Anti-Epileptic Agents

Phenytoin is prototypical of many of the anti-epileptic agents. While still used in the treatment of trigeminal neuralgia, it has largely been supplanted in clinical practice by newer, less toxic agents.

Anti-epileptic agents as a class of drugs are extensively used in the treatment of chronic pain. While their mechanism of action is not completely understood, they have been shown to decrease the release of excitatory neurotransmitters such as norepinephrine, glutamate and substance P. As a class of compounds they appear to bind to the α2δ subunit of type L voltage-sensitive calcium channels and/or to the voltage dependent sodium channels in the central nervous system (CNS).

The major problem with the anticonvulsants is their narrow therapeutic index. Most anti-epileptic agents will cause side effects, most commonly sedation, near or within their therapeutic range. The hope is that future agents in this class will have lesser toxicities extending their therapeutic range.

Agents Used at Schlesinger Pain Centers

  • Gabapentin (Neurontin)
  • Pregabalin (Lyrica)
  • Phenytoin (Dilantin)
  • Carbamazepine (Tegretol)
  • Topiramate (Topamax)
  • Lamotrigine (Lamictal)

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