Antiepileptics

*barbiturates: thiopental

-used to treat: status epilepticus/seizure/sedation/hypnosis

-hepatically metabolized

-used when other treatment failed

-respiratory depression very common and need monitoring

-available as powder for reconstitution

-compatible with NS

*hydantoin derivatives: phenytoin

-used to treat status epilepticus

-available PO (epanutin 100 mg) and IV (250 mg per 5 ml)

-hepatically metabolized

-CNS side effects are common

-load IV in 250 ml NS

-monitor BP closely

*benzodiazepines derivatives:

1- diazepam:

-used for acute treatment of seizure

-available IV (10mg/2ml)

-compatible with normal saline

-given IV over 5 min or IM

-respiration should be monitored closely

2- clonazepam (rivotril) :

- used for seizure disorders

-hepatically metabolized

-effect in about 30 mim

-long acting benzodiazepine

*carboxamide derivatives: carbamazepine

(tegretol/ neurotop retard)

-used to treat epilepsy

- tegretol available in CR form that should not be crushed

-hepatically metabolized

-available orally

*fatty acids derivatives: valproic acid (convulex retard/ convulex 50mg per ml/ depakine / depakine
chrono as PO)

(convulex 500 mg but containing 400 mg valproic acid and depakine 400 as IV)

-used to treat partial seizure and simple and complex seizure

-we start IV therapy then we shift to PO when tolerated

-retard and chrono tablet should not be crushed

-compatible with NS and administer over 60 min

-it is the most commonly used

*other antiepileptics:

~lamotrigine (lamictal):

-used to treat seizure disorders

-available PO (25mg/50mg/100mg)

-need dose adjustment in hepatic and renal impairment

-it is usually used with valproic acid

~gabapentin (gabatrex/neuroplex):

-used to treat partial seizure

-available PO (300mg/400mg)

-need dose adjustment in renal impairment

-it is usually used as adjunctive therapy

-discontinuation of drug should be done gradually over 1 week

~levetiracetam(keppra):

-used to treat partial seizure, myoclonic seizure, tonic clonic seizure

-available IV (500mg/1000mg) and PO (250mg/500mg/1000mg/100mg per ml)

-maximum daily dose: 3000 mg

-need dose adjustment in renal impairment

-shift from IV therapy to PO when tolerated

-dilute in 100 ml NS and infuse over 15 min

-avoid abrupt withdraw to prevent seizure reoccurrence

~pregabalin (gabrika):

-used to treat partial onset seizure

-used as adjunct therapy

-maximum daily dose: 600 mg

-need dose adjustment in renal impairment

-taper gradually over one week

~lacosamide (vimpat):

-used to treat partial onset seizure and tonic clonic seizure

-available PO(50mg/100mg/150mg)

-used as monotherapy or adjunct therapy

-need dose adjustment in renal impairment

~topiramate (topamax):

-used to treat partial onset seizure and tonic clonic seizure

-used as monotherapy or adjunctive therapy

-maximum daily dose: 400 mg

-need dose adjustment in renal impairment