Partial seizures in adults.
Raises the threshold for seizures and reduces duration of seizures, probably by action on sodium and calcium channels. Therapeutic Effects: ↓ frequency of partial seizures.
Adverse Reactions/Side Effects
CNS: drowsiness, fatigue, agitation/irritability, depression, dizziness, psychomotor slowing, psychosis, weakness. EENT: amblyopia, tinnitus. Resp: cough, pharyngitis. GI: anorexia, nausea, vomiting. GU: kidney stones. Derm: oligohidrosis (↑ in children), rash. Metab: hyperthermia (↑ in children). Neuro: abnormal gait, hyperesthesia, incoordination, tremor. Misc: ALLERGIC REACTIONS, INCLUDING STEVENS-JOHNSON SYNDROME.
PHYSICAL THERAPY IMPLICATIONS
Examination and Evaluation
Monitor allergic responses, including skin reactions such as rash, itching/burning skin, hives, exfoliation, and dermatitis. Notify physician immediately about because certain skin reactions may indicate serious hypersensitivity reactions (Stevens-Johnson syndrome).
Document the number, duration, and severity of seizures to help determine if this drug is effective in reducing seizure activity.
Assess dizziness 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, agitation, irritability, depression, psychosis, or other psychiatric disturbances. Repeated or excessive symptoms may require change in dose or medication.
Assess any gait disturbances, incoordination, tremor, or increased sensation to pain/touch to rule out neuromuscular pathology; that is, try to determine if neurologic signs are drug induced rather than caused by neurologic pathology.
Monitor and report signs of kidney stones, including severe pain in the side and back, pain on urination, bloody urine, and a persistent urge to urinate.
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).
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.
Advise patient about the risk of daytime drowsiness and decreased attention and mental focus. Use care if driving or in other activities that require strong concentration and fast responses.
Instruct patient and family/caregivers to report other troublesome side effects such as severe or prolonged cough, pharyngeal irritation, vision problems, ringing/buzzing in the ears (tinnitus), skin reactions (rash, inadequate sweating), or GI problems (nausea, vomiting, loss of appetite).
Absorption: Well absorbed following oral administration.
Distribution: Binds extensively to red blood cells.