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Antiseizure drugs: Mechanism of action, pharmacology, and adverse effects

Steven C Schachter, MD
Section Editor
Paul Garcia, MD
Deputy Editor
April F Eichler, MD, MPH


While sharing a common property of suppressing seizures, antiseizure drugs have many different pharmacologic profiles that are relevant when selecting and prescribing these agents in patients with epilepsy and other conditions. This includes pharmacokinetic properties, propensity for drug-drug interactions, and side effect profiles and toxicities.

Over the past several decades, the number of available antiseizure drugs has more than doubled. Unlike some of the earliest antiseizure drugs such as phenobarbital, phenytoin, and carbamazepine, many of the currently available antiseizure drugs have simple pharmacokinetics and more limited effects on liver metabolism. This translates into a generally lower rate of side effects, reduced need for serum monitoring, once or twice daily dosing for some, and fewer drug-drug interactions. Despite these advantages, however, there are few data to suggest significant differences in effectiveness among available antiseizure drugs.

Antiseizure drugs are typically grouped by their principal mode of action, although for many drugs, the precise mechanism of action is not known or multiple actions are suspected (table 1). To some degree, the cellular effects of antiseizure drugs are linked with the types of seizures against which they are most effective. An improved understanding of the molecular effects of existing antiseizure drugs as well as development of new antiseizure drugs that act against novel targets may allow for more rationale polytherapy in the future.

For detailed prescribing information, readers should refer to the individual drug information topics within UpToDate. Comprehensive information on drug-drug interactions can be determined using the drug interactions tool (Lexi-Interact online). This tool can be accessed from the UpToDate online search page or through the individual drug information topics in the section on Drug interactions. Complete information on U.S. Food and Drug Administration (FDA) labeling for each drug can be accessed using the FDA searchable database.

The pharmacology of antiseizure drugs is reviewed here. The use of antiseizure drugs in a treatment plan for patients with seizures is discussed separately. Risks of antiseizure drugs in pregnancy are also discussed separately. (See "Initial treatment of epilepsy in adults" and "Overview of the management of epilepsy in adults" and "Risks associated with epilepsy and pregnancy", section on 'Effect of antiseizure drugs on the fetus'.)


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