LECTURE NO.

19 FEBRUARY 2023
2ND SEMESTER A.Y. 2022-2023

CLINICAL CHEMISTRY 2 ANTIEPILEPTIC DRUGS

 Serves as a prophylactic for:
 Epilepsy
Neurologic
 Convulsion
disorders
 Seizures
 Needs to determine therapeutic ranges of each drugs
 Collecting time must be consistent and important to consider
 Preferred specimen is a trough specimen, which is collected at the end of dosing interval

EXAMPLE ACTION TOXIC EFFECT R.O.A HALF LIFE ELIMINATIO T.R P.S.L
N (after a
dose)

PHENOBARBITAL Luminal -a slow acting -Blood Oral 70-100 hrs Hepatic 10-40 10
Solfoton barbiturate concentrate metabolism mg/L hours
that controls do not change
types of dramatically
seizures with a dosing
interval
-trough level
is examined
unless
toxicity is
expected
-drowsiness
-fatigue
Depression
-reduced
mental
capacity

PHENYTOIN Dilantin -Used as a -Initiates Oral 6-24 hours Hepatic 10-20 3-12
FOSPHENYTOIN short term seizures metabolism ug/mL hours
(injectible prophylactic
preform agent in brain (20-80
given to injury to umol/L)
rapidly prevent loss of
metabolize function in a
to form the tissue
parent drug) -Short term

VALPROIC Depakin -Used in -Nausea Oral 11-17 Hepatic 50-120 1-4

ACID/ petitmal and -Lethargy hours metabolism ug/mL hour
VALPROATE absence of -Weight gain
seizure (common (347-
adverse 832
effect) umol/L)

CARBAMAZEPIN Tegretol -Effective for -Leukopenia Oral 4-8 hours Hepatic 4- 4-8
different -Rashes metabolism 12ug/mL hours
seizure -Vertigo
disorder -Nausea (16.9-
-Febrile 50.8
reactions umol/L)

ETHOSUXIMIDE Zarontin -Also used in -Nausea Oral 40-60 Renal 40-100 2-4
treatment for -Vomiting hours Filtration ug/mL hours
petitmal -Anorexia
seizures -Dizziness (283-
(control) -Lethargy 708
umol/L)

FELBAMATE Felbatol -Used for -Aplastic Oral 14-22 Renal 30-60 1-4
seizure anemia hours filtration ug/mL hours
epilepsy for -Hepatic and
children with a failure hepatic 126-252
mixed seizure metabolism umol/L

ARZEL S. VERAN 1
 TRANS: Module 19

disorder known
as Lennox-
Gastaut
syndrome

GABAPENTIN Neurontin -Administered -Fatigue Oral 5-9 hours Unchanged 12-20 2-3
in conjunction -Ataxia (w/ or by kidney ug/mL hours
with -Dizziness w/o through
antiepileptic -Weight gain generali RENAL 70.1-
drugs that zed FILTRATION 116.8
suffering from seizure) umol/L
a complex
partial seizure

LAMOTRIGINE Lamictal -Used to treat -Neurological Oral 15-30 Hepatic 2.5-15 3 hours
partial and effects hours metabolism ug/mL
generalized -Dizziness
seizures -
Gastrointesti
nal
disturbances

LEVETIRACETAM Keppra -For partial -Dizziness Oral 6-8 hours Renal 8-26 1 hour
and generalized -Weakness filtration ug/mL
seizures

OXCARBEZEPIN Trileptal -Used in -Same with Orally 8-10 hours 12-35 8 hours
partial CARBAMAZEPINE ug/mL
seizures -Leukopenia
-Secondary in -Rashes
generalized -Vertigo
tonic xlonic -Nausea
seizure -Febrile
reactions

TAGABINE Gabitril -For partial -CNS Oral 4-13 hours Hepatic 20-100 1-2
seizure -Confusion metabolism ng/mL hours
-Difficulty
in speaking
(stuttering)
-Tingling
sensation in
extremities
(hands and
fingers)
-Mild
sedation

TOPIRAMATE -Used for -Change of Orally 20-30 hrs Renal -Based 1-4
partial and taste with filtration on hours
generalized particular trough
seizure foods such as collect
soda and beer ion
-pin and -must
needle be <25
sensation in mg/L or
extremities 75
umol/L

ZONISAMIDE Zonegram -Anticonvulsant -Difficulty Oral 50-70 10-38 4-7

-Used also in in breathing hours ug/mL hours
partial and -Low BP reduced to
generalized -Slow heart 25-35
seizures rate hours in
-Loss of patients
consciousness receiving
mono
therapy
wherein
other
antiepilep

ARZEL S. VERAN 2
 TRANS: Module 19

tic drugs
are
administer
ed

PSYCHOACTIVE DRUGS

EXAMPLE ACTION TOXIC EFFECT R.O.A HALF ELIMINATION T.R P.S.L

LIFE (after
a
dose)

LITHIUM Eskalith -Mode altering -Apathy lethargy Oral 10-35 Renal 0.5-1.2 2-4
Lithobid drug bipolar -Speech hours filtration nmol/L hours
disorder with difficulty
concurrent -Muscle weakness
depression
aggressive /
self-
mutilating
behavior

Determination:
-ISE
-FEP
-AAS

TRICYCLIC Imipramine Used for -Seizure Oral 17-40 Hepatic

ANTIDEPRESSANT Amitriptyline -Depression -Cardiac hours metabolism
(TCA) Doxepin -Insomnia arrhythmia
-Extreme -Unconsciousness Active
apathy metabolites:
-Loss of -Desipramine
libido -
Nortiptyline
-Effects are
not seen in 2-
4 weeks after
initiation of
therapy
-Correlation
between serum
concentration
and
therapeutic
effects of TCA
are moderate
to weak

CLOZAPINE Clozaril -Treatment of Oral 8-16 Hepatic 350-420 2

FazaClo refractory hours metabolism ng/mL hours
schizophrenia

OLANAZPINE Zyprexa -Schizophrenia -Tachycardia Oral 21-54 Hepatic 20-50

-Acute manic -Decrease Common hours metabolism ng/mL
episode of consciousness
recurrent -Coma IM
bipolar Fastest
disorder absorpt
ion

ARZEL S. VERAN 3