7/18/2011 1 Clinical Use of Antiepileptic Drugs and Clinical Use of ...
7/18/2011 1 Clinical Use of Antiepileptic Drugs and Clinical Use of ...
7/18/2011 1 Clinical Use of Antiepileptic Drugs and Clinical Use of ...
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7/<strong>18</strong>/<strong>2011</strong>Safety <strong>and</strong> tolerability• New generation AED proved to havebetter side effect pr<strong>of</strong>ile• However, new generation AED still carrysome significant side effect, for example• Topiramate:• glaucoma, renal calculi, cognitiveimpairmentInitiation/dose• Patients remain at risk for anotherseizures until reaching therapeutic level• Favorable AED :• Initiation at therapeutic dose• Rapid titration• Linear relationships pharmacokinetics5556AEDs initiated at therapeutic dose(minimum effective dose)• 1 st generation AEDs• Sodium valproate 500-750 mg/d• 2 nd generation AEDs• Levetiracetam 250 mg, bid• If necessary, 500 mg, bidAEDs initiated at therapeutic dose(minimum effective dose)• Phenytoin & Phenobarbital• Despite <strong>of</strong> starting with therapeuticdose, steady state <strong>of</strong> serum drug levelneed a week (5-half life period)• Phenytoin : 3-5 mg/kg/d (300 mg/d)• Phenobarbital : grain 1 /d57581 st gen AEDsSodiumvalproate• If necessary,• 250-500 mg/d• every few daysRapid titration2 nd gen AEDsLevetiracetam• If necessary,• 500 mg/d• every dayHepatic enzyme induction• Most 1 st gen AEDs except valproatestrongly induce cytochrome P450 system• Most new generation AED have no orminimal enzyme inducing effect• Many intrinsic substances such asvitamins <strong>and</strong> hormones are subjected toinduced metabolism• Several drugs are metabolized viacytochrome P450 system596010
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