Newer Anticonvulsants
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Drugs 2000 Jul; 60 (1): 23-33 0012-6667/00/0007-0023/$25.00/0 © Adis International Limited. All rights reserved.
Newer Anticonvulsants Comparative Review of Drug Interactions and Adverse Effects Anne Sabers and Lennart Gram1 Dianalund Epilepsy Hospital, Dianalund, Denmark
Contents Abstract . . . . . . . . . . . . . . . . . . . . . . . . . 1. Interactions and Tolerability of New Anticonvulsants 1.1 Oxcarbazepine . . . . . . . . . . . . . . . . . . . 1.2 Vigabatrin . . . . . . . . . . . . . . . . . . . . . . 1.3 Lamotrigine . . . . . . . . . . . . . . . . . . . . . 1.4 Gabapentin . . . . . . . . . . . . . . . . . . . . . 1.5 Tiagabine . . . . . . . . . . . . . . . . . . . . . . 1.6 Topiramate . . . . . . . . . . . . . . . . . . . . . 2. Which Drug for Which Patient? . . . . . . . . . . . . . 2.1 Patients with Partial Seizures . . . . . . . . . . . . 2.2 Patients with Generalised Seizures . . . . . . . . 2.3 Elderly Patients . . . . . . . . . . . . . . . . . . . 2.4 Women of Childbearing Age . . . . . . . . . . . 2.5 Patients With Mental Retardation . . . . . . . . 3. Conclusions . . . . . . . . . . . . . . . . . . . . . . . .
Abstract
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The tolerability and drug interaction profiles of 6 new anticonvulsants: oxcarbazepine, vigabatrin, lamotrigine, gabapentin, tiagabine and topiramate, are reviewed. In general, these new anticonvulsants are well tolerated and drug interaction problems are minor with the exception of the risk of failure of oral contraceptives during treatment with oxcarbazepine or topiramate. In this review, the clinical implications of the tolerability of these drugs are discussed for different patient groups. The choice of which new anticonvulsant for which patient depends upon individual factors, in particular, seizure type, tolerability and practical administration factors. Treating elderly patients may be complicated by an increased sensitivity to adverse effects as these patients very often receive polytherapy for accompanying diseases. Drugs with very simple pharmacokinetic properties may be preferred in this group. Women of childbearing age face specific problems related to the epilepsy and to treatment with anticonvulsants. These include impaired fertil
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