Summary of Antiepileptic Drugs Available in the United States of America

Abstract

Two and one-half decades ago, the choice of antiepileptic drugs (AEDs) was relatively limited. Beginning in August 1993 in the United States, the first new AED in approximately 15 years was approved by the U.S. Food and Drug Administration (FDA). Since then a panoply of AEDs have been approved. The vast majority of these are in new drug classes, and many have novel mechanisms of action. Furthermore, most have pharmacokinetic properties which are different from older AEDs. Now that approximately 28 AEDs are available in the U.S. it can be challenging for epileptologists, neurologists, pharmacists, nurses, trainees, and other healthcare professionals to quickly access and cross-reference information needed in clinical practice to optimally select and use these medications. The Treatments Committee of the American Epilepsy Society created this document as a tool to help meet this need. Data for these summaries were obtained in July 2018 from the most recent FDA-approved prescribing information (PI) for each AED available on the www.FDA.gov website (1). It was noted that PIs for all AEDs approved since 1993, carbamazepine, divalproex and phenytoin were substantially more detailed than were PIs for other older drugs. Phenobarbital is no longer listed on the FDA website, but an older PI was used to obtain FDA-approved information (2). In instances where PIs lacked important data to permit comparison of one AED to another, AED pharmacology texts were used to supplement the tables (3,4). Serum level ranges are based on the clinical experience of the Treatments Committee members. The FDA-approved PI was the primary source of information to compile these tables. It is important to emphasize that the actual practice of providers may differ substantially from official approved indications, doses, dose frequency and other parameters. Table 1 is a condensed summary of data on all AEDs currently available in the United States as of July 5, 2018. Table 2 is an expanded summary of these AEDs, adding additional data on pharmacokinetics, adverse effects, and drug-drug interactions. These tables will also be made available as PDF documents on the website of the American Epilepsy Society, and will be updated periodically. The hope is that providers will find these to be beneficial in the advanced care of persons with epilepsy.