Summary Tables

Summary Tables
Michael Privitera
TABLE 15.1. CHOOSING ANTIEPILEPTIC DRUGS ON THE BASIS OF DRUG INTERACTION AND ADVERSE EFFECT PROFILES
Issue or Effect More Favorable Less Favorable Comments
Drug inter actions GBP, LEV, PGB PHT, CBZ, PB, VPA PB, PHT, and CBZ are potent inducers of hepatic metabolism, whereas VPA is an inhibitor; PHT and VPA are highly protein bound
Interaction with oral contraceptive GBP, LEV, VPA, PGB PB, PHT, CBZ, OXC, TPM TPM lowers oral contraceptive concentrations only at dosages above 200 mg/d; LTG concentrations may be lowered by oral contraceptive use
Hepatic disease GBP, LEV, PGB PHT, PB, CBZ, VPA VPA can be hepatotoxic and may cause platelet dysfunction
Skin rash VPA, GBP, TPM, LEV, PGB PB, PHT, CBZ, LTG, OXC OXC has lower rash rate than CBZ
Concentration or other cognitive abilities LTG PB, PHT, TPM, ZNS At 100 mg/d as monotherapy, TPM had much less negative effect; most AEDs at high doses can cause these adverse effects
Sedation LTG PB, PHT, LEV, GBP, OXC, CBZ, TGB, TPM, ZNS, PGB Categorized as sedating if somnolence is listed as one of the five most common adverse effects
Weight Weight loss—TPM, ZNS Weight gain—VPA, GBP, PGB Weight loss may not be desirable in certain circumstances
GBP, gabapentin; LEV, levetiracetam; PGB, pregabalin; PHT, phenytoin; CBZ, carbamazepine; PB, phenobarbital; VPA, valproate; OXC, oxcarbazepine; TPM, topiramate; LTG, lamotrigine; ZNS, zonisamide; TGB, tiagabine.
TABLE 15.2. USING ANTIEPILEPTIC DRUGS FOR EPILEPSY TREATMENT
Indication Method/treatment mode Drug(s) Comments
A. Professional organization recommendations: American Academy of Neurology1,2
Seizures—partial onset Add-on Standard AED: PB, PHT, CBZ, VPA Newer AED: GBP, LTG, TPM, TGB, OXC, LEV, ZNS Newer AEDs may be better tolerated than the standard, with equivalent efficacy; the data do not answer questions about other potential advantages of newer AEDs such as better pharmacokinetics, less disturbance of the hormonal milieu, improved safety, and less laboratory monitoring
Seizures—primary Generalized Add-on TPM LTG (absence only)
Seizures—symptomatic generalized (Lennox–Gastaut syndrome) Add-on LTG, TPM
Seizures—partial-onset—children Add-on GBP, LTG, OXC, TPM
Seizures—mixed partial or generalized-onset Monotherapy TPM, LTG, OXC GBP (partial only) Insufficient evidence to make a recommendation on individual syndromes; insufficient evidence to make monotherapy recommendations on LEV, TGB, or ZNS
B. Systematic reviews by the Cochrane collaboration3,4,5,6,7
Partial seizures VPA, GBP, LTG, TPM, TGB, OXC, LEV, ZNS  
Absence seizures Insufficient evidence to inform clinical practice
C. U.S. Food and Drug Administration (FDA) Indications
Partial seizures Initial monotherapy PHT, OXC, TPM, PB, CBZ For topiramate, ages 10 years and older; for PB, PHT, CBZ there is no specific mention of monotherapy.
  Titration to monotherapy VPA, LTG, FBM
Partial seizures Add-on PHT, PB, CBZ, VPA, FBM, GBP, LTG, TPM, TGB, LEV, OXC, ZNS, PGB
Primary generalized tonic-clonic Add-on TPM, PHT, PB There is no specific mention of CBZ.
Pediatric partial Add-on GBP, LTG, OXC, TPM PB, PHT, and CBZ are not specifically mentioned.
Lennox–Gastaut Add-on LTG, TPM, FBM Felbamate is recommended for use only in those patients who respond inadequately to alternative treatments
AED, antiepileptic drug; PB, phenobarbital; PHT, phenytoin; CBZ, carbamazepine; VPA, valproate; GBP, gabapentin; LTG, lamotrigine; TPM, topiramate; TGB, tiagabine; OXC, oxcarbazepine; LEV, levetiracetam; ZNS, zonisamide; PGB, pregabalin; FBM, felbamate.

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Jul 14, 2016 | Posted by in PHARMACY | Comments Off on Summary Tables

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