8 Seizure medications (antiepileptic drugs, PEDs)

You don’t need a medical degree to understand what seizures are. All of them have been to all of us. A cramp is a painful, unpredictable, and involuntary contraction of skeletal muscles. But sometimes the muscle is just a little twitch. For example, the eye, or more precisely the eyelid, may involuntarily twitch. This is not a cramp, but a fasciation, which is not a synchronous involuntary contraction of the entire muscle, but a trembling of the individual fibers, which are innervated by a small motor branch. It can be bothersome and annoying, but more often than not, it is irrelevant to the topic of the article.

What cramps are?

Here is an example of true but localized seizures. Elderly people as well as patients with heart failure and edema quite often take diuretics. Very well-known and effective is Furosemide, or Lasix, which has a pronounced diuretic effect. But it has an important disadvantage: it also eliminates potassium from the body along with the fluid. So if you take it in a large dose, and at the same time do not compensate for the future loss of potassium by (Panangin or Asparkam tablets), you can reach a state of hypokalemia, in which the concentration of potassium in the blood plasma decreases. The characteristic symptom of hypokalemia after taking diuretics will be cramps, most often at night, and most often in the calf muscles. This is the most common cause of seizures from an unauthorized overdose of diuretics.

Physiological cramping can also occur when swimming in cold water, based on the reflex of tonic contraction – an order to work intensely in conditions of vasospasm and lack of nutrients.

To these examples, you can add a number of other causes that are familiar to doctors. This:

  1. meningitis, or inflammatory disease of the meninges;
  2. Encephalitis, an inflammation of the brain matter;
  3. febrile seizures in children, which are safe but very feared by parents;
  4. Tonic spasms in tetanus, which can be so strong that bones even break.

But this material will deal with a different kind of seizure, and a different kind of medication – not Panangin, and not the anesthetic that kills opisthotonus (spilled seizures) in tetanus. They help with seizures that don’t occur in a muscle or group of muscles, but in the cerebral cortex. Simultaneous synchronous discharge of motor or sensory neurons, focal or general “flash” results in either a seizure syndrome in all its variety, or non-convulsive equivalents (sensory aura, vegetative). The disease is called epilepsy, or epilepsy with panic attacks. But there’s also episyndrome. And what is this, and what is the difference?

Epilepsy or episyndrome?

In addition to epilepsy, which is considered a primary disease with reasons that are not entirely clear, the seizure syndrome (episyndromes) can also be provoked by other pathology, such as a brain tumor, or a dura mater tumor that periodically compresses and irritates the cerebral cortex. Such a condition, in which there is a clear cause of cortical irritation, is not called epilepsy, but episyndromus. Episyndromes are considered to be a secondary phenomenon, and it is important to find the cause in time. Quite often this syndrome occurs as a consequence of severe craniocerebral trauma, as a consequence of purulent encephalitis and meningitis, and in other conditions. If, despite all persistent search for the cause, they have not been successful, and the patient has a periodic clear clinic of seizures, or their equivalents, the diagnosis of epilepsy is made.

The role of EEG in the diagnosis of epilepsy

To diagnose epilepsy and episyndromes, there is only one, but very accurate method of instrumental diagnosis, which is used in different variants. This is a recording of an EEG, or electroencephalogram, which picks up the bio-currents of the brain’s neurons. If there are specific, pathological rhythms on the encephalogram, such as peak-wave complexes, then the patient has increased seizure readiness, and epileptic activity. Such a person will not be allowed to drive a car, he can not serve in the armed forces, will not be a pilot, because at any moment this seizure readiness, registered on the encephalogram, can manifest itself as a real seizure. There are non-convulsive equivalents, too, that should definitely be treated.

Here are anticonvulsants for the treatment of epilepsy, and seizures caused by focal discharges of various cortical areas of the brain. Another name for them is antiepileptic drugs, PEPs.

Do not think that prolonged, and sometimes life-long treatment with a diagnosis of epilepsy these drugs are only intended to prevent the onset of seizures, although this is also very important. Taking antiepileptic drugs can prevent the development of characteristic personality changes called epileptoid psychopathy. characterized by vindictiveness, pathological overreliance, pinching, hypochondria, the absurd contrast of the use of diminutives and endearing nouns (“little knife”, “little bed”) in combination with cruelty.

Epilepsy is a fairly commonly diagnosed illness, and it is a social problem for developed countries. So, in the U.S., about 1% of the population has various diagnoses related to this disease, and more often epilepsy is diagnosed only as a stroke. There are about 50 million patients in the world, and the average frequency of cases in Russia is 7 per 2000 of population, or 1 case per 285 people. That’s quite a lot, and PEPs are in demand. Before we look at anticonvulsants and their effects on the body, – a little bit from the history of treating seizures.

From the history of epilepsy treatment

Perhaps the real, scientific epilepsy began in the mid-nineteenth century. Previously, patients were isolated, lived in monasteries, were considered fools or diviners of truth. It’s true, sometimes they tried to treat them by craniotomy, which often ended in death.

The first successful drug that really had efficacy was potassium bromide, and bromine compounds began to be used as sedatives and anticonvulsants. The reason for the prescription of bromine preparations was one of the false theories, which believed that epilepsy is caused by excessive libido, and the patient should be pacified. Bromine was simply “guessed at,” as well as other remedies. About 50 years epilepsy was treated with bromine preparations, but the true anticonvulsant activity they have no, and only depress the function of the central nervous system.

But with the beginning of the twentieth century, the first drug with true anticonvulsant activity from the group of barbiturates was discovered, called phenobarbital. It has been used for decades to treat various forms of epilepsy and is still used today, albeit with serious limitations. Surprisingly, phenobarbital is the only over-the-counter medication from the barbiturate group in Russia that can be purchased quite freely, although not in its pure form. It is part of the usual Valocordine or Corvalol, together with peppermint oil, hop oil, ethyl bromisovalerianate, and ethyl alcohol, having a sedative and soporific effect.

Then the discoveries poured out of the horn of plenty. In the thirties phenytoin was found, in the late sixties – carbamazepine, which is still considered the “gold standard” in the treatment of epilepsy. Then, since the eighties and nineties, 2nd and 3rd generation antiepileptic drugs began to be used in treatment regimens. This article and discusses the most famous drugs belonging to the first and second generation – in accessible and popular language.

All epilepsy medications should prevent the spontaneous development of a common impulse affecting the entire neuron. For this purpose it is necessary to reduce the activity of neurons, that is – to reduce the action potential, and the ability of a nerve cell to receive from other neurons and transmit excitation. This is accomplished by a variety of mechanisms. First-generation antiepileptics will be discussed first, followed by the more modern. For each drug, synonyms and commercial names registered in the Russian Federation will be given. For drugs, the retail price range relevant to pharmacies of all forms of ownership in the Russian Federation for September 2019 will be given.

A review of modern seizure medications (antiepileptic drugs, PEPs)

Nominationposition in the reviewproduct nameprice
First generation PEP1Carbamazepine (Finlepsin, Tegretol)67€
2Valproic acid (Depakine-chrono, Convulex)234€
3Etosuximide (Suxilept)2 190€
Second generation seizure medications1Lamotrigine (Convulsan, Lamictal, Lamitor, Lamolep, Seizar)790€
2Topiramate (Topamax, Maxitopyr, Topalepsin)736€
3Levetiracetam (Keppra, Comviron, Levetinol, Epiterra, Epitropil)776€
4Neurontin (gabapentin)892€

First-generation PEPs

Surprisingly, all of the antiepileptic activity of first-generation drugs was discovered in randomized studies. There was no deliberate search or modification of already known drugs in search of higher activity. Phenobarbital, phenytoin, valproate, ethosuximide, and other drugs have been randomly found. Let’s consider those that still help patients, even with severe forms of epilepsy, and in some cases they are still preferred by epileptologists even the latest drugs.

Carbamazepine (Finlepsin, Tegretol)


Carbamazepine is probably the most widely used antiepileptic drug. Probably all other drugs account for less sales than carbamazepine alone.

This is because its pharmacological action is not only anticonvulsant, but also analgesic. It relieves a special kind of pain very well, neuropathic pain. This pain develops by a mechanism similar to a burst of neuronal activity in an epileptic seizure. This pain occurs after herpetic neuralgia, in trigeminal neuralgia, and is characterized by a very rapid, attack-like course, the attack looks like an electric shock, has an unpleasant, burning tinge.

In addition, Carbamazepine is used in psychiatry as a normotimic and antimanic drug. Carbamazepine acts by blocking sodium channels and thus prohibits the action potential of neurons. This leads to an increase in the decreased seizure threshold, and reduces the risk of developing a seizure. Karbamazepine is indicated in simple, partial seizures, as well as in generalized states, which are called a large tonic-clonic seizure.

If used in children, it is good at reducing depression and anxiety, reducing the potential for irritability and aggression. Carbamazepine is also prescribed in the treatment of chronic alcoholism, to relieve alcohol withdrawal syndrome, symptoms such as increased agitation and tremors.

There is also a carbamazepine in a prolonged form, which has a longer effect, such as Finlepsin Retard. The merit of this form is that the plasma concentration of the substance is more constant and stable, and less prone to spikes. It improves the anticonvulsant effect. The introduction of a prolonged form made it possible to use Carbamazepine only once a day.

Carbamazepine is annually included in the list of vitally important drugs (VED), and is inexpensive. Thus, Finlepsin in a dosage of 200 mg #50 costs from 200 to 270 rubles., And the domestic generic INN Carbamazepine produced by Obolenskoye, can even be purchased for 60 rubles. Of course, there is a suspicion that it will not work as well as the well-known brands.

Advantages and disadvantages

The advantage of Carbamazepine can be considered the breadth of action, it is used in various forms of epilepsy, and not only in it. It is cheap, prescribed without much trouble for a long period, but has some limitations. It should not be used in cases of severe anaemia and low white blood cell count, in cardiac arrhythmias (atrioventricular block), in cases of hypersensitivity to tricyclic antidepressants, of which it is a representative.

Caution should be exercised in heart failure, and especially in combination with chronic alcoholism, in case of increased secretion of antidiuretic hormone and insufficiency of adrenal cortex, as well as in glaucoma. Pregnant women especially need to be monitored carefully and should use Carbamazepine in minimal dosages. Also a disadvantage is the need to take the drug quite often (except for the retarded form), up to three times a day. Carbamazepine also develops various side effects, most commonly drowsiness, dizziness, decreased appetite, and other disorders. Therefore, it is essential that the patient be monitored by a doctor after starting treatment. There are also symptoms of overdose, and special cases of interactions with other medications, but they are all known, and well studied.

Valproic acid (Depakine-chrono, Convulex)

Valproic acid

This first-generation drug is widely known in our country as Depakine-chrono, which is produced by Sanofi, or Convulex, by the Austrian company Valeant. This medication is more expensive than Carbamazepine at twice or even three times the cost. Depakine 500 mg #30 costs from 220 to 650 rubles., And Convulx has about the same cost.

The active ingredient of Convulex is valproic acid, so experts call these drugs valproates – soluble salts of this acid. They are used in hospitals and outpatients, available in tablets, in syrup, and even in ampoules for intravenous use.

The drug, in addition to its anticonvulsant effect, relaxes muscles by acting as a central myorelaxant (Mydocalm, Sirdalud) and produces a sedative effect. It increases the concentration of the inhibitory mediator, gamma-aminobutyric acid, because it blocks the enzyme that degrades this mediator.

Valproic acid is indicated in quite severe disorders, such as epileptic status, when administered intravenously. The medication is also used for grand, or generalized seizures in adults and children, which can have different courses. Convulex also treats specific syndromes that cause severe epilepsy in children, such as Lennox-Gasto or West’s syndrome. The drug is used to treat febrile childhood seizures as well as to treat manic depressive psychosis in psychiatry, now called bipolar affective disorder. The drug should be used in the dosage and according to the scheme prescribed by the doctor, any self-treatment is excluded.

Advantages and disadvantages

The drug is available in a variety of dosage forms, and can be used in pediatrics, psychiatric practice, and in the management of emergencies. Another plus of valproate is that the drug is effective for all forms of seizures and for all types of epilepsy, so you can start treatment of any form of epilepsy with it, and valproic acid will be the drug of choice, or first-line.

The drug is available, is still not very expensive, but has a number of contraindications. Above all, these are severe hepatic and pancreatic dysfunction, hepatitis and pancreatitis, decreased plasma platelets, and pregnancy and the breastfeeding period. Valproate is prescribed with great caution in children, and especially under the age of three years, as well as if the child takes several antiepileptic drugs at once. A combination of agents is always less predictable than monotherapy.

On the plus side of Convulex and Depakine can be considered fairly good tolerance, and a low number of side effects that depend on the dose. Adverse reactions, if any, are most often nausea, fatigue, flicker of flashes, anemia, or weight gain or loss. In the tests, the patient’s bilirubin level, concentration of liver transaminases and nitrogen may increase.

Valproate and carbamazepine should not be combined in the same patient, since Convulex together with carbamazepine contributes to a milder overdose of the latter. Do not combine Convulex with phenobarbital, neuroleptics, antidepressants and some antibiotics from the carbapenem group.

It is strictly forbidden during treatment with valproate to take alcohol, as well as in the case of other drugs, because the intake of ethanol facilitates the appearance of epileptic seizures. The combination of taking ethanol and valproates leads to an increased toxic effect on the liver.

Etosuximide (Suxilep)


This drug from the group of first generation antiepileptics can be considered by far the most expensive. A bottle of capsules, though, in the amount of 100 pieces, will cost about 3000 rubles., It is not commonly available in pharmacies, and may even be in short supply. If we talk about an average, optimal daily dose, it is 15 mg per kg of weight in adults. Therefore, a person who weighs 80 kg will need 5 of these tablets a day, which means that the pack for 3000 rubles will run out after 20 days of taking. The cost of a one-month course will be approximately 4,500 rubles.

Why Suxilept is used? Primarily for the treatment of minor epileptic seizures. Its niche is special minor seizures with myoclonic component, impulsive juvenile minor seizures, and also special forms of absences. This “narrow specialization” is what allowed Suxilep to be a leader in the “narrow niche”, in demand, despite its relatively high cost. As in any other case, the antiepileptic drug Suxilept starts with a titrated dose, gradually increasing it by one tablet every 5 days until the seizures are reduced or disappear altogether. You can increase the drug, but only to the limit – to a dosage of no more than 6 tablets per day.

Advantages and disadvantages

Suksilep is usually well tolerated, and of contraindications – it is expressed disorders of internal organs: liver and kidney. The drug is contraindicated in pregnant and lactating women, and the side effects of this drug are about the same as those of carbamazepine. Naturally, the greatest disadvantage of the drug is its high price and it is not always available in pharmacies. But still, given its unique action on special forms of epilepsy, we have to put up with these disadvantages – because there are no competitors yet. The drug is only available imported: by the French company Delpharm Lille, or by German companies – Jena Farm, and Mibe Arznaimittel.



Phenobarbital is a really cheap drug, and should have been the beginning of the review of drugs for seizures. One pack of 10 tablets of 100 mg each, sold for only 23 rubles. Practically a monopoly on the production of phenobarbital is held by the Federal enterprise, the Moscow Endocrine Plant. In addition to this dosage, it is available in 50 mg tablets, and 5 mg.

The official instruction to phenobarbital states that it is not only an antiepileptic drug, but also a sleeping pill. Like all barbiturates, it interacts with the special structure of gamma-aminobutyric acid, and decreases the excitability of neuronal cell membranes. Phenobarbital causes drowsiness, hypnotic effects, and sedation in high doses. This is why it is included in Corvalol.

Phenobarbital has another important property, not related to epilepsy. It treats jaundice, but only that jaundice associated with hemolytic disease of newborns, and is not a consequence of viral and alcoholic hepatitis, liver cirrhosis. In addition to epilepsy and seizure syndrome in infants, the drug is shown for spastic paralysis, agitation, sleep disorders, if special, expensive modern drugs are not available.

This is what Corvalol is produced for, to “plug the holes”. If you count the amount of Corvalol that is sold annually in Russia, phenobarbital, even purely by weight, will be the most frequently used anticonvulsant drug used for other indications. Phenobarbital should be taken cautiously and only when recommended by a specialist! Not many people know this, but as little as 2g of phenobarbital taken orally can be fatal, and taking 1g orally causes serious poisoning. This means that half a glass of Corvalol, or 100 ml, drunk, for example, for the purpose of alcohol intoxication, contains 1.82 g of phenobarbital, and after such a “dose” you may not wake up.

Advantages and disadvantages

About phenobarbital or as the proverb says, “an old horse won’t spoil a groove.”. This drug for many years, and even decades was an effective anticonvulsant, but its long-term use was found to cause significant impairment of mental functions, leading to a decrease in intelligence, depressed memory. Patients who have been on phenobarbital monotherapy for a long time have developed quite serious psychoses, especially in childhood.

In this case, the range of phenobarbital on the various forms of epilepsy is not as wide as that of carbamazepine or valproic acid, for example, if we are talking about absconding epilepsy, on the contrary, it worsens the course of this form of the disease, and even sometimes provokes seizures. Therefore, at present, phenobarbital, despite its prevalence and cheapness, is considered the best drug of first choice only when it comes to seizures in newborns.

Second-generation anti-seizure drugs

Since the early 1990s, second-generation seizure medications have entered clinical practice. These are now well-known drugs such as Neurontin and Lamictal, Keppra and Trileptal, Lyrica and Topamax. other means.

If you compare them to first-generation drugs, their main difference is a purposeful search, not a random discovery, and a much smaller number of side effects. First-generation drugs quite often affected various enzyme systems, and inhibited, or increased their activity. This caused unwanted bursts of hormonal background, provoked cognitive disorders. Therefore, there is more simplicity in the treatment of epilepsy with second-generation agents, and patient adherence to treatment is much higher. Of course, the cost of these drugs is also higher.

Given that patients with, for example, generalized epilepsy may have personality changes, this compliance, or adherence, is absolutely essential for success. In general, their main difference is greater safety and better tolerability. To avoid listing and repeating ourselves, here are the most common common side effects for gabapentin, topamax, and lamotrigine. Most often, of course, dizziness followed by transient diplopia, or double vision. Speech disorders have occurred on Topamax, but the most common has always been drowsiness. Let’s look at the most typical and popular representatives of the second generation of seizure medication.

Lamotrigine (Convulsan, Lamictal, Lamitor, Lamolep, Seizar)

Lamotrigine (Convulsan, Lamictal, Lamitor, Lamolep, Seizar)

Lamotrigine is probably the best known second-generation drug among epileptologists, and it is a folic acid antagonist and a pretty good sodium channel blocker. Its role is to inhibit the release of neurotransmitters, which excite neurons, into the synaptic cleft. It is rapidly absorbed when taken orally, and has a fairly long half-life in the body, with a half-life of over 30 hours. Therefore, Lamotrigine may be taken in the morning, once a day.

Lamotrigine is indicated for use in persons over 12 years old for the treatment of various forms of epilepsy, the listing of which does not give anything to a person without a medical background. For example, it is a combination therapy for refractory partial epilepsies as well as Lennox-Gastaud syndrome in children. But it can also be used to treat large seizures, that is, generalized epilepsy. Importantly, it has been named by the International Anti-Epileptic League as the drug of choice for the elderly with a high level of evidence for the treatment of partial forms of.

The average daily dose of Lamotrigine, for example, in combination with carbamazepine is 400 mg. It is also used to treat parkinsonism, and to reduce the risk of depression in bipolar disorder.

The original drug Lamictal, which is produced by Glaxosmithkline from the UK, will cost, on average, 2000 roubles. for the package (capsules 100 mg #30), and this package may be enough for a week. Accordingly, a one-month course of treatment with the original medication will cost 8000 rubles. per month. It is very, very expensive for a Russian. The drug Lamolep by Gedeon Richter will cost 1,400 rubles. In the same dosage, and a one-month course would cost 5,500, but that’s also a high cost. The cheapest analog is Lamotrigine, the generic INN of Canonfarma, and its cost is about 600 rubles. per package.

Advantages and disadvantages

Of the side effects of Lamotrigine, skin rashes, or exanthema, are the most common, and, alas, unpleasant and dangerous. Quite rarely, it manifests as severe Stevens-Johnson or Lyell syndrome, when the skin flakes off, a condition that is life-threatening and has a high mortality rate. If only a patient has the slightest hint of skin changes during the use of Lamotrigine, the drug is urgently withdrawn, since in most cases the rash is persistent and irreversible. This is of course a very serious side effect, but fortunately very rare. The development of this can be avoided if the dose is increased by selecting the right concentration very slowly.

Other “side effects” are vitiligo, drowsiness and nausea, decreased plasma platelets, leukopenia and increased liver transaminases. But when it comes to side effects in the population, Lamotrigine is fairly well tolerated. Patients, in addition to antiepileptic effect, improve mood, it shows antidepressant effect and improves attention. Lamotrigine is good for treating epilepsy in the elderly, and especially in the presence of depression.

Topiramate (Topamax, Maxitopyr, Topalepsin)

Topiramate (Topamax, Maxitopyr, Topalepsin)

The original Topamax, which is produced by Janssen Silag of Switzerland, costs from 1100 to 1300 rubles per package (60 capsules of 50 mg). While the domestic analogue can be purchased at a price of about 190 rubles., We need to take into account that the concentration is half as much, 25 mg, and the number of capsules is also half as much (30 capsules).). Therefore it is necessary to multiply by four to make a fair comparison. And then the equivalent amount of topiramate manufactured in Russia will cost about 800 rubles. Therefore, it is better to go a little further, and buy the original Swiss drug.

Topamax reduces the frequency of action potential, and works with gamma-aminobutyric acid by blocking sodium channels. It is indicated for the treatment of strictly older than two years of age, both newly diagnosed epilepsy, and as part of the complex treatment, along with other drugs. It is important that Topamax may be used for prophylaxis of migraine attacks, and is used only during the period between attacks.

Topamax should be used by opening the capsules, and mixing them with some soft food, swallowed immediately and without chewing. Can also be swallowed whole, but prior dispersal of the drug causes faster and more even absorption. The average daily dose, which should be carefully chosen with your doctor, is about 300 mg. This means that the original product is enough for 10 days, and the cost of a monthly course of treatment will be approximately 3300 rubles.

Advantages and disadvantages

Topiramate is well tolerated, there are no withdrawal symptoms if it is necessary to abruptly cancel this drug. A decrease in body weight was most often observed, depending on the dose. In the presence of obesity, this is a very positive, but, alas, not a necessary side effect. However, there was another. Decreased concentration, dizziness, somnolence, and weakness appeared. This means that during Topamax treatment it is better not to drive. Of course, this applies to persons with migraine, since patients with epilepsy are not allowed to drive. In addition, topiramate is contraindicated in pregnant and lactating women, and in patients with urolithiasis, because the drug may lead to the formation of calcium or phosphate stones – it alkalizes the urine. Women taking hormonal contraceptives against the background of taking Topamax should be particularly monitored. Contraceptive efficacy may be significantly reduced.

Levetiracetam (Keppra, Comviron, Levetinol, Epitherra, Epitropil)


Keppra was first produced by the Croatian company Pliva. It is now produced by the Belgian company UCB-Pharma, and in Russia the drug is produced as levetiracetam by Ozon and R-Pharm. One pack of 30 Keppra tablets will cost about 800 rubles., 250 mg. Domestic medicine will cost more than twice as cheap, levetiracetam company “Ozon” in September 2019 can be bought for 315 rubles.

This drug remains a mystery in many ways, since the antiepileptic mechanism of levetiracetam is still unclear. However, it is used for partial seizures as well as for primary generalized, grand mal seizures in adults and children over 12 years of age. Partial seizures may or may not have secondary generalization, but levetiracetam will be quite effective. It is administered twice a day, and starts a dose of one tablet twice a day. This is the stage of getting used to the drug and evaluating its tolerability. After 2 weeks, the dose is doubled to 1 g per day. Usually this dosage is the beginning of the therapeutic effect, and if necessary, it can be increased, but no more than twice as much, up to 3 g per day. In addition to such monotherapy, there may be a complex therapy, when in addition to levetiracetam, some other drug is prescribed, then the calculation is based on the dosage per kilogram of body weight.

Advantages and disadvantages

Keppra and quality levetiracetam are well tolerated, and reliably improve patients’ quality of life. Of the side effects most often drowsiness, and the higher, the more pronounced it is. In second place – weight loss, diarrhea, double vision. Of course, it is undesirable for persons with the development of drowsiness to drive, but a patient diagnosed with epilepsy can not get a license, so this condition is not very relevant. Also patients with this diagnosis are forbidden to work in dangerous working conditions, with moving machines and mechanisms, this too must be taken into account. After all, it is not always possible for a patient with a first-time seizure syndrome to be immediately dismissed by the occupational health department, or transferred to a non-hazardous job. Levetiracetam in tablets should not be used in children under four years of age, and in the solution – before 1 month. It is cautiously prescribed for the elderly, and those with severe liver damage. In extreme cases, the drug can be used in pregnant women and during breastfeeding, but this should be decided by the board.

Neurontin (gabapentin)

Neurontin (gabapentin)

Unlike antiepileptic drugs of the 2nd generation, gabapentin has acquired a triumphant fame in addition to the treatment of epilepsy, and in another area – the treatment of neuropathic pain, and is more effective than the prescription of carbamazepine. It is known to significantly improve quality of life in chronic, burning, and carbamazepine-unrelieved pain. Gabapentin works for conditions such as trigeminal neuralgia, a condition after shingles called postherpetic neuralgia.

The most expensive product is the original Neurontin, manufactured by Pfizer. One pack of 300 mg capsules of 50 pieces will cost an average of 1000 rubles. The drug Tebantin by Gedeon Richter costs about the same. The maximum cost of Convalis (domestic company Pharmstandard – 700 rubles.), and Belupo’s Catena costs from 350 to 680 rbls.

It would seem to be a low cost, but, unlike other drugs, the selection of therapy with gabapentin and increasing the dose, can have quite large limits.

Gabapentin works a little differently than a simple sodium channel blocker. It has no effect on either capture or metabolism of GABA, the inhibitory mediator. It is thought to affect the calcium channel rather than the sodium channel at all. Importantly, it does not affect the metabolism of dopamine, serotonin, and norepinephrine, and has no side effects of SSRIs, which are used as commonly used antidepressants.

The drug is indicated primarily for the treatment of neuropathic pain, and as an anticonvulsant for the treatment of partial seizures with and without secondary generalization in children over 12 years of age and in adults. It is also used as an adjunctive drug in complex therapy for the treatment of partial seizures.

It was mentioned above that Neurontin and its analogues are sold in 300 mg capsules and one capsule 3 times a day should be started. The maximum dosage is 4 times higher, that is, 3600 mg per day. But doctors note that doses over 1,800 mg per day are unlikely to have a positive effect, usually the pain reduction or anticonvulsant activity works up to that dose, which is a dosage of 2 capsules 3 times a day.

There is no need to fear that the drug will be poorly tolerated, it is perfectly tolerated in doses of up to almost 5 g per day. It is estimated that one pack of Neurontin is sufficient for about 3 days with an average dosage calculation. The monthly course would then cost 10,000 rubles. And given its long-term use for the treatment of neuropathic pain, this pharmacoeconomic aspect is a known problem.

Advantages and disadvantages

A big advantage of gabapentin is its really proven effectiveness, reducing the burning and uncomfortable pain that plagues people at night, and causing even suicide. The inconvenience can be considered frequent intake – three times a day, the need to count the number of capsules until the desired effect is achieved. On the other hand, gabapentin is tolerated very well by almost everyone, and of the side effects the most common are constipation, shortness of breath, blurred vision. Effects are dose-dependent, and drowsiness and movement coordination disorders may also occur at high doses.

It should be remembered that it should not be used in children under 12 years of age as the main drug for the treatment of partial seizures. During pregnancy and breastfeeding it can be used, but again – by agreement of specialists, if the benefit to the mother exceeds the potential risk to the fetus. Since this drug is secreted into breast milk, and the effect or lack thereof on the infant is unclear, breastfeeding against the background of treatment with gabapentin is necessary, taking into account this risk.

What’s next?

Today the twenty-first century has already turned two decades. Third-generation pharmaceuticals, such as Briviak, are already available. However, their use is still inferior to the first and second generation drugs, because even their potential is not yet clear to the end, and even the second generation drugs can be safely used for several decades to treat epilepsy.

On the other hand, co-administration patterns are constantly being improved, new options, I and combinations of drugs are being discovered. Some experts believe that existing medications are sufficient. A much greater effect will be achieved by following as best as possible the following principles of treatment:

  1. Begin treating epilepsy as early as possible, which means that it must be diagnosed as accurately as possible in a timely manner;
  2. You need to choose a drug as a monodrug. This, that is, treatment with one drug, is much more desirable than combining two or even three antiepileptic drugs;
  3. Rationally control the dose, and reduce it to an acceptable level when the effects are greater than the minor side effects.

In addition, non-drug ways of treating this ancient but so well known disease are constantly being improved. Therefore, if you or your relatives have unexplained seizures, it is necessary to urgently contact a neurologist. It is very important to remember that epilepsy is not always a seizure. They can be seen as falls, incomprehensible fainting spells, seizures similar to hysterical seizures, and just an incomprehensible state of stunnedness, and freezing in one posture. Sometimes there are outpatient automatically. It’s good if it’s not pressing a computer key. But sometimes you can continue to cut your own fingers instead of onions. Only after an electroencephalography with provocation, and perhaps several times, after a thorough examination by a neurologist, an epileptologist, can we make a diagnosis and prescribe treatment.

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