ANTIEPILEPTICS, PART 1

phenytoin (Dilantin), fosphenytoin (Cerebyx),

ethosuximide (Zarontin), levetiracetam
DRUG NAME carbamazepine (Tegretol), valproic acid (Depacon),
(Keppra)
sodium valproate (Depakote), lamotrigine (Lamictal)

CLASS Sodium channel blockers Calcium channel blockers

Block voltage-gated Na+ channels; inhibition of action Block voltage-gated Ca2+ channels; inhibition
MECHANISM OF ACTION potentials in excitatory neurons; ↓ seizure activity of action potentials in excitatory neurons; ↓
seizure activity

• Epilepsy, generalized seizures, partial seizures

INDICATIONS • Mood disorders

• Phenytoin: PO, IV • Ethosuximide: PO

• Fosphenytoin: IV, IM • Levetiracetam: PO, IV
ROUTE(S) OF • Carbamazepine: PO, IV
ADMINISTRATION • Valproate: PO, IV
• Lamotrigine: PO

Phenytoin, fosphenytoin Ethosuximide

SIDE EFFECTS • Headaches, dizziness, visual disturbances,

hypersensitivity reactions (SJS, TEN, DRESS),
hepatotoxicity, impaired metabolism of vitamin D,
 decreased absorption of folic acid and vitamin B12,
blood dyscrasias, suicidal thoughts • Gastrointestinal problems, fatigue,
• Boxed warning: rapid IV administration can result headache, pruritus, blood dyscrasias,
in hypotension and cardiac arrhythmias DRESS

Carbamazepine Levetiracetam

• Pancreatitis, hepatotoxicity, renal dysfunction, • Suicidal thoughts, SJS, TEN, hepatitis

hypertension, AV block
• Boxed warning: SJS, TEN, DRESS, bone marrow
depression

Valproate

• Gastrointestinal problems, thrombocytopenia,

leukopenia, DRESS, suicidal thoughts, CNS
depression, coma
• Boxed warning: pancreatitis, hepatotoxicity, fetal
toxicity
 Lamotrigine

• Headache, dizziness, dysmenorrhea; seizures,

suicidal thoughts, disseminated intravascular
coagulation, leukopenia, thrombocytopenia
• Boxed warning: SJS, TEN

Phenytoin Ethosuximide

• Pregnancy, sinus bradycardia, heart block, Adams- • Pregnancy, breastfeeding, hepatic or

Stokes syndrome renal disease

CONTRAINDICATIONS AND Carbamazepine Levetiracetam

CAUTIONS

• Pregnancy, breastfeeding, alcoholism, cardiac, • Pregnancy; breastfeeding; pediatric or

hepatic, or renal disease, children < 6 years elderly clients; cardiac, hepatic, or renal
• Not be administered within 14 days of MAOIs, or disease
concomitantly with non-nucleoside reverse
transcriptase inhibitors
 Valproate

• Pregnancy, urea cycle disorders, mitochondrial

disease, hepatic disease

Lamotrigine

• Pregnancy; breastfeeding; severe depression;

clients < 16 years, elderly; cardiac, hepatic, or renal
disease

ANTIEPILEPTICS, PART 2

DRUG NAME vigabatrin (Sabril) gabapentin (Neurontin, Gralise)

CLASS GABA inhibitors GABA analogues

Prevent GABA reuptake into presynaptic neurons; ↑ Structurally similar to GABA

MECHANISM OF ACTION
GABA concentration in synapse; ↓ seizure activity
 • Epilepsy, generalized seizures, partial seizures
INDICATIONS • Mood disorders

ROUTE(S) OF
vigabatrin: PO PO
ADMINISTRATION

Vigabatrin • Depression
• Amnesia
• Somnolence
• Dizziness, gastrointestinal problems, weight gain, • Ataxia
edema, decreased hemoglobin and hematocrit, • Blurred vision, nystagmus, diplopia
SIDE EFFECTS peripheral neuropathy, malignant hyperthermia, • Dry mouth
suicidal thoughts, respiratory depression, • Gastrointestinal problems
pulmonary embolism • Pruritus
• Boxed warning: visual impairment • DRESS
• Leukopenia

Vigabatrin • Pregnancy and breastfeeding

• Children < 3 years old
• Elderly clients
CONTRAINDICATIONS AND • Pregnancy, breastfeeding, children < 2 years old, • Suicidal thoughts
CAUTIONS
elderly clients, hepatic or renal disease, history of • Depression
psychosis or depression • Renal disease
 • Hemodialysis

CONSIDERATIONS: ANTIEPILEPTICS

All antiepileptics

Assessment

• Type, frequency, and duration of seizures

ASSESSMENT AND MONITORING
• Screenings
o Depression, suicidal thoughts
o Pregnancy
• Laboratory test results
o CBC
o Liver and renal function tests
• Diagnostic tests
o ECG (phenytoin, carbamazepine, or lamotrigine)
o Baseline vision test (vigabatrin)

Monitoring
 • Mental status, mood, behavior
• CBC, liver, and renal function
• Evaluate therapeutic effect: decrease in seizure frequency, severity, and
duration

All antiepileptics

• Purpose of medication
• Take exactly as prescribed; do not stop abruptly
• Use reliable contraception while taking an antiepileptic medication
• Wear medical identification
• Side effects
CLIENT EDUCATION o CNS depression
▪ Avoid other CNS depressant medications; alcohol
▪ Avoid activities that require alertness
o Immediately report
▪ Increased risk of suicidal behavior; e.g., anxiety, agitation,
depression, other changes in their mood or behavior
▪ Liver dysfunction; e.g., anorexia nausea, vomiting, and fatigue
▪ Blood dyscrasias; e.g., fever, sore throat, pallor, weakness,
petechiae, easy bruising
 ▪ Skin changes; development of unusual rash
Sodium channel blockers
Phenytoin
• Recognize signs of gingival
hyperplasia; e.g., sore, swollen
gums
• Maintain dental hygiene, folic
acid supplement, regular
dentist visits
• Decrease risk of bone loss:
increase dietary calcium and
vitamin D; weight-bearing
exercises as tolerated
• Report visual disturbances; e.g.,
blurred vision, nystagmus,
diplopia
Carbamazepine
GABA inhibitors
Vigabatrin
• Vision checks every three
months during therapy
• Report vision changes; e.g.,
blurred vision, difficulty
controlling eye movements,
vision loss
• Report symptoms of peripheral
neuropathy; e.g., burning or
numbness in toes or feet
 • Avoid grapefruit / grapefruit
juice
• Report symptoms of
pancreatitis; e.g., upper
abdominal pain, nausea,
vomiting, anorexia
• Report symptoms of water
retention and hyponatremia;
e.g., swelling, weight gain,
headache, muscle weakness or
cramps

Valproate

• Report symptoms of
pancreatitis; e.g., upper
abdominal pain, nausea,
vomiting, anorexia