DIPC 111-120

Oxcarbazepine is a

Anticonvulsant

oxcarbazepine

Trileptal

FDA Indications for oxcarbazepine

Partial seizures

Phenobarbital is a

Anticonvulsant

phenobarbital

Luminal

FDA Indication for phenobarbital

-Seizures

-Status epilepticus

-Sedation

Phenytoin is a

Anticonvulsant

phenytoin

Dilantin

FDA Indication for phenytoin

-Seizures

-Status epilepticus

Topiramate is a

Anticonvulsant

topiramate

Topamax

FDA Indication for topiramate

-Seizures

-Migraine headache prophylaxis

Carbamazepine is a

Anticonvulsant / Mood Stabilizer (C)

carbamazepine

Tegretol

FDA Indication for carbamazepine

Seizures

Bipolar Disorder

Neuropathic pain

Divalproex is a

Anticonvulsant + Mood stabilizer

divalproex

Depakote, Depakote ER

FDA Indication for divalproex

-Seizures

-Bipolar disorder

-Migraine prophylaxis

Lamotrigine is a

Anticonvulsant + Mood stabilizer (L)

lamotrigine

Lamictal

FDA Indication for lamotrigine

-Bipolar disorder

-Seizures

Lithium is a

Anticonvulsant + Mood stabilizer (not first line)

lithium

Lithobid

FDA Indication for lithium

-Bipolar disorder (acute mania, acute episodes with mixed features; maintenance)

Gabapentin is a

Anticonvulsant + Neuropathic pain agent

gabapentin

Neurontin

FDA Indication for gabapentin

-Postherpetic neuralgia

-Seizures

Pregabalin is a

Anticonvulsant + Neuropathic pain agent

pregabalin

Lyrica

FDA Indication for pregabalin

Postherpetic neuralgia, Neuropathic pain associated with diabetic peripheral neuropathy, Neuropathic pain associated with spinal cord injury, Fibromyalgia, Seizures

Oxcarbazepine Adverse/Counsel

COMMON: Nausea/vomiting, dizziness, drowsiness, fatigue, headache, visual disturbances

SERIOUS: Blood dyscrasias, hyponatremia, delayed hypersensitivity reactions (Ex. SJS, TEN), psychiatric effects, suicidal ideation

Drug interactions (CYP3A4 inducer/weak)

MONITOR:

-CBC complete blood count/anemia

-Metabolic panel CMP: sugar, electrolyte (cuz decrease Na), liver, kidney

-Mood changes

-If rash

Phenobarbital Adverse/Counseling

COMMON: CNS depression

SERIOUS: CNS depression, respiratory depression, cardiovascular (hypotension, bradycardia)

Drug interactions (CYP3A4 inducer/strong) Therapeutic drug monitoring Controlled substance May be used off-label for alcohol withdrawal

Phenytoin Adverse/Counseling

COMMON: CNS depression

SERIOUS: Blood dyscrasias, CNS effects, cardiovascular effects, hepatotoxicity, delayed hypersensitivity reactions, suicidal ideation

Drug interactions (CYP3A4 inducer/strong) Therapeutic drug monitoring - MONITOR

Topiramate Adverse/Counseling

COMMON: Abdominal pain, low appetite, dizziness, fatigue, paresthesia

SERIOUS: CNS effects/cognitive dysfunction, kidney stones, ocular effects, heat intolerance, suicidal ideation, weight loss

FDA-labeled in combination with phentermine for weight loss Notorious for side effect Stay hydrated!

Carbamazepine Adverse/Couseling

COMMON: Nausea/vomiting, ataxia, dizziness, drowsiness

SERIOUS: Blood dyscrasias, hyponatremia, cardiac effects, hepatotoxicity, delayed hypersensitivity reactions, CNS effects, suicidal ideation

Drug interactions (CYP3A4 inducer/strong) Therapeutic drug monitoring Genetic testing HLAB in Asian populations: severe side effect risk More often a mood stabilizer

Divalproex Adverse/Counseling

COMMON: N/V/D, weight gain, somnolence

SERIOUS: Hepatotoxicity, pancreatitis, thrombocytopenia (low platelets) suicidal ideation

Multiple dosage forms (DR, ER, capsules, syrup, IV) Therapeutic drug monitoring - MONITOR liver function, platelets? Teratogenic (association with fetal harm)- NOT for preg VPA Valproic acid drug concentration

Lamotrigine Adverse/Counseling

COMMON: Dizziness, somnolence, gait issues, vision changes

ADVERSE: Serious skin rashes / Hypersensitivity reactions (can be life-threatening)*, blood dyscrasias, suicidal ideation

*must be titrated- very long and slow titration- over a period of weeks so no rash steven’s johnsons’s MONITOR Drug interaction with valproic acid (increase lamotrigine concentration so may need to decrease it’s dose)

Lithium Adverse/Counseling

SERIOUS: Cardiac, CNS, dermatologic (exacerbation of acne or psoriasis), N/V/D, hypothyroidism, renal effects, sexual dysfunction, tremor, weight gain

Narrow therapeutic index (therapeutic drug monitoring needed to avoid toxicity) not 1st line, not anitconvulsant, just mood stabilizer

Gabapentin Adverse/Counseling

COMMON: Dizziness, drowsiness, fatigue, gait issues

SERIOUS: CNS and respiratory depression, hypersensitivity reactions, psychiatric effects, suicidal ideation

Often used off-label for diabetic neuropathy Initial dosing/titration Renal dosing Controlled substance (in some states)

Pregabalin Adverse/Counseling

COMMON: Dizziness, drowsiness, visual disturbances, dry mouth, peripheral edema, weight gain (MONITOR)

SERIOUS: CNS and respiratory depression, hypersensitivity reactions, suicidal ideation

Renal dosing Controlled substance