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138 - Tiagabine

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

• Gabitril

Generic?

• Yes

Class

• Antiepileptic drug (AED)

Commonly Prescribed for

(FDA approved in bold)

Adjunctive for partial seizures in adults and children age 12 or older

• Temporal lobe epilepsy (children and adults)

• Panic disorder

How the Drug Works

• Enhances activity of GABA by binding to sites associated with GABA uptake into presynaptic neurons, allowing more GABA to be available to bind to receptors on postsynaptic cells

How Long Until It Works

• Seizures: should decrease by 2 weeks

If It Works

• Seizures: goal is the remission of seizures. Continue as long as effective and well tolerated. Consider tapering and slowly stopping after 2 years without seizures

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

• Epilepsy: titration and combination regimen depends on whether the patients are on an enzyme-inducing drug or not

Tests

• No regular blood tests are recommended

ADVERSE EFFECTS (AEs)

How the Drug Causes AEs

• CNS AEs are probably caused by excess GABA effect

Notable AEs

• Confusion, stuttering, muscle tremor, dizziness, sedation, paresthesias (usually doses > 8mg/day), abdominal pain

• Less commonly, behavioral symptoms such as amnesia, extreme confusion, or seizures or seizure-like symptoms

Life-Threatening or Dangerous AEs

• Can precipitate seizure in some patients (rare)

• Severe rash (rare) including Stevens- Johnson syndrome

• Falls producing accidental injury

Weight Gain

• Common

Sedation

• Common

What to Do About AEs

• Decreasing dose may reduce CNS AEs, especially weakness and sedation

• Titrate more slowly

Type
Chapter
Information
Essential Neuropharmacology
The Prescriber's Guide
, pp. 506 - 508
Publisher: Cambridge University Press
Print publication year: 2015

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  • Tiagabine
  • 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/10.1017/9781316161753.139
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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 Dropbox.

  • Tiagabine
  • 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/10.1017/9781316161753.139
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.

  • Tiagabine
  • 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/10.1017/9781316161753.139
Available formats
×