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Felbamate
Felbamate is an anticonvulsant medication used to treat seizures in patients with epilepsy. It is particularly effective in treating partial seizures and Lennox-Gastaut syndrome, a severe form of childhood epilepsy. Due to the risk of serious side effects, felbamate is typically prescribed when other seizure medications have failed to control seizures or are not tolerated by the patient. Felbamate works by modulating the activity of certain neurotransmitters in the brain, reducing the frequency and severity of seizures.
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Frequently Asked Questions
How long does it take for Felbamate to start working?
Felbamate may take a few weeks to reach its full effectiveness. Seizure control generally improves as the dose is gradually increased to the target range.
Can Felbamate cure epilepsy?
No, felbamate does not cure epilepsy. It helps manage and reduce the frequency of seizures, but treatment is usually long-term to maintain seizure control.
What should I do if I miss a dose of Felbamate?
If you miss a dose, take it as soon as you remember. If it’s close to the time of your next dose, skip the missed dose and continue with your regular dosing schedule. Do not double up on doses to make up for the missed one.
Can I take Felbamate with other seizure medications?
Yes, felbamate is often used in combination with other anticonvulsants. However, your healthcare provider will monitor your response and adjust doses to avoid interactions or side effects.
Why is Felbamate only prescribed in certain cases?
Felbamate is associated with serious side effects, such as aplastic anemia and liver toxicity, so it is typically reserved for patients who have not responded to other seizure medications. Regular blood and liver function monitoring are necessary to minimize risks.
Comprehensive Drug Guide
How Does Felbamate Work?
The exact mechanism by which felbamate controls seizures is not fully understood. However, it is believed to work by modulating the action of gamma-aminobutyric acid (GABA), an inhibitory neurotransmitter in the brain, and by inhibiting N-methyl-D-aspartate (NMDA) receptors involved in excitatory transmission. This dual action helps to stabilize neuronal activity, preventing the abnormal electrical discharges that cause seizures.
Common Dosages
- For partial seizures: Starting dose of 1200 mg/day, divided into 3 or 4 doses. The dose is gradually increased to a maintenance dose of 2400 mg to 3600 mg/day.
- For Lennox-Gastaut syndrome: Starting dose of 15 mg/kg/day, divided into 3 or 4 doses, with gradual increases based on the patient's response.
Typical Dosing
- Adults with partial seizures: Initial dose is 1200 mg per day (divided into 3 or 4 doses), which may be gradually increased to a maximum of 3600 mg per day based on the patient's response.
- Children with Lennox-Gastaut syndrome: Initial dose is 15 mg/kg/day, with gradual dose increases based on clinical response. Maximum dosing is determined by the healthcare provider based on body weight and seizure control.
Typical Dosing
FDA Approved Indications
- Partial seizures: In adults with epilepsy who are not adequately controlled with other medications.
- Lennox-Gastaut syndrome: For children with this severe form of epilepsy, characterized by multiple types of seizures and cognitive impairment.
Who Shouldn't Take Felbamate?
- Known hypersensitivity to felbamate or any of its components.
- History of aplastic anemia or liver disease, as felbamate has been associated with these serious adverse effects.
Advice From The Pharmacist
- Take felbamate exactly as prescribed by your healthcare provider. Do not adjust the dose without consulting your doctor.
- Felbamate can be taken with or without food; however, it should be taken at the same time each day for consistent blood levels.
- Regular blood tests will be required to monitor liver function and blood cell counts, as felbamate has been associated with serious side effects like aplastic anemia and liver toxicity.
- Be alert for signs of liver damage (yellowing of the skin or eyes, dark urine, upper abdominal pain) and aplastic anemia (fatigue, easy bruising, unusual bleeding) and report these symptoms to your healthcare provider immediately.
- Do not stop taking felbamate suddenly, as this may lead to increased seizures. Always consult your doctor before discontinuing the medication.
Side Effects of Felbamate
Common Side Effects
- Drowsiness or fatigue
- Nausea
- Headache
- Insomnia
- Loss of appetite
- Weight loss
Uncommon/Severe Side Effects
- Aplastic anemia: A rare but life-threatening condition in which the bone marrow stops producing enough blood cells.
- Liver toxicity: This can lead to liver failure, characterized by symptoms such as jaundice, dark urine, and abdominal pain.
- Severe allergic reactions (rash, swelling of the face or throat, difficulty breathing)
Risks and Warnings of Felbamate
- Aplastic Anemia: Felbamate has been associated with an increased risk of aplastic anemia, a condition where the bone marrow fails to produce enough blood cells. This can be life-threatening, and regular blood monitoring is required.
- Liver Toxicity: Felbamate can cause liver damage, and patients should have regular liver function tests. The medication should be discontinued if signs of liver damage appear.
- Seizure Risk: Stopping felbamate abruptly may lead to an increase in seizures. Tapering off the medication under medical supervision is necessary to avoid withdrawal seizures.
Interactions with Felbamate
Common Drug Interactions
- Carbamazepine and phenytoin: Felbamate may interact with these anticonvulsants, affecting their levels in the blood and potentially leading to increased side effects.
- Warfarin: Felbamate may increase the effects of warfarin, a blood thinner, raising the risk of bleeding. Regular monitoring of blood clotting times (INR) is recommended.
- Oral contraceptives: Felbamate may reduce the effectiveness of birth control pills, so alternative forms of contraception should be considered.
Alternatives to Felbamate
- Lamotrigine (Lamictal): Another anticonvulsant used to treat seizures, particularly in patients with Lennox-Gastaut syndrome.
- Valproate (Depakote): A commonly used anticonvulsant that can treat a broad range of seizure types.
- Topiramate (Topamax): Another anticonvulsant option for treating partial seizures and Lennox-Gastaut syndrome.
- Levetiracetam (Keppra): An anticonvulsant used to treat partial seizures, with a favorable safety profile.
