Tag Archives: Tiagabine

Emerging Therapies for Insomnia

Most of the late-stage compounds in clinical development for insomnia are non-benzodiazepine gamma-aminobutyric acid -acting agents. These drugs’ developers are hoping that their new compounds, once approved, will achieve less restrictive labeling from regulatory authorities than the currently marketed benzodiazepine and non-benzodiazepine hypnotics — most of which have short-term prescribing limits and all of which… Read More »

Nonbenzodiazepine GABA-A Agonists

As mentioned, non-benzodiazepine gamma aminobutyric acid-A agonists in clinical development are very similar in terms of mechanism of action, safety, and efficacy to the currently marketed non-benzodiazepine hypnotics zolpidem, zopiclone, and zaleplon (which are sometimes referred to as the “Z” drugs). Consequently, none of these clinical-stage compounds is likely to offer major benefits in terms… Read More »

Treatment of Anxiety in the Medically Ill

Psychotherapy An overemphasis on psychopharmacology in the care of medically ill patients may result in overlooking the value of psychotherapy. The first step in the treatment of anxiety is to spend time listening to and talking with the patient. Just as in psychotherapy with any patient, empathic listening is a powerful tool to relieve distress.… Read More »

Pharmacological Treatment of Pain

While medications are often prescribed for all types of chronic pain, research has consistently shown that several classes have proven efficacy for the treatment of neuropathic pain. Ideally, pharmacotherapy of pain would be specifically selected on the basis of considerations of etiology (e.g., ischemic, neuropathic), pathophysiology (e.g., demyelination, central pain), and anatomy (e.g., C fibers,… Read More »

Combination Therapy in Bipolar Disorder

Monotherapy for bipolar disorder is well established as both acute and prophylactic treatment, the most familiar drugs used in these roles being lithium, sodium valproate, and carbamazepine. The choice of agent can be guided at least in part by the subtype of bipolar disorder, for instance, valproate possibly being more efficacious in rapid cycling illness… Read More »

Treatment Of Childhood Absence Epilepsy

Childhood absence epilepsy (CAE) typically requires treatment because the seizures are frequent and interfere with normal cognitive functioning. International League Against Epilepsy Guidelines (Newly Diagnosed Epilepsy) According to the ILAE guidelines, the absence of class I and class II randomized controlled trials (RCTs) for children with absence seizures implies a marked deficiency in adequately powered,… Read More »

Treatment Of Childhood Absence Epilepsy: American Academy Of Neurology Guidelines

New Anti-Epileptic Drugs Only American Academy of Neurology (AAN) guidelines evaluating efficacy of new anti-epileptic drugs state only that lamotrigine is effective in children with newly diagnosed absence seizures (level B recommendation). Ethosuximide After ethosuximide was described as effective in absence epilepsy in 1958, a number of open-label, non-comparative studies where ethosuximide was added to… Read More »

Lithium And Antiepileptic Drugs In Bipolar Depression

Lithium has been the gold standard for the treatment of bipolar illness for over 50 years (). There is more clinical and research experience with this drug than any other used to treat bipolar illness. Its utility in depression has been demonstrated in older studies and is generally underappreciated by the current generation of psychiatrists.… Read More »

Treatment of the epilepsy patient with hepatic disease

The liver is the principal organ of drug metabolism. Some drugs are absorbed from the gut, delivered to the liver and undergo first-pass metabolism prior to reaching the systemic circulation. Metabolism of these drugs is significantly affected by hepatic vascular supply; if hepatic blood flow is reduced, first-pass metabolism is decreased and more drug reaches… Read More »

Treatment of the epilepsy patient with renal disease

Seizures may occur in uraemic encephalopathy, dialysis disequilibrium syndrome and dialysis encephalopathy. In addition, renal insufficiency and dialysis may both have effects on anti-epileptic drug pharmacokinetics. Renal impairment can alter the fraction of anti-epileptic drug absorbed, volume of distribution, protein binding and renal drug clearance. Renal impairment may alter the gastric pH, cause small intestinal… Read More »