Antiepileptics for psychiatric illness: Find the right match
Current Psychiatry. 2010 December;09(12):50-66
December 1, 2010|Current Psychiatry
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Selecting the optimal agent requires knowing each drug’s efficacy and safety profile
Because concentrations of newer AEDs—including gabapentin, lamotrigine, levetiracetam, oxcarbazepine, tiagabine, topiramate, and zonisamide—have not been shown to correlate with therapeutic response, monitoring of serum concentrations is not necessary. However, routine laboratory tests to monitor for adverse effects are recommended.
Table
Therapeutic concentration monitoring for carbamazepine and valproate
| Medication | Suggested therapeutic range (trough level)* | Supratherapeutic presentation |
|---|---|---|
| Carbamazepine | 4 to 12 μg/mL | Ataxia, gastrointestinal upset, drowsiness, dizziness, diplopia, rash |
| Valproate (divalproex) | 50 to 125 μ/mL | Ataxia, nystagmus, tremor, hallucinations |
| *Values may vary among laboratories Source: Reference 23 | ||
Related Resources
- McElroy SL, Keck PE, Post RM, eds. Antiepileptic drugs to treat psychiatric disorders. New York, NY: Informa Health-care USA, Inc.; 2008.
- U.S. Food and Drug Administration. Suicidal behavior and ideation and antiepileptic drugs. www.fda.gov/Drugs/DrugSafety/PostmarketDrugSafetyInformationforPatientsandProviders/UCM100190.
Drug Brand Names
- Carbamazepine • Carbatrol, Equetro, others
- Clozapine • Clozaril
- Gabapentin • Neurontin
- Lamotrigine • Lamictal, Lamictal XR
- Levetiracetam • Keppra, Keppra XR
- Oxcarbazepine • Trileptal
- Pregabalin • Lyrica
- Tiagabine • Gabitril
- Topiramate • Topamax
- Valproate (Divalproex) • Depakote, Depakote ER
- Zonisamide • Zonegram
Disclosure
The authors report no financial relationship with any company whose products are mentioned in this article or with manufacturers of competing products.
