Class MOA Anti-epileptic Prolonged inactivation of Na+ channels No effect on glutamate or GABA neurotransmission Very high lipid solubility Oxidized to 10,11-epoxide which is as active as parent molecule t1/2 = 10-20h (high variability between patients) Phenobarbital or phenytoin reduces t1/2 to 9h Lots of DDIs due to metabolism through P450 system


Pharmacodynamics Clinical Use Initiation of therapy of simple and complex partial seizures Initiation of therapy of tonic-clonic seizures Therapeutic concentrations: 6-12 g/mL CNS side-effects prominent above 9 g/mL Add phenytoin if treatment unsatisfactory after a month or more Start 200 mg BID and titrate to 600-1200 mg/d Toxicity Drowsiness Diplopia Ataxia Aplastic anemia (1 in 200,000) Agranulocytosis Transient leucopenia Transient changes in hepatic enzymes Teratogen Primary generalized epilepsy (may induce status epilepticus)

Side Effects


Sign up to vote on this title
UsefulNot useful