tiagabine

Contraindicated in:

Hypersensitivity.

Use Cautiously in:

All patients (may ↑ risk of suicidal thoughts/behaviors);
Hepatic impairment (↓ dose/increased interval may be necessary);
Patients receiving concurrent non–enzyme-inducing antiepileptic drug therapy such as valproates (may require lower doses and/or slower titration);
Using tiagabine for off-label uses or other conditions leading to ↑ levels (may ↑ risk of new onset seizures);
OB: Pregnancy, lactation, or children <12 yr (safety not established).

Adv. Reactions/Side Effects ⬆ ⬇

CV: chest pain, edema, hypertension, palpitations, syncope, tachycardia

Derm: alopecia, dry skin, rash, sweating

EENT: abnormal vision, ear pain, tinnitus

GI: abdominal pain, gingivitis, nausea, stomatitis

GU: dysmenorrhea, dysuria, metrorrhagia, urinary incontinence

Metab: weight gain, weight loss

MS: arthralgia, neck pain

Neuro: dizziness, drowsiness, nervousness, weakness, ataxia, cognitive impairment, confusion, difficulty concentrating, hallucinations, headache, mental depression, personality disorder, SUICIDAL THOUGHTS, tremors

Resp: dyspnea, epistaxis

Misc: allergic reactions, chills, lymphadenopathy

Interactions ⬆ ⬇

Drug-drug:

Carbamazepine, phenytoin, primidone, and phenobarbital↓ levels.

Drug-Natural Products:

St. John's wort may ↓ levels.

Availability ⬆ ⬇

(Generic available)

Tablets: 2 mg; 4 mg; 12 mg; 16 mg

Route/Dosage ⬆ ⬇

PO (Adults >18 yr): 4 mg once daily initially for 1 wk; may ↑ by 4–8 mg/day at weekly intervals, up to 56 mg/day in 2–4 divided doses.
PO (Children 12–18 yr): 4 mg once daily initially for 1 wk; may ↑ by 4 mg/day after 1 wk, then may ↑ by 4–8 mg/day at weekly intervals, up to 32 mg/day in 2–4 divided doses.

US Brand Names ⬆ ⬇

Action ⬆ ⬇

Enhances the activity of gamma-aminobutyric acid, an inhibitory neurotransmitter.

Therapeutic effects:

Decreased frequency of seizures.

Classifications ⬆ ⬇

Therapeutic Classification: anticonvulsants

Pharmacokinetics ⬆ ⬇

Absorption: 90% absorbed following oral administration.

Distribution: Unknown.

Protein Binding: 96%.

Metabolism/Excretion: Mostly metabolized by the liver; 2% excreted unchanged in urine.

Half-Life: Without enzyme-inducing antiepileptic drugs: 7–9 hr; with enzyme-inducing antiepileptic drugs: 4–7 hr.

Time/Action Profile ⬆ ⬇

(blood levels)

ROUTE	ONSET	PEAK	DURATION
PO	unknown	45 min	unknown

Patient/Family Teaching ⬆ ⬇

Instruct patient to take medication as directed. Take missed doses as soon as possible unless almost time for next dose. Do not double doses. Do not discontinue abruptly; may cause increase in frequency of seizures. Instruct patient to read the Medication Guide before starting and with each Rx refill, changes may occur.
Advise patient to notify health care professional immediately if frequency of seizures increases.
May cause dizziness. Caution patient to avoid driving or activities requiring alertness until response to medication is known. Do not resume driving until physician gives clearance based on control of seizure disorder.
Advise patient and family to notify health care professional if thoughts about suicide or dying, attempts to commit suicide; new or worse depression; new or worse anxiety; feeling very agitated or restless; panic attacks; trouble sleeping; new or worse irritability; acting aggressive; being angry or violent; acting on dangerous impulses; an extreme increase in activity and talking, other unusual changes in behavior or mood occur.
Advise patient to notify health care professional of all Rx or OTC medications, vitamins, or herbal products being taken and to consult with health care professional before taking other medications, especially St. John's wort.
Instruct patient to notify health care professional of medication regimen prior to treatment or surgery.
Advise patient to carry identification describing disease process and medication regimen at all times.
Advise patient to notify health care professional if pregnancy is planned or suspected or if breast feeding.

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Indications ⬇

Contraind./Precautions ⬆ ⬇