Magazine article Drug Topics

New Drugs Offer Advantage as Anticonvulsants

Magazine article Drug Topics

New Drugs Offer Advantage as Anticonvulsants

Article excerpt

Enthusiasm is running high for the first new anticonvulsants since the introduction of valproic acid 14 years ago. Commented Timothy A. Pedley, president, American Epilepsy Society, and professor of neurology, Columbia University, College of Physicians & Surgeons: "They are not just 'me too' drugs. They have novel mechanisms of action and are easier to use in some ways than existing anticonvulsants because they have fewer side effects or drug interactions."

The agents, gabapentin (Neurontin, Warner-Lambert Co.) and felbamate (Felbamyl, Carter-Wallace Inc.), were unanimously recommended for approval by the Food & Drug Administration's Peripheral & Central Nervous System Drug Advisory Committee. A third agent, lamotrigine (Lamictal, Burroughs Wellcome Co.), is likely to be reviewed by the committee this year.

User friendly: Unlike other antiepileptic agents, which are eliminated hepatically, gabapentin is renally eliminated and causes fewer drug interactions. "That," said Thomas Browne, M.D., professor and vice chairman, department of neurology, Boston University School of Medicine, a coinvestigator in gabapentin clinical trials, "makes it very user friendly for both physicians and patients."

Adding gabapentin to existing antiseizure regimens, Browne noted, does not require the expensive and inconvenient monitoring called for with other anticonvulsants. Interactions between drugs can cause their levels to increase or decrease, he said, leading to either toxicity or seizures.

Among elderly patients, often on a multiplicity of drugs, freedom from drug interactions with gabapentin may be especially important, Pedley stressed. "It has been recognized in recent years that there is; second peak of seizure activity in the elderly the first is in early childhood! associated with degenerative brain disease such as stroke and Alzheimer's."

Study results presented at the annual meeting of the American Epilepsy Society in Seattle under scored gabapentin's efficacy and safety in follow-up extended out to five years.

A total of 443 patients in the United States and abroad with refractory partial seizures, despite treatment with other anticonvulsants, participated in two trials. Gabapentin was administered daily at 600 mg to 2400 mg as an add-on therapy for patients demonstrating positive response to gabapentin in prior trials. The percentage of patients experiencing side effects was very high, according to Ilo E. Leppik, M.D., clinical professor of neurology and pharmacy practice, University of Minnesota Medical School, but side effects were generally very mild.

" Gabapentin! …

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