Summary of Antiepileptic Drugs Available in the United States of America

The current review summarizes the main antiepileptic drugs available for prescription in the United States as of July 2018. One condensed, and one expanded, table of the major properties of 28 AEDs are presented both to assist clinicians in providing care to persons with epilepsy and to facilitate the training of those in health care educational programs.

This table is not intended to constitute recommendations, only to provide an easy reference listing of products on the market.

Two and one-half decades ago, the choice of antiepileptic drugs (AEDs) was relatively limited. Beginning in August 1993 in the United States, the first new AED in approximately 15 years was approved by the U.S. Food and Drug Administration (FDA). Since then a panoply of AEDs have been approved. The vast majority of these are in new drug classes, and many have novel mechanisms of action. Furthermore, most have pharmacokinetic properties which are different from older AEDs.

Now that approximately 28 AEDs are available in the U.S. it can be challenging for epileptologists, neurologists, pharmacists, nurses, trainees, and other healthcare professionals to quickly access and cross-reference information needed in clinical practice to optimally select and use these medications. The Treatments Committee of the American Epilepsy Society created this document as a tool to help meet this need. Data for these summaries were obtained in July 2018 from the most recent FDA-approved prescribing information (PI) for each AED available on the www.FDA.gov website (1). It was noted that PIs for all AEDs approved since 1993, carbamazepine, divalproex and phenytoin were substantially more detailed than were PIs for other older drugs. Phenobarbital is no longer listed on the FDA website, but an older PI was used to obtain FDA-approved information (2). In instances where PIs lacked important data to permit comparison of one AED to another, AED pharmacology texts were used to supplement the tables (3,4). Serum level ranges are based on the clinical experience of the Treatments Committee members. The FDA-approved PI was the primary source of information to compile these tables. It is important to emphasize that the actual practice of providers may differ substantially from official approved indications, doses, dose frequency and other parameters.

Table 1 is a condensed summary of data on all AEDs currently available in the United States as of July 5, 2018. Table 2 is an expanded summary of these AEDs, adding additional data on pharmacokinetics, adverse effects, and drug-drug interactions. These tables will also be made available as PDF documents on the website of the American Epilepsy Society, and will be updated periodically. The hope is that providers will find these to be beneficial in the advanced care of persons with epilepsy.

TABLE 1.

CONDENSED LIST OF AEDS

TABLE 2.

EXPANDED LIST OF AEDS

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Notes: All AEDs confer an elevated risk of suicidal ideation and behavior, as well as increased risk of teratogenesis. All women becoming pregnant while taking AEDs are encouraged to enroll themselves with the North American AED Pregnancy Registry by calling 1-888-233-2334 or at www.aedpregnancyregistry.org. In the USA, report AED adverse effects to www.fda.gov/medwatch.

Key:

5HT

serotonin

adj

adjunctive treatment

AMPA

aminohydroxy methylisoxazole propionic acid

BDZ

benzodiazepine

BP

blood pressure

CBC

complete blood count

CMP

complete metabolic profile

CYP

cytochrome P450

DA

dopamine

DDI

drug-drug interaction

DRESS

drug reaction with eosinophilia and systemic symptoms (formerly, multiorgan hypersensitivity)

EIAED

enzyme-inducing anti-epileptic drug e.g., CBZ, PHT, PB, PRM

EtOH

ethanol

F

bioavailability

FIAS

focal impaired awareness seizure

focal

focal-onset seizures with or without progression to bilateral tonic-clonic seizures

GABA

gamma aminobutyric acid

GTCS

generalized-onset tonic-clonic seizures

HA

headache

HTN

hypertension

LGS

Lennox-Gastaut syndrome

MA

metabolic acidosis

MAOI

monoamine oxidase inhibitor

MHD

monohydroxy derivative of OXC (R- and S-li-carbazepine)

mono

monotherapy

N/V

nausea and vomiting

OC

oral contraceptive

PB

protein binding

PI

prescribing information

POLG

mitochondrial DNA polymerase γ

RBC

red blood cell

SE

status epilepticus

SJS

Stevens Johnson syndrome

sz

seizure

TCA gamma

tricyclic antidepressant

TEN

toxic epidermal necrolysis

TCS

tonic-clonic seizure

TDM

therapeutic drug monitoring

TSC

tuberous sclerosis complex

URI

upper respiratory infection

WBC

white blood cells.

TREATMENTS COMMITTEE

• David G. Vossler, M.D., Chair

• Danielle Andrade, M.D., M.Sc., FRCPC

• Jacquelyn Bainbridge, Pharm.D., FCCP

• Michelle Dougherty, M.D.

• Tyler E. Gaston, M.D.

• Barry E. Gidal, Pharm.D.

• William Gump, M.D.

• Charuta Joshi, MBBS

• Siddharth Kapoor, M.D., FANA, FAHS, FAES

• Jeffrey Kennedy, M.D.

• Ismail S. Mohammed, M.D., FRCPC

• Juan G. Ochoa, M.D.

• Alexander M. Papanastassiou, M.D.

• Mikiko Y. Takeda, Pharm.D., M.S., Ph.C.

• Alan R. Towne, M.D., M.P.H.

• Mindi M. Weingarten, Pharm.D., BCPPS

TREATMENTS TASK FORCE

• David G. Vossler, M.D., Chair

• Barry E. Gidal, Pharm.D.

• Mindi M. Weingarten, Pharm.D., BCPPS