Linked Life Data

9352959

Source:http://linkedlifedata.com/resource/pubmed/id/9352959

Statements in which the resource exists as a subject.
PredicateObject
rdf:type
lifeskim:mentions
pubmed:issue
4
pubmed:dateCreated
1997-12-2
pubmed:abstractText
In the last few years a number of new anticonvulsants have been introduced into clinical practice mainly as add-on therapy in patients who do not become seizure-free while receiving established anticonvulsants. Up to now, no single drug has been shown to be more effective at controlling seizures of a particular type than another, so other factors such as mechanism of action, pharmacokinetics, dosage regimens or the spectrum of adverse drug reactions and interactions are used when making a choice between one agent and another. The mechanism of action of tiagabine and vigabatrin is very specific; both agents increase gamma-aminobutyric acid (GABA) levels through inhibition of reuptake and catabolism respectively. However, the mechanism of action of gabapentin is unknown and those of felbamate, lamotrigine and topiramate are not sufficiently clarified as yet, and may be multiple. Great advances have been made in improving the pharmacokinetic characteristics of these newer anticonvulsants. Gabapentin and vigabatrin exhibit relatively ideal pharmacokinetic properties as they are not bound to proteins, are excreted mostly unchanged in the urine and show linear pharmacokinetics. Lamotrigine possesses a highly variable elimination half-life depending on the co-medication. Tiagabine is highly protein bound and zonisamide shows nonlinear pharmacokinetics; both these drugs are extensively metabolised. Problematic drug interactions between newer anticonvulsants and other drugs in general occur rarely when these agents are given concomitantly. However, in common with most new drugs, there are very few data on the use of the newer anticonvulsants in women of childbearing age. Studies done so far on interactions with oral contraceptives used low anticonvulsant dosages for a very short time. The newer anticonvulsants elicit adverse reactions that, while not being unique, are particularly associated with that drug. For example, felbamate may cause aplastic anaemia and fulminant liver failure, lamotrigine is prone to cause skin rash, and oxcarbazepine may cause symptomatic hyponatraemia. Topiramate and zonisamide cause kidney stones, and vigabatrin may induce psychiatric syndromes. Although highly diverse in structure and activity, these newer drugs offer new possibilities for treating refractory epilepsy. However, since no single factor can dictate the choice of drug nor predict the success of treatment, prescribing of these rather expensive drugs has to depend upon careful consideration of the aims of treatment, the characteristics of the drug and the needs of the individual patient.
pubmed:language
eng
pubmed:journal
pubmed:citationSubset
IM
pubmed:chemical
pubmed:status
MEDLINE
pubmed:month
Oct
pubmed:issn
0114-5916
pubmed:author
pubmed:issnType
Print
pubmed:volume
17
pubmed:owner
NLM
pubmed:authorsComplete
Y
pubmed:pagination
228-40
pubmed:dateRevised
2008-11-21
pubmed:meshHeading
pubmed-meshheading:9352959-Adult, pubmed-meshheading:9352959-Anticonvulsants, pubmed-meshheading:9352959-Biological Availability, pubmed-meshheading:9352959-Calcium Channels, pubmed-meshheading:9352959-Drug Interactions, pubmed-meshheading:9352959-Drug Prescriptions, pubmed-meshheading:9352959-Excitatory Amino Acid Agonists, pubmed-meshheading:9352959-Excitatory Amino Acid Antagonists, pubmed-meshheading:9352959-Female, pubmed-meshheading:9352959-Half-Life, pubmed-meshheading:9352959-Humans, pubmed-meshheading:9352959-Male, pubmed-meshheading:9352959-Potassium Channels, pubmed-meshheading:9352959-Protein Binding, pubmed-meshheading:9352959-Sodium Channels, pubmed-meshheading:9352959-Synaptic Transmission, pubmed-meshheading:9352959-Teratogens, pubmed-meshheading:9352959-Tissue Distribution, pubmed-meshheading:9352959-gamma-Aminobutyric Acid
pubmed:year
1997
pubmed:articleTitle
Newer anticonvulsant drugs: role of pharmacology, drug interactions and adverse reactions in drug choice.
pubmed:affiliation
Department of Clinical Pharmacy, University Hospital of Nijmegen, The Netherlands.
pubmed:publicationType
Journal Article, Review, Research Support, Non-U.S. Gov't