I. Gabapentin Medication

Gabapentin belongs to a group of medications called anticonvulsants. Anticonvulsants are used to control seizure disorders. Gabapentin medication is effective in helping to control partial seizures (convulsions) in adults with epilepsy.

In psychiatry Gabapentin medication may also be used to stabilize mood, and treat anxiety. Gabapentin medication may also be used to treat headache and chronic pain.

Gabapentin medication is also used to help relieve certain types of nerve pain, and may be prescribed for other nervous system disorders.

Anticonvulsants: Gabapentin Information

Anticonvulsants (Gabapentin) are a family of drugs that depress abnormal nerve activity in the brain, thereby blocking seizures. Barbiturates and benzodiazepines are commonly used to prevent and treat seizure disorders, as well as other conditions. Though some people are maintained on a single drug, most take two or more anticonvulsant medications to prevent seizures. Consequently, many studies report interactions that occur in individuals taking several anticonvulsants.

Medications can be divided into older medications (called first-generation anticonvulsants) and more recently developed medications (second-generation anticonvulsants).

First-Generation Anticonvulsants

Phenytoin (Dilantin®): Phenytoin is one of the more commonly used agents and often is considered the first-line drug to treat partial and generalized tonic-clonic (grand mal) seizures and status epilepticus.

Phenytoin drug is thought to work by suppressing electrical activity in brain nerve cells. Phenytoin drug can be given orally or intravenously (IV), and a newer form of the drug, fosphenytoin (Cerebryx®), can be injected into muscle. The oral form has the benefit of once-a-day dosing.

Carbamazepine (Tegretol®/Carbatrol®): Carbamazepine drug is commonly prescribed for the treatment of partial and generalized tonic-clonic (grand mal) seizures. The mechanism by which it works is not well understood. In oral form, it can be taken 2 to 3 times a day; a recent development of the drug in sustained-release form allows for twice-a-day dosing.

Phenobarbital: Phenobarbital drug is used to treat both partial and generalized seizures. It also is used as part of the protocol after phenytoin use in status epilepticus as well as in neonatal epilepsy. It is available in oral and intravenous forms.

Valproate (Depakote®): This is prescribed for partial seizures, generalized tonic-clonic (grand mal) seizures, absence (petit mal) seizures, and myoclonic epilepsy. Its mechanism of action is thought to be related to the effect of a brain substance known as GABA (gamma-aminobutyric acid). It is available in oral form and must be taken 2 to 3 times per day for adequate dosing.

Second-Generation Anticonvulsants

Topiramate (Topamax®): Topiramate drug is used with other anticonvulsant drugs in the treatment of partial seizures and generalized tonic-clonic seizures in adults and children aged 2 to 16. Its precise mechanism of action is unknown, but its anticonvulsant activity may be due in part to increasing GABA (gamma-aminobutyric acid), a neurotransmitter that inhibits excitation of nerve cells in the brain. It is available in oral form, including sprinkles for children, and is taken twice daily. There are few drug interactions between topiramate and other medications or other anticonvulsants.

Gabapentin (Gabapentin®): Gabapentin drug is indicated for the adjunct treatment of partial seizures, with or without secondary generalization. Although it is structurally related to the substance GABA (gamma-aminobutyric acid), it does not interact with GABA receptors in the brain, and its mechanism of action is unknown. It is available in oral form and is taken 3 times daily.

Lamotrigine (Lamictal®): Lamotrigine drug is used for the adjunct treatment of partial seizures. Its precise mechanism of action is unknown. It is presently available in oral form and is taken twice daily. No laboratory monitoring of drug levels are necessary.

Tiagabine (Gabitril®): Tiagabine drug is indicated for adjunct therapy in adults with partial seizures. Its mechanism of action may be related to its effect on the brain substance GABA (gamma-aminobutyric acid). It is available in oral form and should be given in divided doses 2 to 4 times daily. Its metabolism may be altered when taken with other anticonvulsants.

Levetiracetam (Keppra®): Levetiracetam drug is approved for use in adults as adjunct therapy for the treatment of partial seizure disorders. It is available in tablet form and as an oral solution for patients who prefer a liquid or cannot swallow tablets. Side effects can include fatigue, imbalance, and behavioral changes, which often dissipate after the first month of treatment.

Oxcarbazepine (Trileptal®): Levetiracetam drug is indicated for monotherapy (used alone) and adjunct therapy (in addition to other medications) in adults who have partial seizures and as adjunct therapy in children aged 4 and older who have partial seizures. When used as monotherapy, Trileptal causes very few of the side effects associated with other AEDs.

Zonisamide (Zonegram®): Zonisamide drug is approved for use in adults as adjunct therapy for partial seizures. It has however, been used fairly extensively in other countries for use in other seizure types including generalized seizures, myoclonic seizures, and absence seizures. Patients who are allergic to sulfonamide drugs should not use zonisamide because it is a derivative of this class of drug.

Ethosuximide (Zarontin®): Ethosuximide agent is used to treat absence (petit mal) seizures. It is thought to work by suppressing brain cell activity that is associated with lapses of consciousness. It is given orally and is available as a tablet or flavored syrup.

Primidone (Mysoline®): Primidone drug is a barbiturate that contains phenobarbitol. It is used to control generalized tonic-clonic (grand mal) seizures and partial seizures and is used in adults and children over 8 years old. Primidone is not known to interact with other drugs. It is present in breast milk and is associated with neonatal hemorrhage and coagulation defects similar to vitamin K deficiency. Patients hypersensitive to phenobarbital should not take primidone.

Epilepsy: Information

Epilepsy is the tendency to have repeated seizures that begin in the brain. Epilepsy is a physical condition that starts in the brain - a neurological condition. It is a symptom that the way a person's brain works is sometimes disrupted. When this happens, a person may suddenly have a seizure. Many people will have a single seizure at some time in their lives, but this does not mean that they have epilepsy. If a person has epilepsy it means they have had more than one seizure that began in the brain.

Seizures
Seizures can happen for many different reasons. A person with diabetes may have a diabetic seizure if their blood sugar level is too high. A person with epilepsy has an epileptic seizure if their usual brain activity is suddenly disturbed.

Some people call their seizures by a different name - such as a fit, funny turn, attack or blackout.

Seizures can be of two types - generalized or partial. What you experience (your symptoms) will depend on where the change in brain activity begins and how widely and rapidly it spreads out.

Generalized seizures involve the whole brain. There are several types, including - tonic-clonic, absence and myoclonic.

Partial seizures, as the name suggests, start in just one part of the brain. They can be either simple partial seizures or complex partial seizures but either way the electrical discharge may stay in one spot or may spread to the rest of the brain.

Side effects of Gabapentin (Anticonvulsants)

Side effects associated with Gabapentin include:

• Anemia
• Excessive hair growth (hirsuitism/hypertrichosis)
• Imbalance
• Lethargy

Side effects include drowsiness, imbalance, nausea, anemia, and low, white blood cell count (neutropenia).

Possible side effects of Gabapentin include drowsiness, cognitive impairment, and irritability.

Side effects of Valproate include liver damage (hepatotoxicity), nausea, weight gain, hair loss (alopecia), and tremor.

Side effects of Gabapentin include drowsiness, nausea, dizziness, and coordination problems. Children may have difficulty concentrating and may become aggressive. Acute glaucoma and visual abnormality, a potentially very serious complication, has been reported in a small number of patients. If abnormal visual symptoms occur, patients should notify a physician immediately.

Side effects of Gabapentin include fatigue, dizziness, and imbalance.

Side effects of Lamictal include headache, nausea, dizziness, and skin rash. The appearance of the potentially life-threatening skin rash, particularly for patients who also are taking valproate (Depakote®), should be reported immediately to a physician.

Side effects of Tigabine include dizziness and somnolence.

Side effects of Oxcarbazepine are usually mild or moderate and include the following:

• Abdominal pain, nausea, vomiting
• Dizziness
• Double vision
• Drowsiness, fatigue
• Loss of coordination, abnormal gait

Side effects of Zonisamide can include dizziness, imbalance, and fatigue.

Potential side effects produced by Ethosuximide include the following:

• Gastrointestinal-nausea and vomiting, abdominal pain, cramps, diarrhea, weight loss
• Genitourinary-vaginal bleeding, blood in urine (microscopic hematuria)
• Hematological-bone marrow suppression
• Integumentary-excessive hair growth (hirsutism), skin rash, systemic lupus erythematous (SLE)
• Neurological-headache, dizziness, sleep disturbances, aggression, incoordination, fatigue, inability to concentrate

Potential side effects of Primidone include:

• Blurred vision
• Fatigue
• Incoordination
• Nausea and vomiting
• Sexual impotence (erectile dysfunction)
• Vertigo
• Weight loss

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III. Useful links

http://www.cdc.gov/

http://www.fda.gov/

http://www.fda.gov/cder/ogd/

http://www.nih.gov/

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi

http://www.health.gov.on.ca/

National Library of Medicine

World Health Organization

http://www.mayoclinic.com/index.cfm

MedicineNet.com

Drugdigest.org

Healthsquare.com

http://www.drugdigest.org/DD/DVH/Uses/0,3915,292%7CGabapentin,00.html

http://www.vh.org/adult/patient/psychiatry/medications/gabapen.html

http://www.vitacost.com/science/hn/Drug/Anticonvulsants.htm

http://www.epilepsynse.org.uk/pages/info/leaflets/explaini.cfm

http://www.epilepsy.org.uk/intro/symptoms.html

http://www.neurologychannel.com/epilepsy/medications.shtml

Pharmacy sites

http://www.roche.com/home/company/com_hist.htm

http://www.healthdigest.org/Bactrim-DS(Oral)_2006_PRO.php

http://www.hsforum.com/stories/storyReader$1509

http://www.hsforum.com/stories/storyReader$1516

http://www.hsforum.com/stories/storyReader$1504

http://www.people.vcu.edu/~urdesai/atc.htm#Process%20of%20clotting

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