If this is not your name, click here.
| | If this is not your name, click here. | | |
| | Contact Us | Order Now | Journals | Bookstore | Register a colleague | | |
| |  DG DISPATCH - AAP: New Antiepileptic Drugs For Children By Lara Pullen Special to DG News
CHICAGO, IL -- November 2, 2000 -- Drug therapy remains the mainstay of antiepileptic therapy, according to a review of new treatments currently available in the United States. Dr. James W. Wheless of the University of Texas, in Houston, provided an update on these newer antiepileptic drugs (AED) and their role in the pediatric population at the American Academy of Pediatrics (AAP) Annual Meeting in Chicago, Illinois. The goal of therapy is to relieve all seizures while at the same time providing a safe medication for the patient. To that end, nine new drugs have recently been introduced into the United States market: felbamate, gabapentin, lamotrigine, topiramate, tiagabine, levetiracetam, oxcarbazepine and zonisamide. A new drug, vigabatrin, shows promise but has is not currently available in the U.S. The first step when making a prescription decision is to determine the nature of the seizure that the child is having. Drugs such as felbamate, lamotrigine and topiramate are broad spectrum and can be used to treat numerous seizure types. Other drugs, such as gabapentin, tiagabine and oxcarbazepine can be described as "niche drugs", because their efficacy is largely limited to specific types of seizures. In some cases, the drug must be introduced immediately into the child’s system. This requires intravenous (IV) loading and requires drugs whose pharmacokinetic profile allows for rapid introduction. Drugs suitable for IV use include the older drugs, such as fosphenytoin, valproate and phenobarbital. Many of the newer drugs, such as zonisamide, topiramate and lamotrigine require several weeks to reach the maintenance dose. Finally, Dr. Wheless said, physicians should consider the safety profile of each drug when choosing a treatment. He described gabapentin as one of the safest medications available for the treatment of epilepsy. The newest drugs (oxcarbazepine, levetiracetam and tiagabine) also appear to be safe, although they have more limited patient exposure. Felbamate and lamotrigine have safety concerns that make them poorer choices for first line therapy.
|
