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Vigabatrin
Vigabatrin is an anticonvulsant medication used to treat certain types of seizures. It is primarily prescribed for patients with infantile spasms (West syndrome) and refractory complex partial seizures (seizures that are not controlled by other medications) in patients aged 10 years and older. Vigabatrin works by increasing levels of gamma-aminobutyric acid (GABA), a neurotransmitter that inhibits the brain's excessive electrical activity, helping to control seizures.
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Frequently Asked Questions
How long does it take for vigabatrin to start working?
Vigabatrin may start reducing seizure frequency within a few days to a week of starting treatment, but it may take longer to achieve full benefits. Regular monitoring by your healthcare provider is important.
Can vigabatrin cause permanent vision damage?
Yes, vigabatrin can cause irreversible vision loss, primarily affecting peripheral vision. Regular eye exams are required during treatment and for several months after discontinuation.
Can vigabatrin be used in children?
Yes, vigabatrin is approved for use in children with infantile spasms and older children with refractory complex partial seizures. However, vision monitoring is crucial, even in pediatric patients.
What should I do if I miss a dose of vigabatrin?
If you miss a dose, take it as soon as you remember. If it is close to the time of your next dose, skip the missed dose and take your next dose at the scheduled time. Do not double the dose to make up for a missed one.
Is it safe to stop vigabatrin suddenly?
No, stopping vigabatrin suddenly can cause increased seizures or withdrawal symptoms. Always taper off the medication under the supervision of your healthcare provider.
Comprehensive Drug Guide
How Does Vigabatrin Work?
Vigabatrin works by irreversibly inhibiting GABA transaminase, the enzyme responsible for breaking down GABA in the brain. By increasing the levels of GABA, an inhibitory neurotransmitter, vigabatrin helps to calm the excessive electrical activity in the brain that leads to seizures.
Common Dosages
- 500 mg oral tablets
- 500 mg powder for oral suspension
Typical Dosing
- For infantile spasms: The recommended starting dose is 50 mg/kg per day, divided into two doses. The dose may be increased as needed up to 150 mg/kg per day.
- For complex partial seizures: The typical starting dose is 500 mg twice daily. The dose may be increased in increments of 500 mg up to a maximum of 3,000 mg per day based on patient response.
Typical Dosing
FDA Approved Indications
- Treatment of infantile spasms (West syndrome) in infants aged 1 month to 2 years.
- Adjunctive therapy for refractory complex partial seizures in patients aged 10 years and older who have not responded to other treatments.
Who Shouldn't Take Vigabatrin?
- Known hypersensitivity to vigabatrin or any component of the formulation.
- Patients with preexisting or significant vision loss, as vigabatrin can cause permanent vision damage.
Advice From The Pharmacist
- Take vigabatrin exactly as prescribed by your healthcare provider. It is usually taken twice daily, with or without food.
- Regular vision testing is required while taking vigabatrin, as the medication can cause irreversible vision loss. Eye exams are recommended every 3 months during treatment.
- If using the powder for suspension, mix it with water as instructed by your healthcare provider and take it immediately.
- Do not stop taking vigabatrin suddenly, as this can cause an increase in seizure activity. Consult your doctor if you need to stop or adjust your dose.
Side Effects of Vigabatrin
Common Side Effects
- Drowsiness
- Fatigue
- Weight gain
- Tremor
- Headache
Uncommon/Severe Side Effects
- Permanent vision loss (peripheral vision loss is the most common)
- Depression, anxiety, or mood changes
- Increased seizure activity
- Severe allergic reactions (swelling, rash, difficulty breathing)
Risks and Warnings of Vigabatrin
- Vision Loss: Vigabatrin can cause irreversible vision loss, typically affecting peripheral vision. All patients should undergo regular eye exams every 3 months during treatment and for a period after discontinuation.
- Suicidal Thoughts: Like other antiepileptic drugs, vigabatrin may increase the risk of suicidal thoughts or behaviors. Patients should be closely monitored for signs of mood changes or depression.
- Withdrawal Seizures: Abrupt discontinuation of vigabatrin can lead to withdrawal seizures or an increase in seizure frequency. Tapering off the medication under medical supervision is recommended.
Interactions with Vigabatrin
Common Drug Interactions
- Other antiepileptic drugs: Vigabatrin can be used in combination with other seizure medications, but dose adjustments may be necessary.
- CNS depressants: Combining vigabatrin with sedatives or alcohol may increase the risk of drowsiness, dizziness, or respiratory depression.
Alternatives to Vigabatrin
- Topiramate (Topamax): Another anticonvulsant used for refractory seizures and infantile spasms.
- Lamotrigine (Lamictal): An anticonvulsant used for a wide range of seizure types, including complex partial seizures.
- Levetiracetam (Keppra): A commonly used antiepileptic medication for partial-onset and generalized seizures.
