Other Anticonvulsants

See Table 28-5.

TABLE 28-5

OTHER ANTICONVULSANTS

	Mechanism of Action		Potential Effects in Overdose	Potential Treatments		Comments
Gabapentin	Ca2+ channel inhibition (#945;2-#948; subunit)		Sedation, ataxia, myoclonus	Supportive		Wide therapeutic index
Lamotrigine	Na+ channel		Sedation,	Supportive,		Long delay to reach
		inhibition	seizures, QRS prolongation		benzodiazepines (seizures), sodium bicarbonate (QRS prolongation)		steady state (esp. w/ VPA)
Lacosamide		(Slow) Na+ channel inhibition	Sedation, ataxia		Supportive, benzodiazepines (seizures), sodium bicarbonate (QRS prolongation)		Excreted unchanged, attractive d/t lack of CYP interactions
Levetiracetam		Modulation of neurotransmitter release binding to SV2A	Sedation, bradycardia		Supportive		Limited data in overdose, significant toxicity reported at high levels 300-400 #956;g#8725;mL
Topiramate		Na+ and Ca2+ channel inhibition, AMPA/kainate inhibition	Sedation, ataxia, myoclonus, seizures		Supportive care, hemodialysis in severe poisoning		Impairs renal carbonic anhydrase #8594; hyperchloremic metabolic acidosis
Zonisamide		Na+ and T-type Ca2+ channel inhibition	Sedation, possible: hypotension, QRS prolongation, seizures		Supportive, benzodiazepines (seizures), sodium bicarbonate (QRS prolongation)		Severe toxicity in large overdoses reported (gt;4 g)

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