AED Uses MOA Aggravates SE Toxicity

Carbamazepine
tegretol

TDM:
Total 4-12mg/L
Toxic >30
Focal S Stabilizes inactivated sodium
channels (excitable)
Absence
Myoclonic
GTC
Drowsy/dizzy
Rashes
Ataxia/diplopia
SJS
Agranulocytosis
Lamotrigine
2
Absence
both
2
others
Stabilize neuronal mbrane
(inhibit release excitatory AA
glutamate & sodium channel)
Dravet synd
JME
Dizzy
Insomnia
Rash
SJS
Phenytoin
dilantin

*highly protein bound
TDM:
Total 10-20ug/ml
Free 1-2.5ug/ml
Lethal >100
2
Focal S
2
others (except A/M)

Na efflux (influx) from motor
cortex neuron mbrane
stabilization; slow conduction
velocity
Absence
typical

Myoclonic

dizzy/sedation
diplopia
gum hypertrophy
megaloblastic anemia
hirsutism

Na valproate
depacon
*highly protein bound
TDM:
Total 50-100ug/ml
Free 6-20ug/ml
Lethal >150
Focal S
All others
2
Infantile spasm


/enhance GABA @
postsynaptic R; inhibit Na & Ca
channels
Weight gain
Alopecia
N/epigastric pain
Thrombocytopenia
Tremor
Hepatic toxicity
(<2y/o)
Prancreatitis
encephalopathy
Levetiracetam
keppraXR

2
Absence
typical
Inhibit N-type Ca channel;
facilitate GABA inhibitory
transmission
Dizzy
Irritability/ behavioral change
Malaise

Clonazepam
Clobazam
Myoclonic Long acting BDZ(presynaptic
GABA inhibition
Lennox-G
synd
cause tonic
status

Drowsy
Hypotonia
Salivary & bronchial
hypersecretion
Aggression

Phenobarbitone
TDM:
Total 15-40ug/mll
Toxic >60
2
Focal S
2
GTC/C
2
Myoclonic
antiS in GABAa-mediated
neurotransmission; depresses
sensory & motor cortex & CBL
Absence Drowsy/ ataxia
Rash
Behavioral changes

Topiramate
2
All (except absence
typical
)
2
Infantile spasm
Inhibit neuronal voltage-
dependent Na channels;
enhance GABA inhibitory action
Weight loss
Mental slowing
Hypohydrosis/renal calculi

Vigabatrin
*esp tuberous sclerosis
Infantile spasm
Others:
pred/ACTH

Irreversible inhibitor GACA
transaminase in brain
Myoclonic
Absence
Weight gain
Drowsy/dizze
Mood changes
Peripheral visual
field constriction
(tunnel vision)