Class
- Antiepileptic drug (AED)
Tiagabine
Commonly Prescribed for
(FDA approved in bold)
- Partial seizures in adults and children age 12 or older
- Temporal lobe epilepsy (children and adults)
- Panic disorder
Tiagabine
How the Drug Works
- Enhances activity of GABA by binding to sites associated with GABA uptake into presynaptic neurons, allowing more GABA to be available to bind to receptors on postsynaptic cells
Tiagabine
How Long Until It Works
- Seizures – should decrease by 2 weeks
Tiagabine
If It Works
- Seizures – goal is the remission of seizures. Continue as long as effective and well-tolerated. Consider tapering and slowly stopping after 2 years without seizures
Tiagabine
If It Doesn’t Work
- Increase to highest tolerated dose
- Epilepsy: consider changing to another agent, adding a second agent or referral for epilepsy surgery evaluation
Tiagabine
Best Augmenting Combos for Partial Response or Treatment-Resistance
- Epilepsy: titration and combination regimen depends on whether the patient is on an enzyme-inducing drug or not
Tiagabine
Tests
- No regular blood tests are recommended
Adverse Effects (AEs)
Tiagabine
How Drug Causes AEs
- CNS AEs are probably caused by excess GABA effect
Tiagabine
Notable AEs
- Confusion, stuttering, muscle tremor, dizziness, sedation, paresthesias (usually doses > 8 mg/day), abdominal pain
- Less commonly, behavioral symptoms such as amnesia, extreme confusion, or seizures or seizure-like symptoms
Tiagabine
Life-Threatening or Dangerous AEs
- Can precipitate seizure in some patients (rare)
- Severe rash (rare) including Stevens-Johnson syndrome
- Falls producing accidental injury
Tiagabine
Weight Gain
- Common
Tiagabine
Sedation
- Common
Tiagabine
What to Do About AEs
- Decreasing dose may improve CNS AEs, especially weakness and sedation
- Titrate more slowly
Tiagabine
Best Augmenting Agents for AEs
- Initially dose at night to avoid sedation
