BNF for Children 2011-2012

226 4.8.1 Control of the epilepsies BNFC 2011–20124 Central nervous system£61.77; 400 mg, 60-tab pack = £102.96. Label: 21,counselling, driving (see notes above), hypersensitivitysyndrome (see above)StiripentolStiripentol is licensed for use in combination with clobazamand valproate as adjunctive therapy of refractorygeneralised tonic-clonic seizures in children with severemyoclonic epilepsy in infancy (Dravet Syndrome). Itshould be used under specialist supervision.STIRIPENTOLCautions perform full blood count and liver functiontests prior to initiating treatment and every 6 monthsthereafter; monitor growth; interactions: Appendix 1(stiripentol)Contra-indications history of psychosisHepatic impairment avoid—no information availableRenal impairment avoid—no information availablePregnancy see Pregnancy, p. 216Breast-feeding present in milk in animal studies; seealso Breast-feeding, p. 217Side-effects nausea, vomiting; aggression, anorexia,ataxia, drowsiness, dystonia, hyperexcitability, hyperkinesia,hypotonia, irritability, sleep disorders, weightloss; neutropenia; less commonly fatigue, photosensitivity,rash, and urticariaIndication and doseSevere myoclonic epilepsy in infancy. By mouthChild 3–18 years initially 10 mg/kg in 2–3divided doses; titrate dose over minimum of 3 daysto max. 50 mg/kg/day in 2–3 divided dosesDiacomit c (Alan Pharmaceuticals) TACapsules, stiripentol 250 mg (pink), net price 60-cappack = £284.00; 500 mg (white), 60-cap pack =£493.00. Label: 1, 8, 21, counselling, administrationPowder, stiripentol 250 mg, net price 60-sachet pack= £284.00; 500 mg, 60-sachet pack = £493.00.Label: 1, 8, 13, 21, counselling, administrationExcipients include aspartame (section 9.4.1)Counselling Do not take with milk, diary products, carbonateddrinks, fruit juice, or with food or drink that contains caffeineTiagabineTiagabine is used as adjunctive treatment for focalseizures with or without secondary generalisation thatare not satisfactorily controlled by other antiepileptics.TIAGABINECautions avoid in acute porphyria (section 9.8.2);avoid abrupt withdrawal; interactions: Appendix 1(tiagabine)Driving May impair performance of skilled tasks (e.g. driving)Hepatic impairment in mild to moderate impairmentreduce dose, prolong the dose interval, or both; avoidin severe impairmentPregnancy see Pregnancy, p. 216Breast-feeding manufacturer advises use only ifpotential benefit outweighs risk; see also Breastfeeding,p. 217Side-effects diarrhoea; dizziness, tiredness, nervousness,tremor, impaired concentration, emotional lability,speech impairment; rarely confusion, depression,drowsiness, psychosis, non-convulsive status epilepticus,bruising, and visual disturbances; suicidalideation; leucopenia also reportedIndication and doseAdjunctive treatment for focal seizures with orwithout secondary generalisation not satisfactorilycontrolled by other antiepileptics. By mouthWith enzyme-inducing drugsChild 12–18 years initially 5–10 mg in 1–2divided doses, increased in steps of 5–10 mg dailyat weekly intervals; usual maintenance dose 30–45 mg daily in 2–3 divided dosesWithout enzyme-inducing drugsChild 12–18 years initially 5–10 mg in 1–2divided doses, increased in steps of 5–10 mg dailyat weekly intervals; initial maintenance dose 15–30 mg daily in 2–3 divided dosesGabitril c (Cephalon) ATablets, f/c, tiagabine (as hydrochloride) 5 mg, netprice 100-tab pack = £40.89; 10 mg, 100-tab pack =£81.77; 15 mg, 100-tab pack = £122.66. Label: 21TopiramateTopiramate can be given alone or as adjunctive treatmentin generalised tonic-clonic seizures or focal seizureswith or without secondary generalisation. It canalso be used as adjunctive treatment for seizures associatedwith Lennox-Gastaut syndrome. Topiramate isalso licensed for prophylaxis of migraine (section4.7.4.2).TOPIRAMATECautions avoid abrupt withdrawal; risk of metabolicacidosis; risk of nephrolithiasis—ensure adequatehydration (especially in strenuous activity or warmenvironment); avoid in acute porphyria (section 9.8.2);interactions: see p. 215 and Appendix 1 (topiramate)Important Topiramate has been associated with acutemyopia with secondary angle-closure glaucoma, typicallyoccurring within 1 month of starting treatment. Choroidaleffusions resulting in anterior displacement of the lens andiris have also been reported. If raised intra-ocular pressureoccurs:. seek specialist ophthalmological advice;. use appropriate measures to reduce intra-ocular pressure;. stop topiramate as rapidly as feasibleHepatic impairment use with caution in moderate tosevere impairment—clearance may be reducedRenal impairment use with caution if estimatedglomerular filtration rate less than 60 mL/minute/1.73m 2 —reduced clearance and longer time to steady-stateplasma concentrationPregnancy see Pregnancy, p. 216Breast-feeding manufacturer advises avoid—presentin milk; see also Breast-feeding, p. 217