7/18/2011 1 Clinical Use of Antiepileptic Drugs and Clinical Use of ...

7/18/2011ผู ้ป่ วยชาย อายุ 64 ปี• Dilated cardiomyopathy• Chronic atrial fibrillation• Cardiac liver cirrhosis• Epilepsy attributed to old cerebralembolismผู ้ป่ วยชาย อายุ 64 ปี• He needs AED with better pharmacokineticprofile• No liver toxicity• Not induce hepatic coma• Not metabolized by liver• Not induce cyp 450 enzyme thatmetabolize warfarin• Therefore, all 1 st gen AEDs not suitable6768ผู ้ป่ วยชาย อายุ 64 ปี2 nd gen AED that has suitable profile areLevetiracetamPregabalinGabapentin• Topiramate > 200 mg/d may have livertoxicity.• Lamotrigine is glucuronidated by liver.• Children• Women• The elderlySpecial groups6970AED in women• Women with childbearing potential• Hormonal contraception• Pregnancy• Breast feeding• Bone health particularly in postmenopausal periodValproate in pregnancy• Several observational studies reported• higher rates of major congenitalmalformations with use of valproate Vsother AEDs such as carbamazepine orlamotrigine(Harden et al, Epilepsia 2009; Artama et al, Neurology 2005; Vajdaet al, Obstet Gynecol 2007; Wide et al, Acta Paediatr 2004;Wyszynski et al, Neurology 2005; Morrow et al, J Neurol NeurosurgPsychiatry 2006; Veiby et al, Epilepsia 2009)717212