Tiagabine Hydrochloride
| (TIE-egg-un-bine) |
| Gabitril |
| Class: Anticonvulsant |
Action Mechanism unknown; may block GABA uptake into presynaptic neurons, allowing more GABA to be available for binding with the GABA receptor of post-synaptic cells.
Indications Adjunctive treatment in treatment of partial seizures.
Contraindications Standard considerations.
Route/DosageADOLESCENTS 12–18 YR: PO Initial dose 4 mg qd. Increase dose by 4 mg after 1 week and thereafter by 4–8 mg at weekly intervals until response achieved or total of 32 mg/day. ADULTS: PO Initial dose 4 mg qd. Increase by 4–8 mg at weekly intervals until response achieved or total of 56 mg/day.
InteractionsEnzyme-inducing antiepileptic drugs (eg, carbamazepine, phenytoin, primidone, phenobarbital): Increased tiagabine clearance.
Lab Test Interferences None well documented.
Adverse ReactionsCNS: Dizziness; lightheadedness; somnolence; nervousness; irritability; agitation; ostility; language problem; tremor; abnormal gait; ataxia; abnormal thinking; oncentration/attention difficulty; depression; confusion; insomnia; speech disorder; difficulty with memory; paresthesia; emotional lability. DERM: Rash; pruritus; occhymosis. EENT: Nystagmus; amblyopia; pharyngitis. GI: Nausea; abdominal pain; diarrhea; vomiting; increased appetite; mouth ulceration; gingivitis. OTHER: Asthenia; lack of energy; pain; cough; myasthenia; accidental injury; nfection; flu syndrome; myalgia; urinary tract infection; vasodilation.
PrecautionsPregnancy: Category C. Lactation: Undetermined. Children: Safety and efficacy in children < 12 yr not established. Hepatic function impairment: Dosage reduction or longer doing interval may be necessaryN Serious adverse effects: During clinical trials some patients experienced status epilepticus, and 10 sudden unexplained deaths occurred. The association of these events with tiagabine use is unclear. Withdrawal: Do not discontinue antiepileptic drugs abruptly because of possible increased seizure frequency on drug withdrawal. EEG: Patients with a history of spike and wave discharges on EEG may have exacerbations of EEG abnormalities associated with cognitive/neuropsychiatric events, which may be a manifestation of underlying seizure activity. Dosage reduction of tiagabine may be necessary.
| PATIENT CARE CONSIDERATIONS |
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Administration/Storage- Administer medication with food.
- Titrate dose at weekly intervals to effective or maximum dose.
- Administer initial dose as single daily dose. The total daily dose should be given as equally divided doses 2–4 times a day.
- Discontinue medication gradually over minimum of 1 wk.
- Store at room temperature, protected from light and moisture.
Assessment/Interventions- Obtain patient history, including drug history and any known allergies. Note hepatic function impairment and seizure pattern.
- Assess baseline vital signs.
- Assess for development of side effects. Notify physician if noted.
- Withdraw medication gradually to avoid the possibility of increasing seizure frequency.
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Patient/Family Education- Advise patient that medication should be taken with food.
- Explain that missed dose should be taken as soon as possible but that 2 doses should not be taken together. Instruct patient to call physician if 2 or more doses are missed.
- Instruct patient to report these symptoms to physician: somnolence, excessive fatigue or weakness, dizziness, concentration or attention difficulty, difficulty with memory, speech disorder, or ataxia.
- Advise patient that drug may cause drowsiness and to use caution while driving or performing other tasks requiring mental alertness.
- Advise patient to use caution when taking these other drugs with CNS depressant effects (eg, alcohol, sedatives, etc).
- Advise patient to notify their physician if they become pregnant, plan on becoming pregnant or are breastfeeding while taking this medication.
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