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Anticonvulsants


Definition


  • A compound used to prevent or treat seizures
  • Classic agents: carbamazepine (Tegretol), phenobarbital (Luminal), phenytoin (Dilantin), ethosuximide (Zarontin), valproic acid (Depakene, Depakote). Newer agents gabapentin (Neurontin), lamotrigine (Lamictal), oxcarbazepine (Trileptal), vigabatrin (Sabril), topiramate (Topamax), zonisamide (Zonegran)

Use


  • Treatment of seizure disorders
  • Normal therapeutic levels: see Table 16.7

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TABLE 16 " “7Normal Therapeutic Levels of AnticonvulsantsView LargeTABLE 16 " “7Normal Therapeutic Levels of Anticonvulsants Drug Level (mg/L Serum/Plasma) Carbamazepine 6.0 " “12 10,11-Epoxide 0.2 " “2.0 Phenobarbital 15 " “40 Phenytoin 10 " “20 Ethosuximide 40 " “100 Valproic acid 50 " “100 Gabapentin 2.2 " “6.1 Lamotrigine 0.4 " “9.0 Oxcarbazepine 0.5 " “1.2 10-Hydroxycarbazepine 3.7 " “37 Vigabatrin 18 " “77 Topiramate 1.7 " “8.0 Zonisamide 2.9 " “28

Limitations


  • Phenobarbital may be detected by immunoassay-based screening tests for barbiturates in urine and serum.
  • Immunoassay tests are available for semiquantitative analysis in serum of topiramate, valproic acid, phenytoin, phenobarbital (may demonstrate significant cross-reactivity with other barbiturates), and zonisamide.
  • Lamotrigine, breakdown products or artifacts of topiramate, carbamazepine, 10-OH-carbazepine, and phenytoin may be detected in general drug screens in urine or serum that utilize alkaline or weakly acidic liquid- or solid-phase extractions followed by gas chromatography or GC/MS analysis.
  • For the majority of anticonvulsants, specific tests are required.
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