Primidone Clonazepam

Treatments of first choice for cortical myoclonus are valproic acid (sodium valproate) and clonazepam. Primidone and phenobarbital may also be useful. Piracetam has advantages in these circumstances, as its addition to existing treatments is rarely accompanied by sedation. 

From the clinical point of view, antiepileptic drugs are primarily divided into two categories those effective in treating major attacks (phenytoin, carbamazepine, mephobarbi-tal, and also primidone), and those effective in treating minor attacks (ethosuximide, acetazolamide, clonazepam, trimethadione, and valproic acid). 

From the chemical point of view, formally, antiepileptic drugs could be classified as derivatives of hydantoins (phenytoin, mephenytoin, ethotoin), barbiturates (phenobarbital, mephobarbital, and primidone), succinimides (ethosuximide, methosuximide, phensux-imide), benzodiazepines (diazepam, chlorodiazepoxide, clonazepam, lorazepam), oxazo-lidines (trimethadione, paramethadione), and also valproic acid, carbamazepine, and acetazolamide. 

Carbamazepine also can induce the enzymes that metabolize other anticonvulsant drugs, including phenytoin, primidone, phenobarbital, valproic acid, clonazepam, and ethosuximide, and metabolism of other drugs the patient may be taking. Similarly, other drugs may induce metabolism of carbamazepine the end result is the same as for autoinduction, and the dose of carbamazepine must be readjusted. A common drug-drug interaction is between carbamazepine and the macrolide antibiotics erythromycin and trolean-domycin. After a few days of antibiotic therapy, symptoms of carbamazepine toxicity develop this is readily reversible if either the antibiotic or carbamazepine is discontinued. 

For simple and complex partial seizures and secondary generalized tonic-clonic seizures, the first line drugs are - carbamazepine, valproate and phenytoin. Second line drugs include - acetazolamide, clobazam, clonazepam, ethosuximide, felbamate, gabapentin, lamotrigine, levetiracetam, oxacarbamazepine, primidone, tiagabine, topiramate and vigabactin. 

For generalized absence seizures, first line treatment is with valproate or ethosuximide and second line treatment with acetazolamide, clobazam, clonazepam, lamotrigine, phenobarbitone and primidone. 

Myoclonic seizures are best treated with valproate but, as a second choice, with clobazam, clonazepam, ethosuximide, lamotrigine, phenobarbitone, piracetam or primidone. 

Carbamazepine is a hepatic microsomal enzyme inducer and therefore will lower the serum concentration of a wide variety of drugs given concurrently. These include the antiepileptic drugs phenytoin, primidone, valproate, ethosuximide and clonazepam. In addition, carbamazepine can compromise the therapeutic effects of oral contraceptives, oral anticoagulants, beta-blockers, haloperidol and theophylline. 

Essential tremor is often, and with justice, called benign, but a few individuals may be incapacitated by it. Alcohol, through a central action, helps about 50% of patients but is plainly imsuitable for longterm use and a nonselective P-adrenoceptor blocker, e.g. propranolol 120 mg/day, will benefit about 50% clonazepam or primidone are sometimes beneficial. 

Anticonvulsants. Carbamazepine, phenobarbital and primidone accelerate warfarin metabolism (enzyme induction) the effect of phenytoin is variable. Clonazepam and sodium valproate are safe. 

Phenobarbital Phenytoin Primidone Felbamate Lamotrigine Tiagabide Topiramate Valproate Zonisamide Clobazam Clonazepam Diazepam usually compensated by the effect of the added drug risk of toxicity when interfering drug is discontinued drug... 

Clinically important, potentially hazardous interactions with alcohol, anticholinergics, barbiturates, benzodiazepines, butabarbital, chloral hydrate, chlordiazepoxide, chlorpromazine, clonazepam, clorazepate, diazepam, ethchlorvynol, fluphenazine, flurazepam, hypnotics, lorazepam, MAO inhibitors, mephobarbital, mesoridazine, midazolam, narcotics, oxazepam, pentobarbital, phenobarbital, phenothiazines, phenylbutazone, primidone, prochlorperazine, promethazine, quazepam, secobarbital, sedatives, temazepam, thioridazine, tranquilizers, trifluoperazine, zolpidem... 

Clinically important, potentially hazardous interactions with amlodipine, anisindione, anticoagulants, aprepitant, atorvastatin, barbiturates, benzodiazepines, butabarbital, carbamazepine, chlordiazepoxide, clarithromycin, clonazepam, dorazepate, corticosteroids, cyclosporine, dexamethasone, diazepam, dicumarol, erythromycin, ethotoin, felodipine, flurazepam, fluvastatin, fosphenytoin, isradipine, itraconazole, ketoconazole, lorazepam, lovastatin, mephenytoin, mephobarbital, midazolam, nicardipine, nifedipine, nimodipine, nisoldipine, oxazepam, pentobarbital, phenobarbital, pimozide, pravastatin, primidone, quazepam, rifampin, secobarbital, simvastatin, St John s wort, temazepam, warfarin... 

Simultaneous mephobarbital, paramethadione, phenobarbital, primidone Noninterfering chlorazepate, clonazepam, diazepam, thioridazine, valproic acid Interfering phenytoin... 

Simultaneous carbamazepine-10,11-epoxide, clonazepam, dihydrodihydroxycarbamaze-pine, hexobarbital, p-hydroxyphenobarbital, 5-(m-hydroxyphenyl)-5-phenylhydantoin, 5-(p-hydro QT)henyl)-5-phenylhydantoin, nitrazepam, phenobarbital, phenylethylmaleimide, phenytoin, primidone... 

Noninterfering acetaminophen, N-acetylprocainamide, amikacin, amitriptyline, ampicil-lin, carbamazepine, cefamandole, cefazolin, cefoperazone, cefotaxime, cefoxitin, ceftazidime, ceftizoxime, cephalexin, cephalothin, cephapirin, chloramphenicol, ciprofloxacin, clonazepam, (yclosporine, desipramine, digoxin, disopyramide, ethosuximide, gentamicin, haloperidol, imipramine, kanamycin, lidocaine, mezlocillin, netilmicin, nortriptyline, phenobarbital, phenytoin, primidone, procainamide, propranolol, quinidine, salicylic acid, streptomycin, sulfamethoxazole, theophylline, thiamphenicol, ticarcillin, tobramycin, trimethoprim, vancomycin... 

Noninterfering acetaminophen, acetylmorphine, amiodarone, amobarbital, amphetamine, bendroflumethiazide, benzocaine, benzoylecgonine, benzthiazide, butalbital, carbamaze-pine, chlorothiazide, clonazepam, cocaine, codeine, cotinine, cyclosporine, cyclothiazide, desalkylflurazepam, diamorphine, dicumerol, ephedrine, ethaciynic acid, ethanol, eth-chlorvynol, ethosuximide, furosemide, glutethimide, hydrochlorothiazide, hydrocodone, hydroflumethiazide, hydromorphone, lorazepam, mephentermine, meprobamate, meth-amphetamine, metharbital, methoxsalen, methoxyphenteramine, methsuximide, meth-ylcyclothiazide, metoprolol, MHPG, monoacetylmorphine, morphine, normethsuximide, oxazepam, oxycodone, oxymorphone, pentobarbital, phencyclidine, phenteramine, phenylephrine, phenytoin, polythiazide, primidone, prochlorperazine, salicylic acid, sulfanilamide, THC-COOH, theophylline, thiazolam, thiopental, thioridazine, tocainide, trichlo-romethiazide, trifluoperazine, valproic acid, warfarin... 

Noninterfering acetaminophen, allopurinol, amikacin, amoxapine, amytal, bretylium, caffeine, carbamazepine, carisoprodol, chloramphenicol, chlordiazepoxide, chlorpropamide, clonazepam, codeine, diazepeun, disop30 amide, droperidol, ethinamate, ethinamate, etho-suximide, fluphenazine, flurazepam, furosemide, gentamicin, haloperidol, hydrochlorothiazide, hydro yzine, ibuprofen, kanamycin, lidocaine, loxapine, meperidine, mepho-barbital, meprobamate, methaqualone, methotrexate, morphine, nafcUlin, naloxone, neomycin, perphenazine, phenacetin, phenobarbital, phenytoin, prazepam, primidone, procaine, propoxyphene, reserpine, salicylamide, salicylic acid, secobarbital, spironolactone, theophyUine, thiopental, thioridazine, tobramycin, valproic acid, verapeunil... 

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