Side Effects
Relatively high incidence (1:1000) of causing Steven-Johnson Syndrome
Lamotrigine (Lamictal). More common if taken with valproate and a delayed titration schedule must be used.
Topiramate (Topamax)
High and selective affinity for synaptic vesicle protein 2A (SV2A) in the brain, decreasing excitatory neurotransmitter release
Briveracetam (Briviact)
Agonist at 5H-2 receptors
Fenfluramine (Fintepla)
Infantile spasms
ACTH, Vigabitran (Vigabtrin 1st line in TSC)
Can cause significant hyponatremia by increasing ADH, with an incidence of 3%
Oxcarbazepine (Trileptal). Risk of hyponatremia is higher than with carbamazepine (Tegretol).
Ataxia, megaloblastic anemia/blood dyscrasias, hirsutism, cerebellar atrophy, gingival hyperplasia
Phenytoin (Dilantin)
Binds to T-type voltage sensitive calcium channels, reducing exciteability
Ethosuxamide (Zarontin)
Noncompetitive antagonist of the AMPA receptor, decreases glutamate
Perampanel (Fycompa)
Dravet
Valproate
Clobazam, fenfluramine, and stiripentol (Diacomet)
Cannabidiol (Epidiolex)
Ketogenic diet
Visual field cuts and progressive, permanent vision loss, despite discontinuation.
Vigabatrin (Sabril). This risk requires baseline and q3 visual checks with ophthalmology and should be discontinued at the first sign of vision loss.
Ataxia, osteoporosis, depression, contractures
Phenobarbital
Enhances the slow inactivation of sodium channels.
Lacosamide (Vimpat)
Blocks sodium channels. Also, increase potassium conductance and modulate the activity of high-voltage activated calcium channels.
Oxcarbazepine (Trileptal)
Lennox-Gastaut syndrome
Valproate
Lamotrigine
Rufinamide (Banzel)
Basically anything else
Weight gain, pancreatitis, thrombocytopenia, Alopecia, liver failure
Valproate (Depakote).
Ataxia, diplopia, PR prolongation
Lacosamide (Vimpat)
Inhibits voltage-gated sodium channels and a positive allosteric modulator of GABA.
Cenobamate (Xcopri)
Allosteric modulator of GABA receptor subunits, extends the amount of time the chloride ion channel is open.
Phenobarbital
Dravet-Avoid
Carbamazepine, oxcarbazepine, lamotrigine, phenytoin
Boxed warning for causing aggression; also ataxia and weight gain
Perampanel (Fycompa)
Serotonin syndrome, valvular heart disease
Fenfluramine (Fintepla)
Decreases glutamate via blocking AMPA and kianate receptors, increases GABA receptor activity, and blocks sodium channels
Topiramate (Topamax)
Clobazam (Onfi)
Status epilepticus Tx (1st, 2nd 3rd and 4th line)
BEnzodiazepine (10 mg midazolam, IM or 4 mg x 2 of lorazepam IV)
ASM load- Keppra 60 mg/kg, Depakote 40 mg/kg, fosphenytoin/phenytoin 20 mg /kg
ALso consider Briviact 300 mg push or lacosamide 400 mg load
2nd ASM agent load
Sedative burst suppression with IV midazolam or ketamine->Pentobarb coma