(BQ) Part 1 book “Behavioural neurology of antiepileptic drugs “ has contents: Comparative evidence and clinical scenarios, phenobarbital and primidone, phenytoin, pregabalin, other antiepileptic drugs - rufinamide, lacosamide, perampanel, and other contents. | Chapter 9 Phenobarbital and primidone Phenobarbital and primidone are non- proprietary first- generation antiepileptic drugs (AEDs; Figs 9. – ). Preparations Phenobarbital Tablets • Phenobarbital 5 mg (28- tab pack £). • Phenobarbital 30 mg (56- tab pack £). • Phenobarbital 60 mg (56- tab pack £). Oral solution Phenobarbital 3 mg/ mL (500 mL £). Primidone Tablets • Primidone 50 mg ( 00- tab pack £). • Primidone 250 mg ( 00- tab pack £). Generic formulation MHRA/ CHM advice is to minimize risk when switching patients with epilepsy between different manufacturers’ products (including generic products): • Category : doctors are advised to ensure that their patients are maintained on a specific manufacturer’s product. Indications Epilepsy: monotherapy and adjunctive therapy of all seizures apart from focal seizures. chapter 9 78 • behavioural neurology of antiepileptic drugs AEDs Brivaracetam Eslicarbazepine Zonisamide Pregabalin Levetiracetam Oxcarbazepine Tiagabine Topiramate Gabapentin Lamotrigine Vigabatrin Clobazam Piracetam Clonazepam Valproate Carbamazepine Ethosuximide Primidone Phenobarbital 1920 1930 Phenytoin 1940 1950 1960 1970 1980 1990 2000 2010 Fig. 9. Chronology of the clinical use of phenobarbital and primidone O H N O HN O Fig. Chemical structure of phenobarbital H N HN O Fig. Chemical structure of primidone chapter 9 O year phenobarbital and primidone • 79 Phenobarbital Recommendations summarized from NICE (20 2) • Seizure types: on referral to tertiary care (focal seizures). • Epilepsy types: on referral to tertiary care (idiopathic generalized epilepsy, benign epilepsy with centrotemporal spikes, Panayiotopoulos syndrome, late- onset childhood occipital epilepsy). Primidone Neurology: treatment of essential tremor. Dose titration Phenobarbital Epilepsy: 60– 80 mg nocte. Primidone Epilepsy— monotherapy: 25 mg nocte, increased by 25 mg every 3 days to 500 mg daily, .
