The Toxicity of Newer and Lesser-Known Anticonvulsant Drugs
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ACUTE CARE PHARMACOLOGY AND TOXICOLOGY (A KING, SECTION EDITOR)
The Toxicity of Newer and Lesser-Known Anticonvulsant Drugs Steven J. Walsh 1 & Richard J. Chen 1 & Muhammed Ershad 1 & James A. Krueger 1
# Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose of Review This review describes newer and lesser-known anticonvulsant drugs. Due to increased diagnostic accuracy of seizure disorder subtypes, as well as escalating off-label and experimental usage, these agents are becoming more commonplace. Important mechanisms of action, pharmacokinetics/pharmacodynamics, critical medication interactions, adverse reactions, toxicities, and treatment strategies are discussed. Recent Findings Cenobamate, clobazam, eslicarbazepine, ethosuximide, everolimus, felbamate, lacosamide, perampanel, methsuximide, levetiracetam (and the related compound brivaracetam), rufinamide, stiripentol, vigabatrin, and zonisamide are reviewed. As with much in medical toxicology, data and recommendations are derived mainly from physiology bench research, case studies, and expert opinion. Summary Anticonvulsants are a heterogeneous group of drugs, with newer and lesser-known agents increasing in prominence. These drugs have varied and unique mechanisms of action and toxicities, with which clinicians should be familiar. Keywords Adverse medication effect . Anticonvulsant . Antiepileptic . Epilepsy . Seizure . Toxicology
Introduction Anticonvulsants are a diverse group of drugs with varied mechanisms of action. Many are well-characterized and frequently used; however, a variety of newer and lesserknown anticonvulsants are rising in prominence. Toxicities from these drugs are neither well-established nor frequently encountered by most clinicians. A quick
This article is part of the Topical collection on Acute Care Pharmacology and Toxicology * Steven J. Walsh [email protected] Richard J. Chen [email protected] Muhammed Ershad [email protected] James A. Krueger [email protected] 1
Department of Emergency Medicine, The Poison Control Center at Children’s Hospital of Philadelphia, Division of Medical Toxicology, Einstein Healthcare Network, Korman Research Building, Suite B-9, 5501 Old York Road, Philadelphia, PA 19141, USA
reference table for the information included in this review is contained in Table 1. Supportive care including oxygenation, ventilation, and hemodynamic support with crystalloid and vasopressors is the hallmark of therapy for all xenobiotics discussed. Those caring for these patients should exclude coingestants that may be contributing to the patient’s clinical condition. Most of these drugs are sedating; therefore, rhabdomyolysis, aspiration pneumonitis, and concomitant trauma should be considered. All testing discussed in this review is in addition to the minimum studies typical for a toxicology patient: an electrocardiogram, electrolyte panel, acetaminophen and salicylate concentrations, and a pregnancy test (if applicable). While concentrations of these agents are available fr
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