TABLE: AED summary

Drug Mechanism(s) of Action Advantages Disadvantages

Older AEDs
CBZ Voltage-gated Na+ channel Less expensive Indicated for partial seizures only;
Carbamazepine blockade Mood stabilizer in some cases can worsen
(Tegretol, Tegretol Treats some neuropathic pain generalized onset seizures*
XR, Carbatrol) Known gold-standard rate of (PGE)
teratogenesis Drug interactions (incl OC,
Warfarin, statins)
Enzyme induction
Hypersensitivity reactions
Possible bone density loss
Hyponatremia
Leukopenia (us. Asymptomatic)
Rare aplastic anemia
PB Phenobarbital Prolongs GABA-A activation Broad spectrum (partial onset* and Sedation
(Phenobarb) generalized onset seizures) Withdrawal
Inexpensive Drug interactions (OC, Warfarin,
QD dosing statins, etc)
IV available Possible bone density loss
PHT Phenytoin Voltage-gated Na+ channel Inexpensive Indicated for partial onset seizures
(Dilantin) blockade QD dosing only
IV available (now as fosphenytoin) Complicated pharmacokinetics
IM available Drug interactions (OC, Warfarin,
statins, etc)
Highly protein bound
Hypersensitivity
Bone density loss
Sedation
Cosmetic effects
VPA Valproic acid 1. Increased GABA-ergic Broad spectrum (partial onset and Drug interactions inhibits hepatic
and derivatives transmission generalized onset seizures, but metabolism driving up levels of
(Depakene, 2. Reduced release and/or more often used for generalized certain drugs
Depakote ER, effects of excitatory amino onset seizures) High protein binding
Depakote DR) acids (NMDA?) Useful in migraine, bipolar disease Dose-dependent hematological
3. Voltage-gated Na+ channel IV, sprinkles and QD forms toxicity (including
blockade available thrombocytopenia and acquired
4. Modulation of dopaminergic von Willebrand disease)
and serotoninergic Tremor, parkinsonism
transmission Weight gain
Teratogenic and in utero
neurodevelopmental risks
Rare sedation
Hepatic toxicity esp. in <2yo
Newer Commonly Used AEDs
LCM Lacosamide 1. Enhances slow inactivation of No known drug interactions Indicated for partial onset seizures only, for
(Vimpat) voltage-gated Na+ channels IV available now
2. Reduces of CRMP-2 activity Sedation
Lightheadedness/gait dysfunction
LTG Lamotrigine 1. Presynaptic inhibition of Broad spectrum (partial onset and Hypersensitivity syndromes
(Lamictal, Lamictal neurotransmission (eg, generalized onset seizures) including SJS, up to 3.8/1000
XR) GLU, ASP) BID or with XR new exposures
2. Voltage-sensitive Na+ Useful in depression/bipolar Can worsen myoclonus in some
channel blockade disorder cases
TABLE: AED Summary (continued)

3. Inhibits high-voltage Slow uptitration effective dose

activated Ca2+ currents delayed for 5-8 weeks
Levels affected by OC, EIAEDs,
VPA
LEV Levetiracetam Binds to synaptic vesicle Broad spectrum (partial onset and Possible neurobehavioral side-
(Keppra, Keppra protein 2A (SV2A) generalized onset seizures) effects
XR) No drug interactions
IV available
Rapid titration
BID or QD with XR
OXC Oxcarbazepine Voltage-sensitive Na+ channel blockade Few drug interactions Indicated for partial onset seizures only; in
(Trileptal, Oxtellar) Rapid titration some cases can worsen generalized-onset
BID or QD with XR seizures (PGE)
Medium enzyme induction
Interferes with OC
Hypersensitivity
Hyponatremia
TPM Topiramate 1. Voltage-gated Na+ channel Broad spectrum (partial onset and Slow titration
(Topamax, Qudexy, blocker generalized onset seizures) Cognitive effects
Trokendi) 2. Voltage-gated Ca2+ channel Few drug interactions May interfere w/ OC at higher
blocker BID or QD with XR doses
3. Enhances GABA-A Useful in migraine Potential for weight loss
4. Inhibition of AMPA Potential for weight loss Renal stones (rare)
5. Carbonic anhydrase Anhidrosis Glaucoma (rare)
inhibitor Anhidrosis

Less Commonly Used AEDs

Clobazam (Onfi) Prolongs GABA-A Cl- opening Broad spectrum (partial onset and generalized Severe withdrawal side effects
onset seizures) cannot be stopped suddenly
Long-acting/ QD dosing Increased incidence of pneumonia or
few drug interactions respiratory illness
broad spectrum cognitive and sedation effects
some anxiolytic effects
Clonazepam (Klonopin) Prolongs GABA-A Cl- opening Broad spectrum (partial onset and generalized Tachyphylaxis
onset seizures) Physical addiction and dependence
useful for myoclonus
Useful for anxiety
Can be used as abortive/rescue therapy
Dissolving tablet available
Eslicarbazepine (Aptiom) Voltage-Gated Na+ channel blockade QD dosing Indicated for partial onset seizures only
Primarily renally excreted interferes with OC
Relatively lower incidence of hyponatremia
than OXC
Ethosuximide T-type Calcium channel Oral solution available Only effective for absence seizures
(Zarontin) blocker GI side-effects
Behavioral and psychiatric issues
Ezogabine Potassium channel opener Does not affect the metabolism of other AEDs Indicated for partial onset seizures only, for
(Potiga) now
Discoloration of the skin
Retinal abnormalities
Rare urinary retention
Psychiatric symptoms
QT prolongation
Felbamate (Felbatol) 1. GABA-A enhancement Broad spectrum (partial onset and generalized Serious potential side-effects, including liver
2. NMDA blockade onset seizures) failure and aplastic anemia
Oral solution available TID dosing
Gabapentin (Neurontin, Binds 2 subunit of L-type voltage- No drug interactions Indicated for partial onset seizures only
Horizant) regulated Ca2+ channels (High- Rapid titration Dose-dependent absorption
Voltage Activated class) Useful in neuropathic pain and spasticity, Weight gain
restless leg syndrome Somnolence
Some anxiolytic effects
May improve sleep quality
QD dosing available
Lorazepam (Ativan) GABA-A enhancement Acute seizure treatment (status Not recommended for long-term
(Benzodiazepine) epilecticus) use
IV available Somnolence
TABLE: AED Summary (continued)

Dizziness
Poor coordination
Double vision
Aggressive behavior
Suicidal thoughts
Pregabalin (lyrica) Binds alpha2delta subunit of L-type No drug interactions Indicated for partial onset seizures only
voltage-gated Ca2+ channels Rapid titration Weight gain
Useful in neuropathic pain, spasticity & Somnolence
restless leg syndrome Edema
Some anxiolytic effects
May improve sleep quality
More reliable absorption than gabapentin
Rufinamide (banzel) Prolongation of inactive state of sodium Specifically tested in Lennox Gastaut GI side-effects
channel Syndrome; most effective in treating Ataxia
atonic seizures Nausea/vomiting
Sedation/drooling
Tiagabine (Gabatril) Inhibitor of GABA uptake Few drug interactions Indicated for partial onset seizures only
Rarely used, can cause status epilepticus
High protein binding
Slow titration
Cognitive, GI side-effects
Vigabatrin (Sabril) Irreversible GABA-transaminase inhibitor Proven efficacy in infantile spasms Risk for loss of visual field mandatory in
depth ophthalmological assessments
Psychiatric side-effect risks
Weight gain
Zonisamide (Zonegran) 1. Fast inactivation of voltage-dependent Broad spectrum (partial onset and generalized Hypersensitivity (sulfa analogue)
sodium channel onset seizures) Potential for weight loss
2. T-type calcium channel inhibitor Few drug interactions Possible mood worsening
3. Carbonic anhydrase inhibitor Potential for weight loss Rare renal stones
Mild antiparkinsonian effects
Some headache prophylaxis
QD dosing
QD: once daily; BID: twice daily; TID: three times daily; QID: four times daily; OC: oral contraceptive;
AED: Anti-Epilepsy Drug; EIAED: Enzyme-Inducing Anti-Epilepsy Drug

*Remember, partial onset seizures begin focally, but can progress to secondarily generalized seizures (convulsions); Generalized-onset
seizures refer to those seizures which begin as a generalized electrographic process (including absence seizures, myoclonic seizures,
convulsions of PGE = primary generalized epilepsy, atonic seizures, and tonic seizures).