Class
- Antiepileptic drug (AED)
Vigabatrin
Commonly Prescribed for
(FDA approved in bold)
- Infantile spasms in children (ages 1 month-2 years)
- Adjunctive for treatment-resistant epilepsy
- Complex partial seizures
- Cocaine or methamphetamine dependence
Vigabatrin
How the Drug Works
- Inhibits catabolism of GABA by inhibiting gamma-aminobutyric acid transaminase (GABA-T). This increases synaptic levels of GABA. Does not act directly on GABA receptors. May decrease levels of excitatory neurotransmitters (glutamate, aspartate, glutamine) in the brain
Vigabatrin
How Long Until It Works
- Seizures –by 2 weeks
Vigabatrin
If It Works
- Seizures – goal is the remission of seizures. Continue as long as effective and well-tolerated
Vigabatrin
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
Vigabatrin
Best Augmenting Combos for Partial Response or Treatment-Resistance
- Often used in combination with other AEDs. Lack of significant drug interactions make it easier to use than many other AEDs
Vigabatrin
Tests
- No regular blood tests are recommended
Adverse Effects (AEs)
Vigabatrin
How Drug Causes AEs
- CNS AEs are probably caused by changes in GABA levels
Vigabatrin
Notable AEs
- Somnolence, fatigue, weight gain, headache, dizziness, anxiety, depression, ataxia, hyperactivity (children), psychosis (adults)
Vigabatrin
Life-Threatening or Dangerous AEs
- Retinal atrophy and visual field defects in about 1/3 of patients, peaking at 1 year but occurring as soon as a few weeks. Visual field loss may be irreversible
Vigabatrin
Weight Gain
- Not unusual
Vigabatrin
Sedation
- Not unusual
Vigabatrin
What to Do About AEs
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