Can we say which antiepileptic should be used? The antiepileptics

Can we say which antiepileptic selleckchem should be used? The antiepileptics of choice for the treatment and prophylaxis of clozapine-induced seizures are valproate and lamotrigine. Valproate has the most data to support its use and it is widely regarded as the drug of choice. It does not appear to cause any major changes in clozapine plasma levels, although data are contradictory. It has mood-stabilizing properties and acts as an antimanic agent, so potentially

optimizing therapeutic benefit. In addition, it is effective over a broad spectrum of antiepileptic activity and it is generally well tolerated. Rare adverse effects in common with clozapine include agranulocytosis and neutropenia, Inhibitors,research,lifescience,medical and so close monitoring would be prudent. Valproate is teratogenic and is not recommended in women of child-bearing age. Baseline monitoring of liver function, full blood count, weight and height is essential, with follow Inhibitors,research,lifescience,medical ups at 6-monthly intervals (weight at 3-monthly intervals). The clinical benefits of lamotrigine for Inhibitors,research,lifescience,medical the treatment and prophylaxis of clozapine-induced seizures are being increasingly recognized by clinicians; it possesses mood-stabilizing (at least in respect to depressive episodes) [Bowden et al. 2003] and acute antidepressant properties [Geddes et al. 2009] and has been shown to have a beneficial additive antipsychotic effect when added

to clozapine therapy for schizophrenia [Tiihonen et al. 2009]. In Inhibitors,research,lifescience,medical addition, lamotrigine is not sedative and does not cause weight gain. It is a good alternative to valproate in females of child-bearing age, as it is not a major teratogen (although it may be associated with cleft palate) [Holmes et al. 2008]. A disadvantage to its use in the urgent treatment of clozapine-induced seizures is the gradual titration needed to achieve a therapeutic dose (up to Inhibitors,research,lifescience,medical 6 weeks). Topiramate may

also have a place in the treatment and prophylaxis of clozapine-induced seizures; it should perhaps be considered for those patients with significant clozapine-induced weight gain. However, the risks of worsening of psychosis should be noted. Pregabalin might be considered in patients with Carfilzomib anxiety also requiring seizure prophylaxis. Carbamazepine and phenytoin should be avoided in clozapine therapy due to serious adverse effects additive to those of clozapine, which could potentially lead to clozapine cessation. The manufacturers of clozapine advise against the concurrent use with carbamazepine because of the risk of bone marrow suppression. If concurrent use is unavoidable, higher clozapine doses may be required as the pharmacokinetic interaction could cause clinical deterioration in the patient. Phenobarbital is not ideal in combination with clozapine and its use should be avoided. It is a very sedative drug so the additive sedative effects could potentially be very debilitating.

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