Anticonvulsants

Anticonvulsants (also known as antiepileptic drugs, AEDs) are medications used primarily to prevent and control seizures. Many also have indications in neuropathic pain, mood stabilization, and other neurologic or psychiatric conditions.

• Drug class: Antiepileptic / anticonvulsant agents
• ATC code: N03A
• Mechanisms of action (varies by drug):
  • Sodium channel blockers (e.g., phenytoin, carbamazepine)
  • Calcium channel blockers (e.g., ethosuximide)
  • GABA enhancers (e.g., phenobarbital, gabapentin)
  • Glutamate inhibitors (e.g., perampanel)
  • Synaptic vesicle protein modulators (e.g., levetiracetam)

• Epilepsy (partial and generalized seizures)
• Status epilepticus
• Neuropathic pain (e.g., postherpetic neuralgia, diabetic neuropathy)
• Bipolar disorder (e.g., valproate, lamotrigine)
• Migraine prophylaxis (e.g., topiramate)
• Off-label: tinnitus, fibromyalgia, anxiety disorders

• Common: Drowsiness, dizziness, ataxia, GI upset
• Serious: Stevens-Johnson syndrome, hepatotoxicity, blood dyscrasias, teratogenicity
• Neuropsychiatric: Mood changes, suicidal ideation (monitor closely)

• Many are CYP450 inducers or inhibitors (especially older agents)
• Monitor plasma levels if narrow therapeutic index (e.g., phenytoin, valproate)
• Avoid combinations that lower seizure threshold (e.g., certain antibiotics, antidepressants)

• Liver function tests (e.g., valproate, carbamazepine)
• CBC (e.g., carbamazepine, ethosuximide)
• Serum drug levels when indicated
• Mood and behavior (especially in adolescents)

• Choose based on seizure type, comorbidities, age, and pregnancy status
• Some agents have off-label uses beyond epilepsy
• Teratogenicity is a major concern — avoid valproate in women of childbearing age unless no alternatives

• Antiepileptic drugs (AEDs)
• Antiseizure medications (ASMs)

• Epilepsy
• Neuropathic pain
• GABAergic system
• Mood stabilizers