepine or NMDA receptors
- Aplastic anemia may be related to a reactive metabolite, 2-phenylpropenal
Felbamate
Notable AEs
- Most common: Anorexia, vomiting, insomnia, headache, dizziness, somnolence
- Less common: Rash, acne, edema, rhinitis, otitis media, diplopia, abnormal taste or vision
Felbamate
Life-Threatening or Dangerous AEs
- Liver failure, often with rapid onset (2–4 weeks)
- Aplastic anemia, often fatal and usually beginning 5–30 weeks after starting treatment
Felbamate
Weight Gain
- Unusual
Felbamate
Sedation
- Common
- Usually dose related
Felbamate
What to Do About AEs
- Most AEs resolve with reduction in dose
- For serious AEs discontinue drug
Stay updated, free articles. Join our Telegram channel
Full access? Get Clinical Tree
