A Brief Review of Brand-Name Antiepileptic Drugs

MAY 18, 2016
Epilepsy is a brain disorder that predisposes an individual to recurrent unprovoked seizures. Approximately 2.2 to 3 million Americans have epilepsy, and 1 in 26 individuals will develop epilepsy or recurring seizures within their lifetime.
 
In addition to the risk of mortality, epilepsy can cause depression, anxiety, mood, and behavior problems, as well as attention and learning difficulties and social isolation (eg, loss of driving privileges, avoidance of public activities). Treating epilepsy is crucial for maintaining seizure control and optimizing a patient’s quality of life.1
 
Many new antiepileptic drugs (AEDs) have hit the market in recent years, offering new hope for patients with epilepsy. There are now multiple new treatment options for partial-onset seizures and Lennox-Gastaut syndrome (LGS).
 
Unlike primary generalized seizures that involve both sides of the brain simultaneously, partial seizures begin with an electrical discharge in a limited area of the brain. They can be further differentiated, depending on the individual’s consciousness during the event.
 
LGS involves multiple different types of seizures, particularly tonic (stiffening) and atonic (drop) seizures. Intellectual development is usually, but not always, impaired. LGS accounts for only 2% to 5% of childhood epilepsies; however, this condition is hard to control and requires life-long treatment.2-3
 
The Table below provides a comparison of brande-name AEDs, excluding branded extended-release (ER) formations, where the non-ER product is available as a generic. It’s important for pharmacists to know the FDA-approved uses, contraindications, and black box warnings for each AED.
 
TABLE: COMPARISON OF BRAND-NAME ANTIELEPTIC DRUGS4-12
Drug Name Mechanism of Action Indications Contraindications/Black Box Warnings Schedule
Aptiom (eslicarbazepine)
 
 
 
Inhibition of voltage-gated
sodium channels
Treatment of partial-onset seizures as
monotherapy or adjunctive therapy
Hypersensitivity to eslicarbazepine acetate or oxcarbazepine N/A
Banzel
(rufinamide)
Sodium channels modulation/slowed recovery from inactivation Adjunctive treatment of seizures associated with LGS in adults and children 1 year and older Familial short QT syndrome N/A
Briviact (brivaracetam) Unknown.  Displays a high and selective affinity for synaptic vesicle protein 2A (SV2A). Treatment of partial-onset
seizures in patients 16 years and older with epilepsy
Hypersensitivity Controlled substance, awaiting  DEA review
Fycompa (perampanel) Non-competitive AMPA glutamate receptor antagonist Adjunctive therapy for the treatment of partial-onset seizures with or without secondarily generalized seizures in patients with epilepsy 12 years and older
 
Adjunctive therapy for the treatment of primary generalized tonic-clonic seizures in patients with epilepsy 12 years and older
Serious or life-threatening psychiatric and behavioral adverse reactions,
including aggression, hostility, irritability, anger, and homicidal ideation and threats
Schedule III controlled substance
Lyrica (pregabalin) Binds to the alpha2-delta site (an auxiliary subunit of voltage-gated calcium channels) Adjunctive therapy for adult patients with partial onset seizures
 
Management of neuropathic pain associated with diabetic peripheral neuropathy
 
Management of postherpetic neuralgia
 
Management of fibromyalgia
 
Management of neuropathic pain associated with spinal cord injury
Hypersensitivity Schedule V controlled substance
Onfi
 (clobazam)
Benzodiazepine Adjunctive treatment of
seizures associated with LGS in patients
2 years and older
Hypersensitivity Schedule IV controlled substance
Potiga (ezogabine) Activates KCNQ channels Adjunctive treatment of partial-onset seizures in patients 18 years and older who have responded inadequately to several alternative treatments and for whom the benefits outweigh the risk of retinal abnormalities and potential decline in visual acuity. Vision loss (retinal abnormalities which may result in damage to the photoreceptors) Schedule V controlled substance
Sabril (vigabatrin) Irreversible inhibitor of γ-aminobutyric acid transaminase (GABA-T), the enzyme responsible for the metabolism of the inhibitory neurotransmitter GABA. This action results in increased levels of GABA in the central nervous system. Adjunctive therapy for adults and pediatric patients 10 years and older with refractory complex partial seizures who have inadequately responded to several alternative treatments and for whom the potential benefits outweigh the risk of vision loss.
 
Monotherapy for pediatric patients with infantile spasms 1 month to 2 years in whom the potential benefits outweigh the potential risk of vision loss.
Vision loss (progressive and permanent bilateral
concentric visual field constriction)
Distributed through specialty pharmacies. Not a controlled substance.
Vimpat (lacosamide) Selectively enhances slow inactivation of voltage-gated sodium channels Monotherapy or adjunctive therapy in patients with partial-onset seizures. N/A Schedule V controlled substance

References
  1. American Epilepsy Society. FAQs. aesnet.org/clinical_resources/faqs. Accessed May 2016.
  2. Epilepsy Foundation. Types of seizures. epilepsy.com/learn/types-seizures. Accessed May 2016.
  3. Epilepsy Foundation. Lennox-Gastaut syndrome (LGS). epilepsy.com/learn/types-epilepsy-syndromes/lennox-gastaut-syndrome-lgs. Accessed May 2016.
  4. Aptiom [package insert]. Marlborough, MA: Sunovion Pharmaceuticals, Inc.; August 2015.
  5. Banzel [package insert]. Woodcliff Lake, NJ: Eisai Inc.; February 2015.
  6. Briviact [package insert]. Smyrna, GA: UCB, Inc; February 2016.
  7. Fycompa [package insert]. Woodcliff Lake, NJ: Eisai Inc.; April 2016.
  8. Lyrica [package insert]. New York, NY: Park-Davis; March 2016.
  9. Onfi [package insert]. Deerfield, IL: Lundbeck Inc.; December 2014.
  10. Potiga [package insert]. Research Triangle Park, NC: GlaxoSmithKline; May 2015.
  11. Sabril [package insert]. Deerfield, IL: Lundbeck Inc.; September 2015.
  12. Vimpat [package insert]. Smyma, GA: UCB, Inc; June 2015.


Mel Seabright, PharmD, MBA
Mel Seabright, PharmD, MBA
Mel Seabright, PharmD, MBA, is a clinical pharmacist specializing in pharmacy benefits management and managed care. He has extensive experience in utilization management, medical writing and drug information.
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