Anti Epileptics | MedicScientist :: Total Health Portal

Carbamazepine

Details About Generic Salt ::  Carbamazepine 

Main Medicine Class:: Nervous System   Sub Medicine Class ::  Anti Epileptics

1C. ANTI-EPILEPTICS in 1. NERVOUS SYSTEM
CARBAMAZEPINE
IMINOSTILBENE DERIVATIVE | ANTI–EPILEPTIC, ANTI-DEPRESSANT
also comes under 1D. Anti-Depressants in 1. Nervous System
PK: A: Slow D: Adult:0.59-2 L/kg, Child: 1.9 L/kg, Neonates:1.5 L/kg(Vd) M: Hepatic E: Urine (72%), feces (28%)

Indications & Dose: BIPOLAR DISORDER Prophylactic therapy PO Adult Initially 400mg/day in 2 divided doses, max 1600mg/dayunresponsive to lithium | EPILEPSY PO Adult Initially 100–200mg OD/BID, MD 0.8–1.2g/day in divided doses, max 1.6–2g/day Child Up to 1 yr: 100–200 mg, 1–5 yrs: 200–400mg, 5–10 yrs: 400–600mg, 10–15 yrs: 0.4–1g Elderly Reduce the initial dose | TRIGEMINAL NEURALGIA PO Adult Initially 200mg/day in 2 divided doses, MD 400-800mg/day in 2 divided doses, max 1200mg/day

Contra: Hypersensitivity, bone marrow depression, with/within 14 days of MAOIs use, concomitant use of nefazodone

Precautions: Avoid abrupt drug withdrawal, hepatic/renal impairment, cardiac disease, history of blood disorders, glaucoma

ADR: Serious: osteomalacia, CHF, SJS, TEN, hepatitis, ARF, thromboembolism, cholestatic jaundice, pulmonary hypersensitivity, arrhythmias, Others: Hyponatremia, drowsiness, dizziness, ataxia, diplopia, nausea, vomiting, anorexia, abdominal pain, diarrhea, constipation, alopecia, arthralgia, fever, proteinuria, paresthesia, photosensitivity, edema, depression

DDI: Serious Warfarin anticoagulant effects reduced, Oxybutynin/Dantrolene/Ritonavir/Valnoctamide causes drug toxicity, Levothyroxine causes hypothyroidism, Isoniazid causes toxicity, Teniposide clearance increased, Danazol doubles the drug levels and causes its toxicity, Allopurinol in high dose raises drug serum level, Cimetidine increases adverse effects by long term use of drug, Fluconazole/Dextropropoxyphene/Fluoxetine/Fluvoxamine/Influenza vaccines/Ketoconazole increases drug level, Erythromycin/Clarithromycin increases drug level and develops toxicity, Verapamil/Diltiazem increases drug level leads to toxicity, Lamotrigine increases levels and causes toxicity, Alcohol increases the drug metabolism, Lithium increases the risk of neurotoxicity, Statins level reduces, Clozapine levels are halved by drug, Ciclosporin/Alprazolam/Fluphenazine/Levetiracetam/Midazolam/Olanzapine/Pregabalin/TCAs/Topiramate/Vincristine levels are reduced, Nifedipine/Felodipine/Nimodipine levels are reduced by drug, Bupropion levels decreases but increases the levels of its active metabolite, Phenytoin levels may increase/decrease by drug, Vit D metabolism disturbance may leads to osteomalacia by long term use of drug, Haloperidol plasma levels are halved by drug, Mebendazole/Albendazole plasma levels reduced, Combined hormonal contraceptives reduces contraceptive efficacy, Phenobarbital reduces drug level and raise its active metabolite, Felbamate reduces drug levels but increases its active metabolite, Hydrochlorothiazide/Furosemide results in hyponatremia Others Valproic acid increases drug active metabolites

Diet: With food

Monitor: CBC, LFT, BUN, drug level,

Zonisamide

Details About Generic Salt ::  Zonisamide 

Main Medicine Class:: Nervous System   Sub Medicine Class ::  Anti Epileptics

1C. ANTI-EPILEPTICS in 1. NERVOUS SYSTEM
ZONISAMIDE
SULFONAMIDE | ANTI-EPILEPTIC
PK: A: Rapid D: 1.45L/kg (Vd) M: Hepatic E: Urine

Indications & Dose: PARTIAL SEIZURES WITH/ WITHOUT SECONDARY GENERALIZATION Adjuvant therapy PO Adult Initially 50mg/day in 2 divided doses, increase after 1wk to 100mg/day in 2 divided doses, may be increase by 100mg q7days, MD 300-500mg/day in 1–2 divided doses

Contra: Hypersensitivity

Precautions: Hepatic/renal impairment, elderly, concomitant use of drugs that increase risk of hyperthermia or nephrolithiasis, avoid abrupt withdrawal

ADR: Serious: SJS, TEN, hepatitis, rhabdomyolysis, hypokalemia, convulsions, pancreatitis, NMS, Others: nausea, vomiting, abdominal pain, paresthesia, diarrhea, dizziness, drowsiness, confusion, ataxia, anorexia, diplopia, dyspnea, insomnia, hallucinations, pruritus

Diet: With/without food

Monitor: BUN, Serum bicarbonate & suicidality

Topiramate

Details About Generic Salt ::  Topiramate 

Main Medicine Class:: Nervous System   Sub Medicine Class ::  Anti Epileptics

1C. ANTI-EPILEPTICS in 1. NERVOUS SYSTEM
TOPIRAMATE
SULFAMATE-SUBSTITUTED DERIVATIVE | ANTI-EPILEPTIC
PK: A: Rapid M: Hepatic E: Urine (70% – 80%)

Indications & Dose: EPILEPSY Adjuvant therapy PO Adult Initially 25mg at HS 1 wk, may be increase by 25-50mg at 1-2 wk intervals, doses >25mg/day must be in 2 divided doses, max 800mg/day | Mono therapy PO Adult Initially 25mg at HS 1 wk, may increase by 25-50mg q1-2wk, doses >25mg/day must be in 2 divided doses max 400mg/day Child 6-10 yr: Initially 0.5-1mg/kg at HS 1 wk, increase by 0.5-1mg/kg q1-2wk max 16mg/kg/day | MIGRAINE Prophylactic therapy PO Adult Initially 25mg OD, may increase weekly by 25mg/day, max 100mg/day in 2 divided doses | PARTIAL SEIZURES Adjuvant therapy PO Adult Initially 25mg OD/BID 1 wk, may increase weekly by 25-50mg/day according to response, MD 100-200mg BID Child >2 yr: Initially 25mg as single dose at HS 1 wk, then increase by 1-3mg/kg q1-2wk, doses >25mg must be in divided doses, max 30mg/kg | Mono therapy PO Adult Initially 25mg BID, may increase weekly by 50mg/day up to 100mg BID, may further increase weekly by 100mg/day, max 200mg BID

Contra: Hypersensitivity

Precautions: Avoid abrupt withdrawal, hepatic/renal impairment, porphyria

ADR: Serious: SJS, TEN, thrombocytopenia, Others: nausea, diarrhea, abdominal pain, dyspepsia, weight loss, anorexia, paresthesia, hypoesthesia, fatigue, headache, dizziness, drowsiness, insomnia, anxiety

DDI: Serious Alcohol causes additive sedative effect, Irinotecan clearance is increased, Levonorgestrel efficacy is reduced, Valproic acid increased risk of encephalopathy (in patients with pre-existing encephalopathy, Phenytoin/Haloperidol levels are increased, Ethinylestradiol levels are modestly reduced, Digoxin levels are reduced, Zonisamide may increase the risk of renal calculi, Ethinyl estradiol plus cyproterone contraceptive efficacy is reduced, Lithium toxicity is increased Others Phenobarbital/Carbamazepine decreases drug serum level

Diet: With/without food

Monitor: Hydration status, electrolytes, symptoms of acidosis, IOP, seizure frequency

Phenytoin

Details About Generic Salt ::  Phenytoin 

Main Medicine Class:: Nervous System   Sub Medicine Class ::  Anti Epileptics

1C. ANTI-EPILEPTICS in 1. NERVOUS SYSTEM
PHENYTOIN
HYDANTOIN | ANTI-EPILEPTIC
PK: A: Slow D: Neonates/ premature: 1-1.2 L/kg, full-term: 0.8-0.9 L/kg, infants: 0.7-0.8 L/kg, child: 0.7 L/kg, adult: 0.6-0.7 L/kg (Vd) E: Urine

Indications & Dose: NEUROSURGERY Prophylactic therapy IV Adult 100-200mg at 4h intervals during surgery & immediately in postoperative period | STATUS EPILEPTICUS Emergency therapy IV Adult Loading dose 15-20mg/kg, max 50mg/min Child Neonate: Loading dose: 20mg/kg then 2.5-5mg/kg BID, 1 month-12 yr: Loading dose: 20mg/kg then 2.5-5mg/kg BID, 12-18 yr: Loading dose: 20mg/kg then 100mg TID/QID | TONIC-CLONIC STATUS EPILEPTICUS IV Adult Inj/inf: 10-15mg/kg at 50mg/min, MD 100mg q6-8h (PO/IV) | VENTRICULAR ARRHYTHMIAS IV Adult 3.5–5mg/kg rate not exceeding 50mg/min, repeated once if needed

Contra: Hypersensitivity, porphyria, avoid parenteral use in sinus bradycardia, sino-atrial block, second & third degree heart block, stokes-adams syndrome

Precautions: Avoid abrupt withdrawal, hepatic/renal impairment, hypotension, HF

ADR: Serious: Hypersensitivity reactions, SJS, TEN, osteomalacia, hepatotoxicity, CNS depression, thrombocytopenia, arrhythmias, CV collapse, hypotension, respiratory collapse, blurred vision, hepatitis, neurological changes, Others: leukopenia, cerebellar vestibular symptom, ataxia, nystagmus, diplopia, slurred speech, behavioural disorders, hallucinations, hyperglycemia, gingival hyperplasia, acne, coarse facies, hirsutism, fever, Headache, sedation, confusion

DDI: Serious Pyridoxine (at high doses) decreases drug level, Chloramphenicol (when given by IV)increases drug level and leads to toxicity, Acenocoumarol causes severe bleeding, Carboplatin/Bleomycin/Ciprofloxacin/Cisplatin/Cyclophosphamide/Diazoxide/Doxorubicin/Etoposide/Folic acid/Mercaptopurine/Methotrexate/Rifampicin/Tamoxifen/Vinblastine/Vincristine decreases drug level, Warfarin efficacy is increased, Cimetidine/Amiodarone/Cotrimoxazole/Felbamate/Fluconazole/Fluoxetine/Fluvoxamine/Imipramine/Isoniazid/Miconazole/Nifedipine/Sulfadiazine/Ticlopidine/Trimethoprim/Voriconazole increases drug level, Disulfiram increases drug level and causes toxicity, Pregabalin level is reduced, Ketoconazole/Itraconazole levels are decreased, Sertraline/Paroxetine levels are reduced, Prochlorperazine/Chlorpromazine may alter the drug level, Thioridazine metabolites are reduced, Metronidazole prolongs half-life of the drug (when given by IV), Nitrofurantoin/Clofazimine reduces drug level Others Allopurinol increases drug level, Nimodipine/Felodipine/Verapamil levels are decreased, Carbamazepine may increase/decrease the drug level

Diet: With food

Monitor: BP, drug level, CBC, LFTs

Pregabalin

Details About Generic Salt ::  Pregabalin 

Main Medicine Class:: Nervous System   Sub Medicine Class ::  Anti Epileptics

1J. DRUGS FOR NEUROPATHIC PAIN in 1. NERVOUS SYSTEM
PREGABALIN
GABA DERIVATIVE | ANTI-EPILEPTIC, ANXIOLYTIC
also comes under 1C. Anti-Epileptics in 1. Nervous System,  1B. Anxiolytics in 1. Nervous System
PK: A: Rapid D: 0.5L/kg (Vd) E: Urine (90%)

Indications & Dose: ANXIETY PO Adult Initially 150mg/day in 2–3 divided doses, increase if necessary at 7-day intervals in steps of 150mg/day, max 600mg/day in 2–3 divided doses | FIBROMYALGIA PO Adult Initially 150mg/day, increase to 300mg/day after 1 wk according to response, followed by 450mg/day | PARTIAL SEIZURES WITH/ WITHOUT SECONDARY GENERALIZATION Adjunct therapy PO Adult Initially 25mg BID, increase at 7-day intervals in steps of 50mg-300mg/day in 2–3 divided doses, increase further after 7 days to max 600mg/day in 2–3 divided doses | PERIPHERAL & CENTRAL NEUROPATHIC PAIN PO Adult Initially 150mg/day in 2–3 divided doses, increase if needed after 3–7 days to 300mg/day in 2–3 divided doses, increase further after 7 days to max 600mg/day in 2–3 divided doses

Contra: Hypersensitivity

Precautions: Avoid abrupt withdrawal, CRF, CHF

ADR: Serious: First-degree AV block, arrhythmia, dysuria, thrombocytopenia, joint swelling, pancreatitis, hypotension, hypoglycaemia, rhabdomyolysis, hypokalemia, CHF, angioedema, SJS, arthralgia, Others: pruritus, hyperglycemia, nausea, vomiting, constipation, drowsiness, flatulence, paresthesia, confusion, fatigue, diplopia, insomnia, myalgia

DDI: Serious Lorazepam/Alcohol efficacy is increased, Oxcarbazepine/Carbamazepine/Phenytoin may reduce drug level

Diet: With/without food

Monitor: Symptoms of myopathy, skin integrity, weight gain, suicidality

Oxcarbazepine

Details About Generic Salt ::  Oxcarbazepine 

Main Medicine Class:: Nervous System   Sub Medicine Class ::  Anti Epileptics

1C. ANTI-EPILEPTICS in 1. NERVOUS SYSTEM
OXCARBAZEPINE
CARBOXAMIDE DERIVATIVE | ANTI-EPILEPTIC
PK: A: Rapid D: 49 L (Vd) M: Hepatic E: Urine

Indications & Dose: PARTIAL SEIZURES WITH/ WITHOUT SECONDARY GENERALIZATION PO Adult Initially 300mg BID, increase according to response in steps of up to 600mg/day q1wk, usual dose 0.6–2.4g/day in divided doses Child 6–18 yr: 8–10mg/kg/day in 2 divided doses, increase according to response in steps of up to 10mg/kg/day q1wk, max 46mg/kg/day in divided doses

Contra: Hypersensitivity

Precautions: avoid abrupt withdrawal, hyponatremia, cardiac conduction disorders, acute porphyria, hepatic/renal impairment

ADR: Serious: SJS, TEN, hepatitis, hyponatremia, pancreatitis, arrhythmias, thrombocytopenia, tremor, Others: diplopia, alopecia, nystagmus, leucopenia, diarrhea, nausea, vomiting, constipation, headache, dizziness, drowsiness, asthenia, ataxia, confusion, urticaria

DDI: Serious Furosemide causes hyponatremia, Phenytoin level is increased, Pregabalin level is reduced, Lamotrigine levels are modestly reduced, Lithium may increase the risk of neurotoxicity, Felodipine serum level is reduced, Combined hormonal contraceptives steroid levels are reduced

Diet: With/without food

Monitor: Seizure frequency, serum sodium, suicidality