Disclosures. AED Options. Epilepsy Pharmacotherapy: Treatment Considerations with Older AEDs
|
|
- Gervase Holmes
- 6 years ago
- Views:
Transcription
1 Epilepsy Pharmacotherapy: Treatment Considerations with Older AEDs BARRY E. GIDAL, PHARMD PROFESSOR SCHOOL OF PHARMACY & DEPT. OF NEUROLOGY Disclosures Speaking honoraria: UCB, Eisai, Sunovion Consultant: UCB, Eisai, Sunovion, Upsher-Smith, Acorda, Epilepsy Consortium AED Options Focal Generalized Tonic Tonicclonic Myoclonic Atonic Infantile Spasms Absence Phenytoin, Carbamazepine eslicarbazepine, Phenobarbital, Gabapentin, Tiagabine, Oxcarbazepine Perampanel Pregabalin Lacosamide i b t i Vigabatrin ACTH Ethosuximide Valproate, Lamotrigine, Topiramate, Felbamate Zonisamide, Levetiracetam, lamotrigine, preampanel, rufinamide
2 Challenges in AED Treatment Co-morbidities Pharmacokinetic issues Pharmacodynamic issues Noncompliance Limited data on efficacy and side effects of AEDs in the elderly Pharmacokinetic Interactions Absorption Adsorption Intestinal Metabolism Transporters Distribution Protein Binding Transporters BBB distribution of drug? Elimination Renal Excretion Hepatic Metabolism polymorphic metabolism? AEDs & Solubility Low Solubility: Phenytoin Carbamazepine Lamotrigine Zonisamide oxcarbazepine
3 Hepatic Drug Metabolism CYP450 UGT 1A 2 2E 1 2C 9 2C1 9 2D 6 3A 4 1A 3 1A 4 1A 9 2B 7 AED effects on Drug Metabolizing Isozymes Older Enzyme inducers (CYP1A2, 2C, 3A, UGTs) carbamazepine phenytoin phenobarbital Inhibitor VPA (CYP2C19, UGT, EH) Newer No effects on CYP: levetiracetam lamotrigine zonisamide vigabatrin Gabapentin/pregabalin Lacosamide rufinamide Modest inducer Oxcarbazepine, Eslicarbazepine, topiramate (CYP3A) Inhibitors Topiramate, oxcarbazepine, Eslicarbazepine (CYP2C19) Anderson GD. Pharmacokinetics and Drug Interactions. In: : Treatment of Epilepsy. Principles and Practice. Wyllie eds. 6 th. Ed. 2015, Traditional AEDs Carbamazepine Phenytoin Sodium Valproate Phenobarbital
4 Carbamazepine: Absorption/Distribution Tablet 80% absorbed compared to solution Slow, erratic absorption Peak = 6-12 hours Suspension: more rapidly absorbed Sustained/controlled release tablet & sprinkle Give BID IV form finally on the way with cyclodextrin vehicle 80-85% protein bound - albumin and alpha 1 acid glycoprotein Guerreiro C, Guerreio M, Mintzer S. Carbamazepie, Oxcarbazepine, Eslicarbazepine. In: Treatment of Epilepsy. Principles and Practice. Wyllie eds. 6 th. Ed. 2015, Metabolism 100% metabolized by the liver Carbamazepine epoxide--major metabolite CBZ CBZ-epoxide CBZ dihydrodiol epoxide CYP 3A4 hydrolase Active metabolite Equal anticonvulsant activity to CBZ May be responsible for many CNS adverse effects Autoinduction of CYP 3A4 Adult single dose t ½ = 33 hours (18-55 hrs) vs approximately 15 hours in chronic dosing: Takes 4-6 weeks to get maximum auto induction. Adverse Effects CNS side effects common (35-50%), more common during initiation therapy, and may dissipate with chronic therapy diplopia ataxia drowsiness headache dizziness anticholinergic side effects blurred vision urinary retention, dry mouth, etc. paresthesias hyponatremia nystagmus
5 Adverse Effects Hematologic Leukopenia Transient leukopenia ( ) and low platelet count is common Thrombocytopenia Aplastic anemia 1/50,000 incidence, fatal in 50%. Most patients on other drugs concurrently Hepatitis Rash Teratogenicity Osteoporosis CBZ RASH - Genetics Increased risk of serious rash (toxic epidermal necrolysis, Stevens-Johnson syndrome) in patients with HLA-B*1502 & HLA-A 3101 Found almost exclusively in patients with Asian ancestry % of patients from China, Thailand, Philippines, Malaysia and Indonesia may test positive. Far less common (1%) in patients from Japan or Korea HLA-A % prevalence in N. European Gidal BE. Carbamazepine Hypersensitivity: Progress toward predicting the unpredictable. Epilepsy Curr Nov;11(6): doi: / Powell G, Holmes EA, et al. Pharmacogenetic testing prior to carbamazepine treatment of epilepsy: patients' and physicians' preferences for testing and service delivery. Br J Clin Pharmacol 2015;80: Phenytoin Absorption/Distribution Good overall bioavailability, but may display marked day-to-day variability in absorption. Decreased & delayed absorption with larger doses (>400 mg) Extensively protein bound 90% to serum albumin Renal failure, hypoalbuminemia, pregnancy, liver disease - alter protein binding Conway J, Morita DA, Glauser TA.Phenytoin and Fosphenytoin. In: Treatment of Epilepsy. Principles and Practice. Wyllie eds. 6 th. Ed. 2015,
6 Individual Total Phenytoin Serum Concentrations in Elderly Nursing Home Residents 35 Total PHT Concentrations (ug/ml) Aged (n=18) Aged (n=21) Aged 85+ (n=17) Individual Elderly Residents Categorized by Age Group at Enrollment Birnbaum et al, Neurology, 60: (2003) PHENYTOIN: Metabolism Pharmacokinetics Long t ½ : mean = hrs range = 7-42 hrs Michaelis-Menten metabolism, 90-95% liver metabolized by saturable kinetics CYP 2C9 & 2C19 isozymes involved Genetic slow and fast metabolizers Liver disease - decreased metabolism Phenytoin-Simulated Dosing Requirements in Elderly vs Younger Adults Phenytoin Concentration (mg/l) Daily Dose (mg/kg) as PHT Acid Elderly (aged years) 1 Vmax=5.5 mg/kg/day Km=5.8 mg/l Nonelderly (aged years) 2 Vmax=8.45 mg/kg/day Km=6.25 mg/l Differences in PHT content Capsules 92% Infatabs 100% Suspension 100% 1. Bauer LA, Blouin RA. Clin Pharmacol Ther. 1982;31: Cloyd J, et al. Presented at: 10th Epilepsy International Symposium; 1978; Vancouver, British Columbia.
7 Phenytoin: Adverse Effects Concentration related Nystagmus (> 20 ug/ml) Ataxia (> 30 ug/ml) Confusion (> 40 ug/ml) Encephalopathy Phenytoin: Adverse effects Rash 5-10% (no genetic link confirmed yet) Gingival hyperplasia (30%-50%) Hirsutism and coarse facial features Osteopenia/osteoporosis- possibly related to increased Vit.D metabolism Vitamin D Metabolism 7-DehydroCholesterol Degradation P450C24 25-HydroxyVitamin D 3 Kidney 1α hydroxylase P450C1 Skin, UVB Liver 25 Hydroxylase P450C25/27 Degradation P450C24 Vitamin D 3 1, 25-HydroxyVitamin D 3
8 Sodium Valproate (VPA): Absorption % absorption for syrup and capsules Time to peak: hr syrup hr regular capsules hr enteric coated tablets Birnbaum AK, Marino S. Valproate. In: Treatment of Epilepsy. Principles and Practice. Wyllie eds. 6 th. Ed. 2015, VPA: Distribution Saturable protein binding within therapeutic range [VPA] < 50 ug/ml FF = 7-11% [VPA] ug/ml FF = 11-15% [VPA] ug/ml FF = 15-25% [VPA] ug/ml FF = 25-30% VPA Metabolism 97% metabolized by the liver Glucuronidation, beta-oxidation - major routes CYP mediated oxidation - minor T ½ = 14 hrs (5-22 hr) adults 11 hrs (5-15 hr) children Polytherapy with inducers can double clearance
9 VPA: Adverse Effects Concentration related side effects - Drowsiness Tremor Confusion - encephalopathy Hyperammonemia Inhibition of platelet aggregation, lowering of platelet count? Drug induced Parkinsonism VPA: Adverse Effects Alopecia Weight gain Hepatotoxicity Transient elevated LFTs is common (15-30%) Fatal hepatotoxicity rare, highest incidence age 0-2 years only few cases in adults > 2 years Usually poorly controlled seizures, mental retardation, polytherapy Prodrome: loss of seizure control, malaise lethargy, drowsiness, weakness, vomiting anorexia, jaundice Incidence increases with polytherapy with inducers Usually occurs 0-3 months (mean 60 days) Pancreatitis--rare, primarily seen in children Teratogenicity Menstrual cycle abnormalities PCO & VPA Treatment Unifying Hypothesis Valproate related weight gain Obesity Insulin resistance Increased insulin secretion SHBG Hyperinsulinemia IGFBP-1 Bioactive androgens Ovarian androgen 1 synthesis Bioactive IGF- Structural changes in the ovaries
Disclosure. Learning Objectives
Linda D. Leary, M.D. Associate Clinical Professor of Pediatrics & Neurology South Texas Comprehensive Epilepsy Center UT Health Science Center San Antonio Disclosure Linda D. Leary, M.D. discloses the
More informationEPILEPSY: SPECTRUM OF CHANGE WITH AGE. Gail D. Anderson, Ph.D.
EPILEPSY: SPECTRUM OF CHANGE WITH AGE Gail D. Anderson, Ph.D. Incidence: 0.5% - 1.0% of U.S. population Peak incidence of onset: first 2 years of life, ages 5-7 years, early puberty and elderly. 125,000
More informationEpilepsy Medications: The Basics
Epilepsy Medications: The Basics B R I A N A P P A V U, M D C L I N I C A L A S S I S T A N T P R O F E S S O R, D E P A R T M E N T O F C H I L D H E A L T H A N D N E U R O L O G Y, U N I V E R S I T
More informationSEIZURES PHARMACOLOGY. University of Hawai i Hilo Pre-Nursing Program NURS 203 General Pharmacology Danita Narciso Pharm D
SEIZURES PHARMACOLOGY University of Hawai i Hilo Pre-Nursing Program NURS 203 General Pharmacology Danita Narciso Pharm D 1 Understand the pharmacodynamics involved in the medications used to treat seizures
More informationNew antiepileptic drugs
Chapter 29 New antiepileptic drugs J.W. SANDER UCL Institute of Neurology, University College London, National Hospital for Neurology and Neurosurgery, Queen Square, London, and Epilepsy Society, Chalfont
More informationAED Treatment Approaches. David Spencer, MD Director, OHSU Epilepsy Center Professor, Department of Neurology
AED Treatment Approaches David Spencer, MD Director, OHSU Epilepsy Center Professor, Department of Neurology Audience Response Keypads Please utilize the keypad at your table to answer questions throughout
More informationAnticonvulsants Antiseizure
Anticonvulsants Antiseizure Seizure disorders Head trauma Stroke Drugs (overdose, withdrawal) Brain tumor Encephalitis/ Meningitis High fever Hypoglycemia Hypocalcemia Hypoxia genetic factors Epileptic
More informationErnie Somerville Prince of Wales Hospital EPILEPSY
Ernie Somerville Prince of Wales Hospital EPILEPSY Overview Classification New and old anti-epileptic drugs (AEDs) Neuropsychiatric side-effects Limbic encephalitis Non-drug therapies Therapeutic wishlist
More informationWhen choosing an antiepileptic ... PRESENTATION... Pharmacokinetics of the New Antiepileptic Drugs. Based on a presentation by Barry E.
... PRESENTATION... Pharmacokinetics of the New Antiepileptic Drugs Based on a presentation by Barry E. Gidal, PharmD Presentation Summary A physician s choice of an antiepileptic drug (AED) usually depends
More information7/31/09. New AEDs. AEDs. Dr. Yotin Chinvarun M.D. Ph.D. Comprehensive Epilepsy and Sleep disorder Program PMK hospital. 1 st genera*on AEDs
Dr. Yotin Chinvarun M.D. Ph.D. Comprehensive Epilepsy and Sleep disorder Program PMK hospital New AEDs AEDs NEW OLD Pregabalin Pregabalin 1 st genera*on AEDs Phenytoin Carbamazepine Valproate Phenobarbital
More informationAdjusting phenytoin dosage in complex patients: how to win friends and influence patient outcomes
Adjusting phenytoin dosage in complex patients: how to win friends and influence patient outcomes Brian Hardy, PharmD, FCSHP, FCCP Coordinator Education and Clinical Programs Department of Pharmacy Sunnybrook
More informationEpilepsy 101. Overview of Treatment Kathryn A. O Hara RN. American Epilepsy Society
Epilepsy 101 Overview of Treatment Kathryn A. O Hara RN American Epilepsy Society Objectives Describe the main treatment options for epilepsy Identify factors essential in the selection of appropriate
More informationI. Introduction Epilepsy is the tendency to have recurrent seizures unprovoked by systemic or acute neurologic insults. Antiepileptic drugs (AEDs)
1 2 I. Introduction Epilepsy is the tendency to have recurrent seizures unprovoked by systemic or acute neurologic insults. Antiepileptic drugs (AEDs) are those which decrease the frequency and/or severity
More informationValproate Case 1: Pharmacokinetics Jose de Leon, MD
Valproate Case 1: Pharmacokinetics 2-12-16 Jose de Leon, MD 1. Valproate Case 1 J Clin Psychopharmacology 2009;29:509-11 http://www.ncbi.nlm.nih.gov/pubmed/19745660 Educational Objectives At the conclusion
More informationSlide 1. Slide 2. Slide 3. Objectives. Why should we care about the elderly? Antiseizure Drugs in Elderly Patients
Slide 1 Antiseizure Drugs in Elderly Patients Angela Birnbaum, Ph.D. Professor Epilepsy Research and Education Program Center for Clinical and Cognitive Neuropharmacology College of Pharmacy University
More informationSODIUM CHANNEL BLOCKERS IN THE 21 ST CENTURY. Professor Martin J Brodie University of Glasgow Glasgow, Scotland
IN THE 21 ST CENTURY Professor Martin J Brodie University of Glasgow Glasgow, Scotland Eisai SODIUM CHANNEL BLOCKERS Declaration of interests UCB Pharma GlaxoSmithKline Lundbeck Takeda Advisory board,
More informationAEDs 2. Bassel Abou-Khalil, M.D.
AEDs 2 Bassel Abou-Khalil, M.D. None Disclosures SAE Question ARS Which is not true of phenytoin? A- half-life increases with increasing serum level B- protein-free portion is elevated in hepatic and renal
More informationSeizure medications An overview
Seizure medications An overview Andrew Zillgitt, DO Staff Neurologist Comprehensive Epilepsy Center Department of Neurology Henry Ford Hospital None Disclosures Objectives A lot to review!!!!! Look at
More informationimproving the patient s quality of life.
Epilepsy is the tendency to have recurrent seizures unprovoked by systemic or acute neurologic insults. Antiepileptic drugs (AEDs) are those which decrease the frequency and/or severity of seizures in
More informationUnderstanding and Managing Epilepsy
Page 1 Understanding and Managing Epilepsy Jacquelyn L. Bainbridge, Pharm.D., FCCP Associate Professor University of Colorado Denver School of Pharmacy & Department of Neurology Supported by an educational
More informationNew AEDs in Uncontrolled seizures
New AEDs in Uncontrolled seizures Uncontrolled seizures/epilepsy Intractable epilepsy, Refractory epilepsy, Pharmacoresistant epilepsy Dr. Suthida Yenjun Traditionally, referred to therapeutic failure
More informationUpdated advice for nurses who care for patients with epilepsy
NICE BULLETIN Updated advice for nurses who care for patients with epilepsy NICE provided the content for this booklet which is independent of any company or product advertised NICE BULLETIN Updated advice
More informationZONISAMIDE THERAPEUTICS. Brands * Zonegran. Generic? Not in US. If It Doesn t Work * Class Antiepileptic drug (AED), structurally a sulfonamide
Z:/3-PAGINATION/SBT/2-PROOFS/NWMS/9780521136723C111//9780521136723C111.3D 376 [376 380] ZONISAMIDE Brands Zonegran Generic? Not in US THERAPEUTICS Class Antiepileptic drug (AED), structurally a sulfonamide
More information2. Antiepileptic Drugs INTRODUCTION
2. Antiepileptic Drugs 89 2 Chapter 2 Antiepileptic Drugs Nathan L. Kanous II, PharmD and Barry E. Gidal, PharmD 1. INTRODUCTION 1.1. Epidemiology of Epilepsy Epilepsy is a chronic neurologic disorder
More informationManagement of Epilepsy in Primary Care and the Community. Carrie Burke, Epilepsy Specialist Nurse
Management of Epilepsy in Primary Care and the Community Carrie Burke, Epilepsy Specialist Nurse Epilepsy & Seizures Epilepsy is a common neurological disorder characterised by recurring seizures (NICE,
More informationDone by: Rola Awad Presented to : Dr. Diana Malaeb Date: 28/2/2013
Done by: Rola Awad Presented to : Dr. Diana Malaeb Date: 28/2/2013 1 Abbreviations AED: antiepileptic drug EEG: electroencephalography SJS: Stevens Johnson syndrome VA: Valproic acid GABA : Gamma amino
More informationTypes of epilepsy. 1)Generalized type: seizure activity involve the whole brain, it is divided into:
Types of epilepsy We have different types of epilepsy, so it is not one type of seizures that the patient can suffer from; we can find some patients with generalized or partial seizure. So, there are two
More informationReview of Anticonvulsant Medications: Traditional and Alternative Uses. Andrea Michel, PharmD, CACP
Review of Anticonvulsant Medications: Traditional and Alternative Uses Andrea Michel, PharmD, CACP Objectives Review epidemiology of epilepsy Classify types of seizures Discuss non-pharmacologic and pharmacologic
More informationIntroduction. 1 person in 20 will have an epileptic seizure at some time in their life
Introduction 1 person in 20 will have an epileptic seizure at some time in their life Epilepsy is diagnosed on the basis of two or more epileptic seizures. Around 450,000 people in the UK have epilepsy
More informationEpilepsy T.I.A. Cataplexy. Nonepileptic seizure. syncope. Dystonia. Epilepsy & other attack disorders Overview
: Clinical presentation and management Markus Reuber Professor of Clinical Neurology Academic Neurology Unit University of Sheffield, Royal Hallamshire Hospital. Is it epilepsy? Overview Common attack
More informationValproate Case 3: Formulations Jose de Leon, MD
Valproate Case 3: Formulations 2-12-16 Jose de Leon, MD 3.Valproate Case 3 Described in J Clin Psychiatry 2004;65:724-5 http://www.ncbi.nlm.nih.gov/pubmed/15163266 Pharmacological explanation provided
More informationPrescribing and Monitoring Anti-Epileptic Drugs
Prescribing and Monitoring Anti-Epileptic Drugs Mark Granner, MD Clinical Professor and Vice Chair for Clinical Programs Director, Iowa Comprehensive Epilepsy Program Department of Neurology University
More informationEpilepsy is a very individualized
... PRESENTATION... Treatment of Epilepsy in 3 Specialized Populations Based on a presentation by Ilo E. Leppik, MD Presentation Summary When discussing the treatment of epilepsy, targeted populations
More informationEpilepsy 7/28/09! Definitions. Classification of epilepsy. Epidemiology of Seizures and Epilepsy. International classification of epilepsies
Definitions Epilepsy Dr.Yotin Chinvarun M.D., Ph.D. Seizure: the clinical manifestation of an abnormal and excessive excitation of a population of cortical neurons Epilepsy: a tendency toward recurrent
More information2018 American Academy of Neurology
Practice Guideline Update Efficacy and Tolerability of the New Antiepileptic Drugs I: Treatment of New-Onset Epilepsy Report by: Guideline Development, Dissemination, and Implementation Subcommittee of
More informationThe Epilepsy Prescriber s Guide to Antiepileptic Drugs
The Epilepsy Prescriber s Guide to Antiepileptic Drugs The Epilepsy Prescriber s Guide to Antiepileptic Drugs Philip N. Patsalos FRCPath, PhD Professor of Clinical Pharmacology and Consultant Clinical
More informationChapter 24 Antiseizures
Chapter 24 1. Introduction Epilepsy is a heterogeneous symptom complex a chronic disorder characterized by recurrent seizures. Seizures are finite episodes of brain dysfunction resulting from abnormal
More informationChildren Are Not Just Small Adults Choosing AEDs in Children
Children Are Not Just Small Adults Choosing AEDs in Children Natrujee Wiwattanadittakun, MD Neurology division, Department of Pediatrics, Chiang Mai University Hospital, Chiang Mai University 20 th July,
More informationThe Selection of Antiepileptic Drugs for the Treatment of Epilepsy in Children and Adults
The Selection of Antiepileptic Drugs for the Treatment of Epilepsy in Children and Adults Jorge J. Asconape, MD KEYWORDS Epilepsy Seizures Antiepileptic drugs Epilepsy is one of the most common chronic
More informationBuspirone Carbamazepine Diazepam Disulfiram Ethosuximide Flumazeil Gabapentin Lamotrigine
CNS Depressants Buspirone Carbamazepine Diazepam Disulfiram Ethosuximide Flumazeil Gabapentin Lamotrigine Lorazepam Phenobarbital Phenytoin Topiramate Valproate Zolpidem Busprione Antianxiety 5-HT1A partial
More informationEpilepsy: pharmacological treatment by seizure type. Clinical audit tool. Implementing NICE guidance
Epilepsy: pharmacological treatment by seizure type Clinical audit tool Implementing NICE guidance 2012 NICE clinical guideline 137 Clinical audit tool: Epilepsy (2012) Page 1 of 25 This clinical audit
More informationModified release drug delivery system for antiepileptic drug (Formulation development and evaluation).
TITLE OF THE THESIS / RESEARCH: Modified release drug delivery system for antiepileptic drug (Formulation development and evaluation). INTRODUCTION: Epilepsy is a common chronic neurological disorder characterized
More informationPharmacological Treatment of Non-Lesional Epilepsy December 8, 2013
Pharmacological Treatment of Non-Lesional Epilepsy December 8, 2013 Michael Privitera, MD Professor of Neurology University of Cincinnati, Neuroscience Institute American Epilepsy Society Annual Meeting
More informationANTIEPILEPTIC DRUGS. Hiwa K. Saaed, PhD. Department of Pharmacology & Toxicology College of Pharmacy University of Sulaimani
ANTIEPILEPTIC DRUGS Hiwa K. Saaed, PhD Department of Pharmacology & Toxicology College of Pharmacy University of Sulaimani 2017-18 Antiepileptic drugs (AEDs) Definitions and Terminology Historical overview
More informationNewer Anticonvulsants: Targets and Toxicity. Laura Tormoehlen, MD Neurology and EM-Toxicology
Newer Anticonvulsants: Targets and Toxicity Laura Tormoehlen, MD Neurology and EM-Toxicology Disclosures No financial disclosures DEFINITIONS Objectives/Outline Mechanism of Action Specific Indications
More informationIntegrating Sentinel into Routine Regulatory Drug Review: A Snapshot of the First Year. Risk of seizures associated with Ranolazine (Ranexa)
Integrating Sentinel into Routine Regulatory Drug Review: A Snapshot of the First Year Risk of seizures associated with Ranolazine (Ranexa) Efe Eworuke, PhD Division of Epidemiology Office of Pharmacovigilance
More informationOptimizing Management of Seizure Disorders
708 Medicine Update 121 Optimizing Management of Seizure Disorders V NAGARAJAN INTRODUCTION Seizure disorders are met with by every consultant in practice almost everyday. In the management of seizure
More informationAPPENDIX K Pharmacological Management
1 2 3 4 APPENDIX K Pharmacological Management Table 1 AED options by seizure type Table 1 AED options by seizure type Seizure type First-line AEDs Adjunctive AEDs Generalised tonic clonic Lamotrigine Oxcarbazepine
More information8/30/10. How to use Antiepileptic drugs properly. 3nd generation AEDs. Introduction. Introduction. Introduction. AEDs. Dr.Yotin Chinvarun M.D., Ph.D.
Introduction How to use Antiepileptic drugs properly Modern treatment of seizures started in 1850 with the introduction of bromides, based on the theory that epilepsy was caused by an excessive sex drive
More informationAntiepilepsy Drugs: Pharmacodynamics and Principles of Drug Selection
Epilepsy Board Review Manual Statement of Editorial Purpose The Epilepsy Board Review Manual is a study guide for trainees and practicing physicians preparing for board examinations in epilepsy. Each manual
More informationValproic acid. Brand Name: Depakene Drug Class: Opportunistic Infection and Other Drugs
Brand Name: Depakene Drug Class: Opportunistic Infection and Other Drugs Drug Description Valproic acid is a carboxylic acid that increases gamma-amino butyric acid (GABA) levels in the central nervous
More informationFDA Approves Carnexiv (carbamazepine) injection as Intravenous Short-Term Replacement Therapy for Certain Seizure Types
FOR IMMEDIATE RELEASE FDA Approves Carnexiv (carbamazepine) injection as Intravenous Short-Term Replacement Therapy for Certain Seizure Types Carnexiv is the first FDA-approved intravenous carbamazepine
More informationPsychotropic Medication
Psychotropic Medication Part 3: Mood Stabilizers with Terry Broda MOOD STABILIZERS Carbolith, Duralith Depakene*, Epival*, Depakote* Lithium Valproic Acid, Divalproex Sodium Valproate Tegretol* Trileptal*
More informationThe importance of pharmacogenetics in the treatment of epilepsy
The importance of pharmacogenetics in the treatment of epilepsy Öner Süzer and Esat Eşkazan İstanbul University, Cerrahpaşa Faculty of Medicine, Department of Pharmacology and Clinical Pharmacology Introduction
More informationAntiepileptics. Medications Comment Quantity Limit Carbamazepine. May be subject Preferred to quantity limit Epitol
Market DC Antiepileptics Override(s) Approval Duration Prior Authorization 1 year Step Therapy Quantity Limit *Indiana Medicaid See State Specific Mandate below *Maryland Medicaid See State Specific Mandate
More informationLAMICTAL GlaxoSmithKline
LAMICTAL GlaxoSmithKline Lamotrigine QUALITATIVE AND QUANTITATIVE COMPOSITION Tablets: LAMICTAL, 25, 50, 100 and 200 mg. Dispersible/Chewable Tablets: LAMICTAL, 2, 5, 25, 50, 100 and 200 mg. PHARMACEUTICAL
More informationAN UPDATE ON ANTIEPILEPTIC AGENTS: FOCUS ON AN UPDATE ON ANTIEPILEPTIC AGENTS: FOCUS ON SECOND GENERATION TREATMENT OPTIONS
Volume 24, Issue 1 October 2008 AN UPDATE ON ANTIEPILEPTIC AGENTS: FOCUS ON SECOND GENERATION TREATMENT OPTIONS Jason Richey, Pharm.D. Candidate Epilepsy is a neurological disorder characterized by sudden
More information2016 Treatment Algorithm for Generalized Convulsive Status Epilepticus (SE) in adults and children > 40 kg
Yale New Haven Health Department of Pharmacy, Department of Neurology 2016 Treatment Algorithm for Generalized Convulsive Status Epilepticus (SE) in adults and children > 40 kg Guideline, YNHHS Original
More informationNew drugs necessity for therapeutic drug monitoring
New drugs necessity for therapeutic drug monitoring Stephan Krähenbühl Clinical Pharmacology & Toxicology University Hospital Basel kraehenbuehl@uhbs.ch Drugs suitable for TDM Narrow therapeutic range
More informationAntiepileptic Drugs for Pediatric Seizures
Antiepileptic Drugs for Pediatric Seizures Ashley Beagle, PharmD PGY2 Pediatric Pharmacy Resident University of Iowa Stead Family Children s Hospital JCPA Monthly Meeting March 20 th, 2018 Header Disclosure
More informationDrug Monograph-Oxcarbazepine
Drug Monograph Generic name: Oxcarbazepine Brand name: Trileptal Manufacturer: Norvatis (www.norvatis.com) Classification: Anti-epileptic drug Similar agents: Carbamazepine Summary Oxcarbazepine is a new
More informationChapter 31-Epilepsy 1. public accountant, and has begun treatment with lamotrigine. In which of the following activities
Chapter 31-Epilepsy 1 Chapter 31. Epilepsy, Self-Assessment Questions 1. BW is a 28-year-old man recently diagnosed with partial seizures. He works as a certified public accountant, and has begun treatment
More informationMYLAN-LAMOTRIGINE PRODUCT MONOGRAPH. Lamotrigine Tablets. 25 mg, 100 mg and 150 mg. Antiepileptic
PRODUCT MONOGRAPH Pr MYLAN-LAMOTRIGINE Lamotrigine Tablets 25 mg, mg and 5 mg Antiepileptic Mylan Pharmaceuticals ULC 85 Advance Road Etobicoke, ON M8Z 2S6 Date of Revision: November 8, 28 Submission Control
More information25 mg, 100 mg and 150 mg Tablets. Antiepileptic. 150 Signet Drive November 01, 2018 Toronto Ontario M9L 1T9 Control #:
PRODUCT MONOGRAPH Pr APO-LAMOTRIGINE Lamotrigine Tablets 25 mg, 100 mg and 150 mg Tablets Antiepileptic APOTEX INC. DATE OF REVISION: 150 Signet Drive November 01, 2018 Toronto Ontario M9L 1T9 Control
More information2018 American Academy of Neurology
Practice Guideline Update Efficacy and Tolerability of the New Antiepileptic Drugs II: Treatment-Resistant Epilepsy Report by: Guideline Development, Dissemination, and Implementation Subcommittee of the
More informationAntiepileptic Drugs for Pediatric Seizures
Header Disclosure Text Antiepileptic Drugs for Pediatric Seizures Ashley Beagle reports that she has no actual or potential conflicts of interest in relation to this presentation Off label use of medications
More informationData from the World Health Organization suggest
CONTINUING PHARMACY EDUCATION Review of the Newer Antiepileptic Drugs Angel Tidwell, PharmD; and Melanie Swims, PharmD, BCPS AUDIENCE This activity is designed for pharmacists, pharmacy directors, managed
More informationNewer AEDs compared to LVT as adjunctive treatments for uncontrolled focal epilepsy. Dr. Yotin Chinvarun. M.D. Ph.D.
Newer AEDs compared to LVT as adjunctive treatments for uncontrolled focal epilepsy Dr. Yotin Chinvarun. M.D. Ph.D. Chronology of antiepileptic drug introduction over the past 150 years 20 15 10 Perampanel
More informationARTICLES Monotherapy in adults and elderly persons
ARTICLES Monotherapy in adults and elderly persons Edward Faught, MD Address correspondence and reprint requests to Dr. Edward Faught, Department of Neurology, University of Alabama at Birmingham Epilepsy
More informationLacosamide (Vimpat) for partial-onset epilepsy monotherapy. December 2011
Lacosamide (Vimpat) for partial-onset epilepsy monotherapy This technology summary is based on information available at the time of research and a limited literature search. It is not intended to be a
More informationEpilepsy Society Therapeutic Drug Monitoring Unit (TDM Unit) Chalfont Centre for Epilepsy Chesham Lane Chalfont St Peter Buckinghamshire, SL9 ORJ
Epilepsy Society Therapeutic Drug Monitoring Unit (TDM Unit) Chalfont Centre for Epilepsy Chesham Lane Chalfont St Peter Buckinghamshire, SL9 ORJ users guide to therapeutic drug monitoring of antiepileptic
More informationNew generation antiepileptic drugs: what do they offer in terms of improved tolerability and safety?
Therapeutic Advances in Drug Safety Review New generation antiepileptic drugs: what do they offer in terms of improved tolerability and safety? Ther Adv Drug Saf (2011) 2(4) 141 158 DOI: 10.1177/ 2042098611411127!
More informationThe primary goal of antiepileptic drug
THE ROLE OF THERAPEUTIC DRUG MONITORING IN PATIENT CARE * Page B. Pennell, MD ABSTRACT The dose-response relationship for antiepileptic drugs (AEDs) varies enormously between and within individual patients.
More informationPEDIATRIC PHARMACOTHERAPY
PEDIATRIC PHARMACOTHERAPY A Monthly Newsletter for Health Care Professionals from the Children s Medical Center at the University of Virginia Volume 7 Number 11 November 2001 A Oxcarbazepine Use in Children
More informationThere is some evidence to suggest that the half-life of felbamate may be prolonged by gabapentin.
amciclovir amciclovir + Probenecid Probenecid is predicted to increase the exposure to penciclovir, the active metabolite of famciclovir, possibly resulting in increased adverse effects. Evidence is limited
More informationEpilepsy is one of the more common
PART ONE An Overview of Medications Used in Epilepsy Parents, families and caregivers, as well as persons with epilepsy, frequently have questions about medications and often turn to the Internet for information
More informationNeuromuscular Disease(2) Epilepsy. Department of Pediatrics Soochow University Affiliated Children s Hospital
Neuromuscular Disease(2) Epilepsy Department of Pediatrics Soochow University Affiliated Children s Hospital Seizures (p130) Main contents: 1) Emphasize the clinical features of epileptic seizure and epilepsy.
More information3/27/2013. T/F Seizures are waves of abnormal electrical activity in the brain
To understand the different types of seizure disorders To identify the basic pharmacological principles in management of seizure disorders To identify the common non-pharmacologic therapies for seizures
More informationDisclosures. Mechanism of Action Importance. Advances in Epilepsy Management: Does Mechanism-of- Action Matter?
Advances in Epilepsy Management: Does Mechanism-of- Action Matter? Barry E. Gidal, PharmD University of Wisconsin-Madison School of Pharmacy & Dept. of Neurology Disclosures Speaking honoraria: UCB, Eisai,
More informationAntiepileptic drugs and cardiovascular disease June 21, 2012
Antiepileptic drugs and cardiovascular disease June 21, 2012 Scott Mintzer, MD Associate Professor of Neurology Jefferson Comprehensive Epilepsy Center Thomas Jefferson University Philadelphia, PA Partners
More informationEpilepsy management What, when and how?
Epilepsy management What, when and how? J Helen Cross UCL-Institute of Child Health, Great Ormond Street Hospital for Children, London, & National Centre for Young People with Epilepsy, Lingfield, UK What
More informationAPPENDIX T - Unit costs of anti-epileptic drugs for 2012 guideline
Drug name APPENDIX T - Unit costs of anti-epileptic drugs for 2012 guideline Unit costs and weighted average unit costs for drug used in the treatment of focal and generalised epilepsies Prescription Cost
More informationPharmacy Medical Necessity Guidelines: Anticonvulsants/Mood Stabilizers
Pharmacy Medical Necessity Guidelines: Anticonvulsants/Mood Stabilizers Effective: December 18, 2017 Prior Authorization Required Type of Review Care Management Not Covered Type of Review Clinical Review
More informationCLINICAL PHARMACOKINETICS INDEPENDENT LEARNING MODULE
CLINICAL PHARMACOKINETICS INDEPENDENT LEARNING MODULE Joseph K. Ritter, Ph.D. Assoc. Professor, Pharmacology and Toxicology MSB 536, 828-1022, jritter@vcu.edu This self study module will reinforce the
More informationWe are IntechOpen, the world s leading publisher of Open Access books Built by scientists, for scientists. International authors and editors
We are IntechOpen, the world s leading publisher of Open Access books Built by scientists, for scientists 3,900 116,000 120M Open access books available International authors and editors Downloads Our
More informationProceedings of the World Small Animal Veterinary Association Mexico City, Mexico 2005
Close this window to return to IVIS Proceedings of the World Small Animal Veterinary Association Mexico City, Mexico 2005 Hosted by: Reprinted in the IVIS website with the permission of the WSAVA anticonvulsant
More informationHormones & Epilepsy 18/07/61. Hormones & Women With Epilepsy (WWE) How different are women? Estradiol = Proconvulsant. Progesterone = Anticonvulsant
How different are women? AED choice in special population Women With Epilepsy (WWE) Updated 2018 Habitus Metabolism Co-morbidities Pasiri Sithinamsuwan Psychosocial stigma Phramongkutklao Hospital Hormonal
More informationI have no financial relationships to disclose.
Julia B. Toub, MD Providence Brain & Spine Institute April 14, 2016 I have no financial relationships to disclose. 1 1. Seizure: the clinical manifestation of an abnormal and excessive synchronization
More informationThe epilepsies: pharmacological treatment by epilepsy syndrome
The epilepsies: pharmacological treatment by epilepsy syndrome This table provides a summary reference guide to pharmacological treatment. Anti-epileptic drug (AED) options by epilepsy syndrome Childhood
More informationTRANSPARENCY COMMITTEE OPINION. 19 July 2006
The legally binding text is the original French version TRANSPARENCY COMMITTEE OPINION 19 July 2006 Keppra 250 mg, film-coated tablets Box of 60 tablets (CIP code: 356 013-6) Keppra 500 mg, film-coated
More informationAnti-epileptic Drugs
Anti-epileptic Drugs We will continue talking about epilepsy which is a chronic disease that has to be managed, so the treatment will be a management treatment, not a single day or week treatment we will
More informationSanta Clara County Mental Health Department Medication Practice Guidelines MOOD STABILIZERS
MOOD STABILIZERS Documentation A. FDA approved indications (see Table 1) 1. Acute mania associated with Bipolar Disorder 2. Bipolar Disorder maintenance 3. Bipolar Depression Documentation B. Non-FDA approved,
More informationPRODUCT MONOGRAPH. eslicarbazepine acetate. 200 mg, 400 mg, 600 mg and 800 mg Tablets. Professed. Antiepileptic
PRODUCT MONOGRAPH Pr APTIOM eslicarbazepine acetate 00 mg, 400 mg, 600 mg and 800 mg Tablets Professed Antiepileptic Sunovion Pharmaceuticals Canada Inc. 6790 Century Ave., Suite 100 Mississauga, Ontario
More informationThe Diagnostic Detective: Epilepsy
The Diagnostic Detective: Epilepsy Some Facts About Epilepsy and Its Causes Seizures are the most common neurologic disorders affecting children 5% of children have a seizure during childhood There are
More informationManagement of Epilepsy In Primary Care Practice. Video Examples. Talk Like a Neurologist: Seizure Types
Management of Epilepsy In Primary Care Practice S. Andrew Josephson MD Carmen Castro Franceschi and Gladyne K. Mitchell Neurohospitalist Distinguished Professor Vice Chairman, Department of Neurology Director,
More informationPRODUCT MONOGRAPH. Lacosamide. 50 mg, 100 mg, 150 mg and 200 mg film-coated tablets. Antiepileptic Agent
PRODUCT MONOGRAPH Pr SANDOZ LACOSAMIDE Lacosamide 50 mg, 100 mg, 150 mg and 200 mg film-coated tablets Antiepileptic Agent Sandoz Canada Inc. 110 rue de Lauzon Boucherville, Quebec J4B 1E6 Date of revision:
More informationDEPAKOTE ER DIVALPROEX SODIUM EXTENDED-RELEASE TABLETS R x Only
Page 1 (No. 3826 and, 7126) 03-5235-R4-Rev. December, 2002 NEW DEPAKOTE ER DIVALPROEX SODIUM EXTENDED-RELEASE TABLETS R x Only BOX WARNING: HEPATOTOXICITY: HEPATIC FAILURE RESULTING IN FATALITIES HAS OCCURRED
More informationYOU CAN NOW DOWNLOAD MISPLACED LESSONS FROM OUR WEBSITE (WWW.WFPROFESSIONAL.COM).
W-F Professional Associates, Inc. 400 Lake Cook Rd., Suite 207 Deerfield, IL 60015 847-945-8050 February 2002 Update: Seizure Disorders, 707-000-02-002-H01 YOU CAN NOW DOWNLOAD MISPLACED LESSONS FROM OUR
More informationOpinion 24 July 2013
The legally binding text is the original French version TRANSPARENCY COMMITTEE Opinion 24 July 2013 FYCOMPA 2 mg, film-coated tablet B/7 (CIP: 34009 267 760 0 8) B/28 (CIP: 34009 268 447 4 5) FYCOMPA 4
More information