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Phenytoin, with its relatively long half-life, can be given once or twice daily. For some patients this may be preferable to carbamazepine, which must be taken more frequently. Concern about the occasional undesirable cosmetic adverse effects of phenytoin makes carbamazepine the drug of choice for other patients. Both phenobarbitone and methylphenobarbitone have a high incidence of sedation when treatment commences. They should not be considered as first-line drugs in adults with epilepsy. Myoclonic seizures respond to benzodiazepines, especially to clonazepam.

Key concepts

Ethosuximide is the drug of choice for absence seizures. It is as effective as sodium valproate and has fewer adverse effects. Drug concentration monitoring The management of epilepsy has been greatly influenced and enhanced by the introduction of rapid, and reproducible, drug assays. A close relationship between serum concentration and therapeutic and toxic effects exists with some antiepileptic drugs e. However, the 'therapeutic range' is only a guide to dosage adjustments.

The clinical response to therapy, symptoms and signs of toxicity, administration history and sampling details must be considered when interpreting serum concentrations. Some patients have adverse effects at low or therapeutic concentrations, while others tolerate high levels without the development of adverse effects. Classification of seizures and drugs used to treat them in the author's order of preference see text. Some of the old terminology is included in brackets. The dose, half-life, 'therapeutic range' and commonly observed adverse effects of the most widely used antiepileptic drugs.

There is also considerable inter individual variation in the relationship between the serum anticonvulsant concentration and seizure control.

Practical Guide on the use of Antiepileptic drugs

The interpretation of serum concentrations should also take into account a drug's pharmacokinetics. Sodium valproate has a wide therapeutic index, large fluctuations in its concentration-time profile and concentration-dependent protein binding. Carbamazepine has a flatter concentration-time profile, a more clearly defined target range, undergoes auto-induction of metabolism and interacts with other drugs. Phenytoin has non-linear kinetics and a narrow therapeutic range. This is of considerable practical importance because small changes in the dose can have profound effects on the plasma drug concentration, which may result in toxicity.

The adverse effects of the antiepileptic drugs may be divided into dose dependent and allergic or idiosyncratic reactions which are unrelated to the serum concentrations. In addition, adverse effects may be related to the formation of a metabolite which has been proposed for carbamazepine 10, 11 -epoxide.


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Table 2 lists the commonly observed adverse effects of some antiepileptic drugs. Starting therapy Patients should be managed, where possible, with a single antiepileptic drug.

The Epilepsy Prescriber's Guide to Antiepileptic Drugs

With the exception of phenytoin which can be introduced at a maintenance dose , most antiepileptic drugs should be introduced slowly to minimise adverse effects. In general, the interval between doses should be less than one third to one half the drug's half-life at steady state. The dose should not be increased until a steady state has been achieved i. Carbamazepine should be introduced at low dosages mg daily in adults and adolescents as it may produce psychomotor impairment.

The dose may be increased shortly after commencing therapy as auto-induction of metabolism and tolerance to the central nervous system adverse effects occur early. Sodium valproate can be introduced at a dose of mg daily. Higher starting doses may cause gastrointestinal adverse effects. Ethosuximide does not require a loading dose, but should also be introduced slowly to minimise the potential gastrointestinal adverse effects.

Maintenance dosage The maintenance dose of carbamazepine may need to be increased during the first few months of therapy because of the auto-induction of metabolism. This effect varies significantly between patients. Patsalos author , Blaise F. Bourgeois editor Sign in to write a review. In stock online Free UK delivery Usually dispatched within 24 hours.

Antiepileptic Drugs and Pregnancy

Quantity Add to basket. This item has been added to your basket View basket Checkout. This practical and concise book is an essential reference guide for use by all clinicians and allied health professionals that treat or care for patients with epilepsy. In full color throughout, this volume presents the antiepileptic drugs AEDs , 34 in total, in alphabetical order and for each AED the information is divided into eight colored sections: general therapeutics, pharmacokinetics, interaction profile, adverse effects, dosing and use, special populations, overview, and suggested reading.

This second edition has been extensively revised and updated. This handy pocket book will be an excellent companion for all clinicians that treat patients with epilepsy.


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Review of previous edition: ' The content is highly clinically significant and well presented Provides a wealth of invaluable information for all who treat patients with epilepsy. There is also a table at the end of the book summarising all known pharmacokinetic interactions between AEDs. I have found it to be very useful in my practice Added to basket. The Female Brain. Louann Brizendine. I Had a Black Dog.

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