Anticonvulsant drugs INDEX

Phenobarbital is still used for the management of partial seizures, generalized tonic-clonic seizures and for the control of status epilepticus. However because of its low therapeutic index and the possibility of dependence, phenobarbital has largely been displaced by other anticonvulsants. For newborns phenobarbital is often the drug of first choice. If given together with sodium valproate the metabolism of phenobarbital may be inhibited while in combination with carbamazepine the serum concentrations of carbamazepine will be reduced due to enzyme induction by phenobarbital. 

In contrast to anticonvulsants and alcohol, drugs such as bupropion, fluoxetine, fluvoxamine, nefazodone, quinidine, paroxetine, and some antipsychotics can inhibit specific CYP enzymes (7, 11, 36, 37, 41, 42, 43 and 44). Thus, TCAs, certain BZDs, bupropion, some steroids, and antipsychotics can all have their metabolism inhibited by drugs such as fluoxetine. For example, fluoxetine at 20 mg/day produces on average a 500% increase in the levels of coprescribed drugs which are principally dependent on CYP 2D6 for their clearance. That can lead to serious or even life-threatening toxicity if the drug has a narrow therapeutic index and the dose is not adjusted for the change in clearance caused by the coadministration of fluoxetine. 

A critical pharmacokinetic parameter that directs safe and effective medication use is the therapeutic index. This parameter establishes a quantitative comparison between a drug s effective concentration and its toxic concentration. The closer these measurements are, the narrower the index, and therefore the more care that must be taken in prescribing. Lithium and anticonvulsants, for example, have narrow therapeutic indices. 

A ter el at. (1984) documented the anticonvulsant properties of PBO and compared them with those of clinically established anti epileptic drugs. PBO administered inlrapcritoncally to mice exerted peak anti maximal electroshock activity and peak neurotoxicity at 5 and 7 hours, respectively. The median neuroluxic dose was I.69U mg kg"1. In the maximal electroshock seizure test I he median effective dose (HD j) was 457 mg kg"1 and the protective index (PI) was 3,69. In the subcutaneous pentylenetetrazol (PTZ) test the ED u was 443 mg kg 1 and PI was 3.81. PBO prevented seizure spread and elevated seizure threshold, and its PI compared favourably with those of clinically useful anticonvulsants,... 

This book may be used as an encyclopedia of medications in which componnds appear under their generic names in alphabetical order from Abacavir sulfate, to Zopiclone, the first componnd of the cyclopytolone class possessing anticonvulsant, anxiolytic, muscle relaxant, and sedative properties. Furthermore, in the index, all drugs, including their generic names and multiple trade names, appear in alphabetical order. 

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