Topiramate Phenobarbital

Tonic-clonic Phenytoin, carbamazepine, valproic acid Lamotrigine, topiramate, phenobarbital, primidone, oxcarbazepine... 

Phenobarbital Phenytoin Topiramate Valproate Oxcarbazepine Topiramate Second-line Clobazam6 Gabapentin Levetiracetam Phenytoin Tiagabine... 

Carbamazepine, phenytoin, phenobarbital, valproate, gabapentin, lamotrigine, levetiracetam, tiagabine, topiramate, zonisamide... 

Phenobarbital Phenytoin Topiramate Valproic acid Valproic acid... 

U.S. Expert Panel 2005 Valproic acid Carbamazepine Lamotrigine Oxcarbazepine Phenobarbital Phenytoin Topiramate Valproic acid Children Carbamazepine Phenobarbital Phenytoin Topiramate Valproic acid Lamotrigine... 

Valproic acid may cause less cognitive impairment than phenytoin and phenobarbital. Some of the newer agents (e.g., gabapentin and lamotri-gine) have been shown to cause fewer cognitive impairments than the older agents (e.g., carbamazepine). Topiramate may cause substantial cognitive impairment. 

Drugs that can decrease carbamazepine serum levels include charcoal, cisplatin, doxorubicin, felbamate, hydantoins, rifampin, phenobarbital, primidone, theophylline. The serum levels of oral contraceptives, haloperidol, bupropion, anticoagulants, felbamate, valproic acid, felodipine, tricyclic antidepressants, acetaminophen, ziprasidone, voriconazole, topiramate, tiagabine, olanzapine, and lamotrigine can be lowered by carbamazepine. 

Phenobarbital Phenytoin (Dilantin) Tiagabine (Gabitril) Topiramate (Topamax) Valproic Acid (Depakene, Depakote) Zonisamide (Zonegran)... 

Partial seizures Carbamazepine Phenytoin Lamotrigine Valproic acid Oxcarbazepine Gabapentin Topiramate Levetiracetam Zonisamide Tiagabine Primidone, phenobarbital Felbamate... 

Drug interactions involving AEDs are shown in Table 52-5. Phenobarbital, phoiytom, primidone and carbamazepine are potent inducers of cytochrome P450 (CYP450), epoxide hydrolase, and uridine diphosphate gjucuronosyltransferase enzyme systems. Valproic acid inhibits many hepatic enzjrme systems and displaces some drugs from plasma albumin. Felbamate and topiramate can act as inducers with some isoforms and inhibitors with others. 

Bromide (1857) was the first drug to be used for the treatment of epilepsy, but it is now obsolete. Phenobarbital, introduced in 1912, controlled patients resistant to bromides. The next success was the discovery in 1938 of phenytoin (a hydantoin) which is structurally related to the barbiturates. Since then many other drugs have been discovered, but phenytoin still remains a drug of choice in the treatment of major epilepsy. Over the past ten years there has been a dramatic increase in the number of new anticonvulsant drugs (vigabatrin, gabapentin, lamotrigine, topiramate, oxcarbazepine, levetiracetam), but none has been shown to be superior to the major standard anticonvulsants (phenytoin, carbamazepine and sodium valproate). 

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... 

Carbamazepine, phenytoin, phenobarbital and primidone, felbamate, oxcarbazepine, and topiramate stimulate the metabolism of oral contraceptive steroids. 

Clinically important, potentially hazardous interactions with carbamazepine, lamotrigine, phenobarbital, primidone, topiramate, valproic acid, vigabatrin... 

Importantly, Loscher et al. found that carbamazepine, felbamate, gabapentin, lamotrigine, phenobarbital, and topiramate are substrates of ABCBl (P-gp) [38]. Crowe et al. also studied the transport of a variety of antiepileptic drugs including vigabatrin, gabapentin, phenobarbitone, lamotrigine, phenytoin, carbamazepine, and acetazolamide in colorectal tumor-derived Caco-2 cell monolayers. They found that only one antiepileptic, acetazolamide, is a weak ABCBl substrate [39]. 

The traditional treatment of tonic-clonic seizures is phenytoin or phenobarbital however, the use of carbamazepine and valproic acid is increasing because these AEDs have a lower incidence of side effects and equal efficacy. Valproic acid generally is considered the drug of first choice for atonic seizures and for juvenile myoclonic epilepsy. Lamotrigine and perhaps topiramate and zonisamide may be alternative agents for these seizure types. 

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