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Tintinalli's Emergency Medicine: A Comprehensive Study Guide, 6e
Newer Antiepileptic Drugs
Sections: Newer Antiepileptic
Drugs, Gabapentin, Lamotrigine, Topiramate, Tiagabine, Oxcarbazepine, Depacon, Extended-Release
Agents, Fosphenytoin, Zonisamide, Levetiracetam.
Topics Discussed: anticonvulsants; fosphenytoin; gabapentin; lamotrigine; levetiracetam; oxcarbazepine; seizures; status epilepticus; tiagabine; topiramate; valproic acid; zonisamide.
Excerpt:
"Newer AEDs are generally indicated in the management of seizures
as add-on drugs, although there are currently numerous studies determining
their value for initial and monotherapy.Gabapentin (Neurontin) is a novel AED with ill-defined mechanism
of action, although it appears to increase the effect of  -aminobutyric
acid (GABA), the major cerebral inhibitor. It has no drug interactions,
is not metabolized, and is not protein bound. It is excreted solely
by the kidneys. The short half-life of 5 to 6 h and the limited
intestinal absorption capability require frequent dosing of three
to four times a day. Dosage is 20 to 60 mg/kg per d, and
maximal dosage can be reached in several days. Side effects are
mild, self-limiting, and usually consist of vertigo, lightheadedness,
and infrequently, behavioral changes. Rarely, myoclonic seizures
have been provoked soon after initiating the drug. Antiepileptic
drug levels are not useful in determining therapeutic and toxic
effects...."
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