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I Like to participate.
Therapeutic Window (TW) for Felbamate. Gamal Hussein, Pharm.D. and Allan
Troupin, M.D. Northeast Louisana University, College of Pharmacy and
LSU-Medical School, Dept. of Neurology.
This is part pf a large study evaluating dose-response curve for felbamate in
monotherapy and polypharmacy for the treatment of refractory seizure. TW was
found to be 50-110mg/l. Data submitted for publication at the Neurology.
Let me know if you are interested, so I can prepare to present it at the
ACCP.
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Felbamate is now used only in rare cases. I imagine there very little
interest in it at present.. However, a poster and an abstract would be
appropriate. Dr.Anaizi
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Felbamate article "Theraputic Windows" was accepted to the Epilepsy. Many
Children still on felbamate. I just discovered a new drug interaction where
Gabapentin decreases felbamat clearance by >50%. This was accepted at the
"Neurology". Anyway, you'r right with regard to the little interest on the
subject. I am just trying to HELP.
I have an excellent Seizure Clinic here in Charity hospital, A pharmacist and
a physician see the patient&family in the same time, this may serve as role
model for other individuals interested in providing progressive
pharmaceutical service with a focus on antiepilepsy drugs/pharmacokinetics
and outpatient clinics. I can discuss our clinic, its evolution and impact on
patient outcome.
Other potential project is Rasmusen Encephalitis. It is a rare disorder of
uncontroled seizure, A case report and literature review may be helpful, if
you decide so. Most of these patients are in the pediatric age group.
phenobarbital coma is the first step adter the failure of available
anticonvulsant which is commenly encountered. The treatment is still unknown,
with plasmaphoresis, IVIG and immunosupressants as options. this subject may
generate a good debate for those intereseted in seizure control. let me know
if I can be of any help. (You may reach me faster at GHussein.-a-.AOL.COM).
thanks
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Dear Hussain,
I find your observation regarding felbamate <-> gabapentin interaction very
interesting. I would be very interested in any observations you might have
regarding the nature of the interaction. My understanding of the
pharmacokinetics of these two antiepileptic drugs is that while felbamate is
metabolized by the liver, gabapentin is not. Indeed, gabapentin is entirely
dependent on glomerular filtration for its elimination; its clearance
appears to be directly proportional to the GFR. What I find curious about
gabapentin is that it does not appear to be reabsorbed to any significant
extent by the renal (proximal) tubules, although it is known to be absorbed
from the small intestine by a Na-dependent co-transport system, which is
normally responsible for the absorption of aminoacids. A similar aminoacids
transport system is known to exist in the proximal tubule.
Thanks\
Anaizi
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NOTES ON GABAPENTIN-FELBAMATE INTERACTION:
Felbamate's elimination by the kidney is known, but not appreciated, since it
is about 50%. My best speculation is that gabapentin competes at the
molecular level for renal excretion of felbamate rather than
competition/induction of hepatic metabolism. We have not yet evaluated other
data that will define the potential effect of felbamate on the excretion of
gabapentin, a possible correlate of the data discovered by my group. These
data were accepted for publication at "Neurology".
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