1 clinically important adverse drug reactions of aeds gitanjali-39:
TRANSCRIPT
![Page 1: 1 Clinically important adverse drug reactions of AEDs Gitanjali-39:](https://reader036.vdocuments.net/reader036/viewer/2022070409/56649e9d5503460f94b9e40e/html5/thumbnails/1.jpg)
1
Clinically important adverse drug reactions of AEDs
Gitanjali-39:
![Page 2: 1 Clinically important adverse drug reactions of AEDs Gitanjali-39:](https://reader036.vdocuments.net/reader036/viewer/2022070409/56649e9d5503460f94b9e40e/html5/thumbnails/2.jpg)
2
Five commonest ADRs with AEDs
• Ataxia• Dizziness• Fatigue• Nausea• Somnolence
Gitanjali-49:
![Page 3: 1 Clinically important adverse drug reactions of AEDs Gitanjali-39:](https://reader036.vdocuments.net/reader036/viewer/2022070409/56649e9d5503460f94b9e40e/html5/thumbnails/3.jpg)
3
Predictable Dose Dependent Reactions• Sedation – phenobarbitone,
primidone, benzodiazepines (all drugs to some extent)
• Nystagmus, ataxia, incoordination, dysarthria (cerebellar signs) – phenytoin, primidone, carbamazepine
Gitanjali-41:
![Page 4: 1 Clinically important adverse drug reactions of AEDs Gitanjali-39:](https://reader036.vdocuments.net/reader036/viewer/2022070409/56649e9d5503460f94b9e40e/html5/thumbnails/4.jpg)
4
Nystagmus
Gitanjali-42:
![Page 5: 1 Clinically important adverse drug reactions of AEDs Gitanjali-39:](https://reader036.vdocuments.net/reader036/viewer/2022070409/56649e9d5503460f94b9e40e/html5/thumbnails/5.jpg)
5
Nystagmus
Gitanjali-50:
![Page 6: 1 Clinically important adverse drug reactions of AEDs Gitanjali-39:](https://reader036.vdocuments.net/reader036/viewer/2022070409/56649e9d5503460f94b9e40e/html5/thumbnails/6.jpg)
6
Unpredictable idiosyncratic reactions
• Aplastic anaemia, hepatotoxicity - Felbamate
• Stevens Johnsons syndrome - Lamotrigine
• Hepatotoxicity - Valproate• Bone marrow suppression -
Carbamazepine
Gitanjali-42:
![Page 7: 1 Clinically important adverse drug reactions of AEDs Gitanjali-39:](https://reader036.vdocuments.net/reader036/viewer/2022070409/56649e9d5503460f94b9e40e/html5/thumbnails/7.jpg)
7Hepatic necrosis
Gitanjali-49:
![Page 8: 1 Clinically important adverse drug reactions of AEDs Gitanjali-39:](https://reader036.vdocuments.net/reader036/viewer/2022070409/56649e9d5503460f94b9e40e/html5/thumbnails/8.jpg)
8
Gitanjali-43:
![Page 9: 1 Clinically important adverse drug reactions of AEDs Gitanjali-39:](https://reader036.vdocuments.net/reader036/viewer/2022070409/56649e9d5503460f94b9e40e/html5/thumbnails/9.jpg)
9
Gitanjali-44:
![Page 10: 1 Clinically important adverse drug reactions of AEDs Gitanjali-39:](https://reader036.vdocuments.net/reader036/viewer/2022070409/56649e9d5503460f94b9e40e/html5/thumbnails/10.jpg)
10
Gitanjali-45:
![Page 11: 1 Clinically important adverse drug reactions of AEDs Gitanjali-39:](https://reader036.vdocuments.net/reader036/viewer/2022070409/56649e9d5503460f94b9e40e/html5/thumbnails/11.jpg)
11
![Page 12: 1 Clinically important adverse drug reactions of AEDs Gitanjali-39:](https://reader036.vdocuments.net/reader036/viewer/2022070409/56649e9d5503460f94b9e40e/html5/thumbnails/12.jpg)
12Aplastic anaemia
Gitanjali-49:
![Page 13: 1 Clinically important adverse drug reactions of AEDs Gitanjali-39:](https://reader036.vdocuments.net/reader036/viewer/2022070409/56649e9d5503460f94b9e40e/html5/thumbnails/13.jpg)
13
Chronic toxicity• Sexual dysfunction, Dupuytren’s
contracture – Phenobarbitone, primidone
• Coarse facies, gingival hyperplasia, hypertrichosis, megaloblastic anaemia, folate defieciency - Phenytoin
• Weight gain, polycystic ovary disease - Valproate
• Bradykinesia, parkinsonian syndrome - Ethosuximide
Gitanjali-46:
![Page 14: 1 Clinically important adverse drug reactions of AEDs Gitanjali-39:](https://reader036.vdocuments.net/reader036/viewer/2022070409/56649e9d5503460f94b9e40e/html5/thumbnails/14.jpg)
14Dupuytren’s contracture
Gitanjali-49:
![Page 15: 1 Clinically important adverse drug reactions of AEDs Gitanjali-39:](https://reader036.vdocuments.net/reader036/viewer/2022070409/56649e9d5503460f94b9e40e/html5/thumbnails/15.jpg)
15
![Page 16: 1 Clinically important adverse drug reactions of AEDs Gitanjali-39:](https://reader036.vdocuments.net/reader036/viewer/2022070409/56649e9d5503460f94b9e40e/html5/thumbnails/16.jpg)
16
![Page 17: 1 Clinically important adverse drug reactions of AEDs Gitanjali-39:](https://reader036.vdocuments.net/reader036/viewer/2022070409/56649e9d5503460f94b9e40e/html5/thumbnails/17.jpg)
17
Gingival hyperplasia
Gitanjali-49:
![Page 18: 1 Clinically important adverse drug reactions of AEDs Gitanjali-39:](https://reader036.vdocuments.net/reader036/viewer/2022070409/56649e9d5503460f94b9e40e/html5/thumbnails/18.jpg)
18
Gum Hyperplasia - phenytoin
![Page 19: 1 Clinically important adverse drug reactions of AEDs Gitanjali-39:](https://reader036.vdocuments.net/reader036/viewer/2022070409/56649e9d5503460f94b9e40e/html5/thumbnails/19.jpg)
19
![Page 20: 1 Clinically important adverse drug reactions of AEDs Gitanjali-39:](https://reader036.vdocuments.net/reader036/viewer/2022070409/56649e9d5503460f94b9e40e/html5/thumbnails/20.jpg)
20
Megaloblastic anemia Blood smear
Gitanjali-49:
![Page 21: 1 Clinically important adverse drug reactions of AEDs Gitanjali-39:](https://reader036.vdocuments.net/reader036/viewer/2022070409/56649e9d5503460f94b9e40e/html5/thumbnails/21.jpg)
21Megaloblasts in marrow
Gitanjali-49:
![Page 22: 1 Clinically important adverse drug reactions of AEDs Gitanjali-39:](https://reader036.vdocuments.net/reader036/viewer/2022070409/56649e9d5503460f94b9e40e/html5/thumbnails/22.jpg)
22
Delayed toxicity
• Neural tube defects (1% risk) - Valproate, Carbamazepine
• Increased risk of cleft lip and palate, cardiac anomalies, CNS anomalies – all drugs
• Fetal hydantoin syndrome - phenytoin
Gitanjali-47:
![Page 23: 1 Clinically important adverse drug reactions of AEDs Gitanjali-39:](https://reader036.vdocuments.net/reader036/viewer/2022070409/56649e9d5503460f94b9e40e/html5/thumbnails/23.jpg)
23
Antiepileptic Therapy & Pregnancy• Antiepileptic medication should not be discontinued in pregnant epileptic women, for whom medication is necessary for prevention of major seizures.
• 4-6% of infants of mothers with epilepsy have malformations
• Most teratogenic – Valproate, phenytoin
• Spina bifida, neural tube defect – Valproate, carbamazepine
• Incidence of malformations greatest with phenytoin plus phenobarbitone compared to Phenobarbitone alone
• Phenytoin, Phenobarbitone, Primidone - Deficiency of vitamin K dependent clotting factor in newborn
• Folate supplementation 0.4mg/day
![Page 24: 1 Clinically important adverse drug reactions of AEDs Gitanjali-39:](https://reader036.vdocuments.net/reader036/viewer/2022070409/56649e9d5503460f94b9e40e/html5/thumbnails/24.jpg)
24 Cleft lip and palateGitanjali-49:
![Page 25: 1 Clinically important adverse drug reactions of AEDs Gitanjali-39:](https://reader036.vdocuments.net/reader036/viewer/2022070409/56649e9d5503460f94b9e40e/html5/thumbnails/25.jpg)
25
![Page 26: 1 Clinically important adverse drug reactions of AEDs Gitanjali-39:](https://reader036.vdocuments.net/reader036/viewer/2022070409/56649e9d5503460f94b9e40e/html5/thumbnails/26.jpg)
26
![Page 27: 1 Clinically important adverse drug reactions of AEDs Gitanjali-39:](https://reader036.vdocuments.net/reader036/viewer/2022070409/56649e9d5503460f94b9e40e/html5/thumbnails/27.jpg)
27
Proconvulsant effects of AEDs
• Carbamazepine can induce Juvenile Myoclonic Epilepsy.
• Phenobarbitone can induce tonic seizures in children with Lennox Gastaut syndrome, can aggravate absence seizures.
• Ethosuximide worsens atonic seizures in children with juvenile myoclonic epilepsy.
Gitanjali-49:
![Page 28: 1 Clinically important adverse drug reactions of AEDs Gitanjali-39:](https://reader036.vdocuments.net/reader036/viewer/2022070409/56649e9d5503460f94b9e40e/html5/thumbnails/28.jpg)
28
COMMONLY USED ANTIEPILEPTICS DURING PREGNANCY AND THEIR POTENTIAL TOXIC EFFECTS
Drug Potential fetal /neonatal effects
1. Carbamazepine Facial dysmorphism, neural tube
defects, hypoplasia of distal phalanges
2. Phenobarbital Neonatal withdrawal, neonatal coagulopathy
3. Phenytoin Facial clefting hypoplasia of distal
phalanges, hypertelorism, neonatal coagulopathy
4. Primidone Neonatal withdrawal, neonatal coagulopathy
5. Valproic acid Facial dysmorphism, neural tube defects
![Page 29: 1 Clinically important adverse drug reactions of AEDs Gitanjali-39:](https://reader036.vdocuments.net/reader036/viewer/2022070409/56649e9d5503460f94b9e40e/html5/thumbnails/29.jpg)
29
Side effects of newer AEDs
Drug Common S.E. Rare S.E.Felbamate Anorexia, nausea,
insomnia, headacheAplastic anemia, Hepatic failure
Fosphenytoin Paraesthesia, pruritus, ataxia, nystagmus
Severe rash,
Steven Johnson’s Syndrome (SJS).
Gabapentin Drowsiness, fatigue, dizziness, nausea, ataxia
None known
Lamotrigine Rash, tremor, dizziness, nausea, headache, weight gain
Severe rash,
SJS.
Gitanjali-49:
![Page 30: 1 Clinically important adverse drug reactions of AEDs Gitanjali-39:](https://reader036.vdocuments.net/reader036/viewer/2022070409/56649e9d5503460f94b9e40e/html5/thumbnails/30.jpg)
30
Cost of Common AEDs
Rs./tab Rs/day• Carbamazepine - 200mg 1.65 4.95• Phenytoin - 100mg 1.05 3.15• Phenobarbitone - 30mg 0.30 3.00• Sodium valproate - 200mg 1.90 14.25• Clonazepam - 0.5mg 1.30 20.80• Clobazam - 5mg 2.80 16.00• Lamotrigine - 25mg 2.75 22.00
Gitanjali-49: