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147 - Vigabatrin

Published online by Cambridge University Press:  06 October 2020

Stephen D. Silberstein
Affiliation:
Thomas Jefferson University, Philadelphia
Michael J. Marmura
Affiliation:
Thomas Jefferson University, Philadelphia
Hsiangkuo Yuan
Affiliation:
Thomas Jefferson University, Philadelphia
Stephen M. Stahl
Affiliation:
University of California, San Diego
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Summary

THERAPEUTICS

Brands

• Sabril

Generic?

• No

Class

• Antiepileptic drug (AED)

Commonly Prescribed for

(FDA approved in bold)

Refractory complex partial seizures in patients ≥ 10 years of age, as adjunctive therapy in patients who have responded inadequately to several alternative treatments

Infantile spasms: monotherapy in infants 1 month to 2 years of age

• Panic disorder

• Cocaine or methamphetamine dependence

How the Drug Works

• Inhibits catabolism of GABA by inhibiting GABA transaminase (GABA-T). This increases synaptic levels of GABA but does not act directly on GABA receptors. May decrease levels of excitatory neurotransmitters (glutamate, aspartate, glutamine) in the brain

How Long Until It Works

• Seizures: by 2 weeks

If It Works

• Seizures: goal is the remission of seizures. Continue as long as effective and well tolerated

• Monitor vision every 3–6 months

If It Doesn't Work

• Increase to highest tolerated dose

• Epilepsy: consider changing to another agent, adding a second agent, using a medical device, or a referral for epilepsy surgery evaluation. When adding a second agent, keep drug interactions in mind

Best Augmenting Combos for Partial Response or Treatment-Resistance

• Often used in combination with other AEDs. Lack of significant drug interactions makes it easier to use than many other AEDs

Tests

• No regular blood tests are recommended

ADVERSE EFFECTS (AEs)

How the Drug Causes AEs

• CNS AEs are probably caused by changes in GABA levels

Notable AEs

• Somnolence, fatigue, weight gain, headache, dizziness, anxiety, depression, ataxia, hyperactivity (children), psychosis (adults), upper respiratory tract infection

Life-Threatening or Dangerous AEs

• Retinal atrophy and visual field defects in about one-third of patients, peaking at 1 year but occurring as soon as a few weeks. Visual field loss may be irreversible

Weight Gain

• Not unusual

Sedation

• Not unusual

Type
Chapter
Information
Essential Neuropharmacology
The Prescriber's Guide
, pp. 543 - 545
Publisher: Cambridge University Press
Print publication year: 2015

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  • Vigabatrin
  • Stephen D. Silberstein, Thomas Jefferson University, Philadelphia, Michael J. Marmura, Thomas Jefferson University, Philadelphia, Hsiangkuo Yuan, Thomas Jefferson University, Philadelphia
  • Edited in consultation with Stephen M. Stahl, University of California, San Diego
  • Book: Essential Neuropharmacology
  • Online publication: 06 October 2020
  • Chapter DOI: https://doi.org/10.1017/9781316161753.148
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  • Vigabatrin
  • Stephen D. Silberstein, Thomas Jefferson University, Philadelphia, Michael J. Marmura, Thomas Jefferson University, Philadelphia, Hsiangkuo Yuan, Thomas Jefferson University, Philadelphia
  • Edited in consultation with Stephen M. Stahl, University of California, San Diego
  • Book: Essential Neuropharmacology
  • Online publication: 06 October 2020
  • Chapter DOI: https://doi.org/10.1017/9781316161753.148
Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

  • Vigabatrin
  • Stephen D. Silberstein, Thomas Jefferson University, Philadelphia, Michael J. Marmura, Thomas Jefferson University, Philadelphia, Hsiangkuo Yuan, Thomas Jefferson University, Philadelphia
  • Edited in consultation with Stephen M. Stahl, University of California, San Diego
  • Book: Essential Neuropharmacology
  • Online publication: 06 October 2020
  • Chapter DOI: https://doi.org/10.1017/9781316161753.148
Available formats
×