What's with all the new medicines?

Richard Dasheiff, M.D.
Professor of Neurology
Epileptologist

Reference materials

What do we call new?
Advantages to rediscovering old drugs.
The following AntiEpileptics are effective and have a role in Epilepsy.
bromides 1857 Cl channel on GABA 1st line for porphyria
phenobarbital 1912 GABA receptor 1st line
ketogenic diet 1921 unknown Lennox-Gastaut
Dilantin 1938 Blocks rapid firing, Na 1st line
Mysoline 1952 GABA 1st line
Celontin 1953 unknown 2nd line for JME
ACTH 1950s unknown infantile spasms
Zarontin 1960 Ca currents 1st line for absence
Tegretol 1974 Na currents 1st line
Tegretol-XR 1996
Carbatrol 1997
Klonopin 1975 GABA 1st line for myoclonic
Depakene 1978 GABA 1st line for JME
Depakote 1983
Sprinkles 1989
Depacon, i.v. 1996
Ativan, i.v. 1982 GABA 1st line for Status
Felbatol 1993 NMDA Lennox-Gastaut
Neurontin 1993 unknown (not GABA) 1st line for pain
Lamictal 1994 Blocks rapid firing 2nd line
Cerebyx, i.v. 1996 prodrug of Dilantin 1st line for Status
Topamax 1996 multiple actions 3rd line
Gabitril 1997 GABA 3rd line
Diastat 1997 GABA rectal valium for Status
Trileptal 2000 unknown 2nd line
Zonegran 2000 Unknown 3rd line
Keppra 2000 Unknown 3rd line
Newly marketed for status epilepticus
Ativan 1-2 mg i.v. push, up to 4 mg
lorazepam 1st line for status
effective
- -
Cerebyx 20 mg PE/kg i.v., 150 mg PE/min
fosphenytoin 1st line for status
PE=phenytoin equivalent effective
- -
Diastat 5-20 mg, rectal depending on age and weight
diazepam outpatient niche
effective
- -
Depacon 20 mg/kg i.v. diluted in 50 ml most fluids, infused over 1 hr
valproic acid Not effective for status
npo patient niche
Newly marketed for Infantile Spasms
Zonegran 200 mg b.i.d.
zonisamide available in Japan, Korea, US
? efficacy
- -
Sabril 100 mg/kg
vigabatrin 1st line
effective
used worldwide except in U.S. because of
visual field constriction due to retinal damage and
reports of brain white matter damage in animals
- -
nitrazepam 1 mg/kg
2nd line
effective
used worldwide except in U.S.
Newly marketed for Lennox-Gastaut
ketogenic 1990's saw a resurgence of enthusiasm
diet best in young patients
moderately effective
- -
Felbatol 1200 mg t.i.d.
felbamate APLASTIC_ANEMIA HEPATIC_FAILURE
effective
- -
Lamictal 300 mg b.i.d.
lamotrigine titrate slow
not effective, causes myoclonus
- -
clobazam 30 mg
used worldwide except in U.S.
moderately effective
Newly marketed for partial seizures
Neurontin 900 mg t.i.d.
gabapentin 3rd line
ineffective against convulsions
1st line for neuropathic pain
- -
Lamictal 300 mg b.i.d.
lamotrigine best 2nd line
titrate slow, 25 qweek
- -
Topamax 200 mg t.i.d.
topiramate 3rd line, kidney stones
titrate slow, 50 qweek
- -
Gabitril 20 mg t.i.d.
tiagabine 3rd line
titrate slow, 4 mg qweek
- -
Trileptal 1200 mg b.i.d.
oxcarbazepine 2nd line
SIADH like Tegretol
- -
Zonegran 300 mg b.i.d.
zonisamide 3rd line
Kidney stones, Rash
Keppra 2000 mg b.i.d.
levetiracetam 3rd line


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