Felbamate

INTRODUCTION

Indications

Used alone (monotherapy) or as adjunctive therapy with other anticonvulsants in treatment of partial seizures. Adjunctive therapy with other anticonvulsants in children (2–14 yr) who have partial or generalized seizures associated with Lennox-Gastaut syndrome. Because of deaths due to aplastic anemia and acute liver failure, felbamate should never be used as a first-line therapy, but should be reserved for patients whose epilepsy is so severe that these risks are considered acceptable given the drug's benefit.

Action

Probably acts by raising seizure threshold and preventing seizure spread. Therapeutic Effects: Decreased incidence of seizures.

Adverse Reactions/Side Effects

CNS: dizziness, drowsiness, fatigue, headache, insomnia, anxiety, psychologic disturbances. EENT: diplopia, pharyngitis, rhinitis, sinusitis. GI: ACUTE LIVER FAILURE, anorexia, constipation, dyspepsia, nausea, vomiting, altered taste, diarrhea, hiccups. Derm: acne, rashes. Hemat: APLASTIC ANEMIA. MS: myalgia. Neuro: ataxia. Misc: flu-like syndrome, weight loss.

PHYSICAL THERAPY IMPLICATIONS

Examination and Evaluation

• Be alert for signs of liver failure, including severe nausea and vomiting, anorexia, abdominal pain, yellow skin or eyes, fever, sore throat, malaise, weakness, facial edema, lethargy, and unusual bleeding or bruising. Report these signs to the physician immediately.

• Monitor signs of aplastic anemia, including unusual fatigue, weakness, dizziness, and pallor. Report these signs to the physician immediately. Periodic blood tests may be needed to monitor WBC and RBC counts.

• Document the number, duration, and severity of seizures to help determine if this drug is effective in reducing seizure activity.

• Assess dizziness or ataxia that might affect gait, balance, and other functional activities (See Appendix C). Report balance problems and functional limitations to the physician, and caution the patient and family/caregivers to guard against falls and trauma.

• Monitor daytime drowsiness, anxiety, or other psychologic disturbances. Repeated or excessive symptoms may require change in dose or medication.

• Assess any muscle pain to rule out musculoskeletal pathology; that is, try to determine if pain is drug induced rather than caused by anatomic or biomechanical problems.

• Periodically assess body weight and other anthropometric measures (body mass index, body composition). Report a rapid or unexplained weight loss or decreased body fat.

Interventions

• Guard against falls and trauma (hip fractures, head injury, and so forth), especially if dizziness or ataxia affect gait and balance. Implement fall-prevention strategies, especially if balance is impaired (See Appendix E).

Patient/Client-Related Instruction

• Advise patient to avoid alcohol and other CNS depressants because of the increased risk of sedation and adverse effects.

• Advise patients on prolonged antiseizure therapy not to discontinue medication without consulting their physician. Abrupt withdrawal may cause increased seizures.

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