Anticonvulsants: choices and costs. Based on a presentation by Nina Graves, PharmD, FCCP

Epilepsy is not a single disease but a constellation of different syndromes and different seizure types. Consequently, establishing a diagnosis on which to base therapy can be complicated. The most commonly used antiepileptic drugs (AEDs) fall into two broad categories: the older AEDs introduced between 1912 and 1973 and the newer AEDs introduced since 1993. The older AEDs have many off-label uses, whereas the newer AEDs, with the exception of gabapentin and lamotrigine, are used exclusively for the treatment of epilepsy. All AEDs are associated to varying degrees with adverse effects on the central nervous system, gastrointestinal tract, blood, liver, and skin. The older AEDs are less expensive than the newer AEDs, but because the newer agents are available in both titration and maintenance-dose strengths, cost savings are possible. Use of the high-strength dose of a newer AED represents a huge cost saving per day compared with using the low-strength dose. Further savings can be realized in the managed care arena if pharmacists are involved in getting patients onto high-strength tablets as quickly as possible.