The Place of Felbamate in the Treatment of Epilepsy

Leppik, Ilo E.; Wolff, Denise L

doi:10.2165/00023210-199504040-00006

Cited by 22 publications

(8 citation statements)

References 32 publications

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“…Adverse interactions usually involve reciprocal potentiation of neurotoxicity: an example is provided by the reduced tolerability of lamotrigine [69], topiramate [70] and felbamate [71,72] in patients comedicated with carbamazepine and, possibly, other AEDs. Beneficial pharmacodynamic interactions are observed when a drug combination results in additive or supraadditive efficacy and less than additive toxicity.…”

Section: Pharmacodynamic Drug Interactionsmentioning

confidence: 99%

“…Felbamate has also been found to have a broad efficacy spectrum [71], and to produce particularly favorable results in patients with drop attacks associated with the Lennox-Gastaut syndrome [113]. The use of felbamate, however, is restricted by the risk of aplastic anemia and liver toxicity.…”

Section: Efficacy Spectrum In Different Seizure Typesmentioning

confidence: 99%

“…Its current role is in the management of seizures refractory to all other appropriate AEDs [71,161]. In most European countries, the only approved indication is the management of refractory seizures associated with the Lennox-Gastaut syndrome.…”

Section: Felbamatementioning

confidence: 99%

“…In most European countries, the only approved indication is the management of refractory seizures associated with the Lennox-Gastaut syndrome. Because of concomitant pharmacokinetic and pharmacodynamic interactions with other AEDs, central nervous system side effects may be prominent in patients in whom felbamate is added on to previous medication, and a reduction in the dosage of concomitant AEDs is often required [71]. Although regular assessment of hematology and liver function parameters are recommended, at least for aplastic anemia there is no evidence that intensive monitoring can reduce the mortality risk.…”

Section: Felbamatementioning

confidence: 99%

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The New Antiepileptic Drugs Pharmacological and Clinical Aspects

Gatti¹,

Bonomi²,

Jannuzzi³

et al. 2000

CPD

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In recent years several new drugs (oxcarbazepine, lamotrigine, topiramate, gabapentin, zonisamide, tiagabine, fosphenytoin, vigabatrin and felbamate) have been added to the therapeutic armamentarium against epilepsy. Some of these represent structural modifications of pre-existing compounds, others were developed with the specific objective of modifying neurotransmitter function, and many more were found to be clinically useful even though their mode of action is unclear or differs from that originally planned. The pharmacokinetics of these drugs differ widely from one agent to another. Some (gabapentin and vigabatrin) are eliminated unchanged in urine and have little or no interaction potential; others (tiagabine, lamotrigine, topiramate, oxcarbazepine, zonisamide, felbamate) are subject to induction of metabolism by concomitant anticonvulsants; lamotrigine is vulnerable to metabolic inhibition by valproate, and felbamate is a powerful enzyme inhibitor in addition to being an inducer of the metabolism of carbamazepine and steroid oral contraceptives. All new antiepileptic drugs have been found to be effective in improving seizure control in patients with partial and secondarily generalized seizures. However, lamotrigine, topiramate, zonisamide and felbamate appear to have broader efficacy against both partial and many generalized seizure types, while vigabatrin is also valuable in the management of infantile spasms. In monotherapy studies, new drugs have not been found to be more efficacious than older agents, but some may offer limited advantages in terms of improved tolerability. On the other hand, serious toxicity restricts considerably the use of vigabatrin and felbamate. Overall, new drugs represent valuable tools in the fight against epilepsy, but because of limited experience and cost considerations their first-line use cannot be recommended in most situations.

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Section: Pharmacodynamic Drug Interactionsmentioning

confidence: 99%

Section: Efficacy Spectrum In Different Seizure Typesmentioning

confidence: 99%

Section: Felbamatementioning

confidence: 99%

Section: Felbamatementioning

confidence: 99%

See 2 more Smart Citations

The New Antiepileptic Drugs Pharmacological and Clinical Aspects

Gatti¹,

Bonomi²,

Jannuzzi³

et al. 2000

CPD

View full text Add to dashboard Cite

show abstract

“…Felbamate was widely proclaimed as the first new AED in many years when it received FDA approval in 1993 for monotherapy in adults with partial seizures and as an adjunctive therapy in children suffering from Lennox-Gastaut syndrome (383,385,387,388). Within the first year on the U.S. market, as many as 120,000 patients took the drug, and it was judged efficacious in many patients whose epilepsy had been refractory to other AEDs (383,387,389).…”

Section: Felbamatementioning

confidence: 99%