A Brief Review of Brand-Name Antiepileptic Drugs

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 DRUGS^4-12

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

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