Other Anticonvulsants (FETT)

Anticonvulsants

SODIUM VALPROATE Lamotrigine

• First-line long-term treatment for tonic-clonic generalized seizures

• Partial (focal) seizures

• Absence epilepsy

• Treatment of established status epilepticus [2]

• Myoclonic seizures

• Migraine prophylaxis

• Bipolar disorder

• Inhibits GABA transaminase → ↑ GABA → ↓ neuronal excitability

• Inactivates Na+ channels

• Gastrointestinal upset

• Tremor

• Alopecia

• Pancreatitis

• Weight gain

• Teratogenicity

  • Especially neural tube defects (contraindicated in women of childbearing age/pregnancy) )

  • See pharmacotherapy during pregnancy

• Hepatotoxicity (rare): LFT should be regularly performed in people taking valproate

• Cytochrome P450 inhibition [3]

• Rash

• Sedation

• Ataxia

• Thrombocytopenia

• Agranulocytosis

PREGNANCY

• Cytochrome P450 inhibition

• First-line treatment for long-term therapy of focal seizures

• Second-line treatment for generalized seizures and absence seizures

• Mood stabilizer for treatment of bipolar disorder

• Inhibition of voltage-gated Na+channels → ↓ glutamate release

• Rash, exfoliative dermatitis, Stevens-Johnson syndrome (slow titration is necessary to prevent skin and mucous membrane reactions)

• Hemophagocytic lymphohistiocytosis

• Rarely hepatotoxic or nephrotoxic

• Blurry vision

• Gastrointestinal symptoms

Hypersensitivity

• Coadministration of carbamazepine, phenobarbital, phenytoin → ↑ clearance