Pharmacokinetics of drugs used for petit mal 'absence' epilepsy

Ethosuximide, clonazepam and valproic acid differ in their chemical structures and properties. They appear to be well absorbed when given by mouth, but their patterns of distribution within the body are different. If these 3 drugs have a common mode of action, the virtual restriction of valproate to extracellular water suggests that this common mode of action is likely to involve receptors on the neuronal cell surface. Even if there is no common mode of action the apparent volume of distribution of valproate is consistent with its known effects on enzymes of the GABA shunt, and in particular on those shunt enzymes which are involved in the transmitter GABA pool in the region of synapses. The 3 drugs also show differences in elimination rate, which make it desirable to give valproate 3 times a day and clonazepam twice a day, whereas ethosuximide could reasonably be given once daily without undesirably wide fluctuations in plasma drug level over the dosage interval. Further studies of the pharmacokinetics of ethosuximide, clonazepam and valproate are still needed, but sufficient data are already available to provide some basis for rational use of these drugs in treating petit mal 'absence' epilepsy.