tiagabine


Also found in: Dictionary, Acronyms, Wikipedia.

tiagabine

 [ti-ag´ah-bēn]
an anticonvulsant agent used orally as the hydrochloride salt as an adjunct in treatment of partial seizures.

tiagabine

(tye-a-ga-been) ,

Gabitril

(trade name)

Classification

Therapeutic: anticonvulsants
Pregnancy Category: C

Indications

Adjunctive treatment of partial seizures.

Action

Enhances the activity of gamma-aminobutyric acid, an inhibitory neurotransmitter.

Therapeutic effects

Decreased frequency of seizures.

Pharmacokinetics

Absorption: 90% absorbed following oral administration.
Distribution: Unknown.
Protein Binding: 96%.
Metabolism and Excretion: Mostly metabolized by the liver; 2% excreted unchanged in urine.
Half-life: Without enzyme-inducing antiepileptic drugs—7–9 hr; with enzyme-inducing antiepileptic drugs—4–7 hr.

Time/action profile (blood levels)

ROUTEONSETPEAKDURATION
POunknown45 minunknown

Contraindications/Precautions

Contraindicated in: Hypersensitivity.
Use Cautiously in: All patients (may ↑ risk of suicidal thoughts/behaviors);Hepatic impairment (↓ dose/increased interval may be necessary);Patients receiving concurrent non–enzyme-inducing antiepileptic drug therapy such as valproates (may require lower doses and/or slower titration);Using tiagabine for off-label uses or other conditions leading to ↑ levels (may ↑ risk of new onset seizures); Obstetric / Lactation / Pediatric: Pregnancy, lactation, or children <12 yr (safety not established).

Adverse Reactions/Side Effects

Central nervous system

  • suicidal thoughts (life-threatening)
  • dizziness (most frequent)
  • drowsiness (most frequent)
  • nervousness (most frequent)
  • weakness (most frequent)
  • cognitive impairment
  • confusion
  • difficulty concentrating
  • hallucinations
  • headache
  • mental depression
  • personality disorder

Ear, Eye, Nose, Throat

  • abnormal vision
  • ear pain
  • tinnitus

Respiratory

  • dyspnea
  • epistaxis

Cardiovascular

  • chest pain
  • edema
  • hypertension
  • palpitations
  • syncope
  • tachycardia

Gastrointestinal

  • abdominal pain
  • gingivitis
  • nausea
  • stomatitis

Genitourinary

  • dysmenorrhea
  • dysuria
  • metrorrhagia
  • urinary incontinence

Dermatologic

  • alopecia
  • dry skin
  • rash
  • sweating

Metabolic

  • weight gain
  • weight loss

Musculoskeletal

  • arthralgia
  • neck pain

Neurologic

  • ataxia
  • tremors

Miscellaneous

  • allergic reactions
  • chills
  • lymphadenopathy

Interactions

Drug-Drug interaction

Carbamazepine, phenytoin, primidone, and phenobarbital induce metabolism and ↓ blood levels; although concurrent therapy is usually necessary, adjustments may be required when altering regimens.

Route/Dosage

Oral (Adults >18 yr) 4 mg once daily initially for 1 wk; may ↑ by 4–8 mg/day at weekly intervals, up to 56 mg/day in 2–4 divided doses.
Oral (Children 12–18 yr) 4 mg once daily initially for 1 wk; may ↑ by 4 mg/day after 1 wk, then may ↑ by 4–8 mg/day at weekly intervals, up to 32 mg/day in 2–4 divided doses.

Availability (generic available)

Tablets: 2 mg, 4 mg, 12 mg, 16 mg

Nursing implications

Nursing assessment

  • Assess location, duration, and characteristics of seizure activity.
  • Assess mental status. May cause impaired concentration, speech or language problems, confusion, fatigue, and drowsiness. Symptoms may decrease with dose reduction or discontinuation.
  • Monitor closely for notable changes in behavior that could indicate the emergence or worsening of suicidal thoughts or behavior or depression.
  • Therapeutic serum levels have not been determined. However, levels may be monitored prior to and following changes in the therapeutic regimen.

Potential Nursing Diagnoses

Risk for injury (Side Effects)

Implementation

  • Do not confuse tiagabine with tizanidine.
  • Oral: Administer with food.
    • Discontinue tiagabine gradually. Abrupt discontinuation may cause increase in seizure frequency.

Patient/Family Teaching

  • Instruct patient to take medication as directed. Take missed doses as soon as possible unless almost time for next dose. Do not double doses. Do not discontinue abruptly; may cause increase in frequency of seizures. Instruct patient to read the Medication Guide before starting and with each Rx refill, changes may occur.
  • Advise patient to notify health care professional immediately if frequency of seizures increases.
  • May cause dizziness. Caution patient to avoid driving or activities requiring alertness until response to medication is known. Do not resume driving until physician gives clearance based on control of seizure disorder.
  • Advise patient and family to notify health care professional if thoughts about suicide or dying, attempts to commit suicide; new or worse depression; new or worse anxiety; feeling very agitated or restless; panic attacks; trouble sleeping; new or worse irritability; acting aggressive; being angry or violent; acting on dangerous impulses; an extreme increase in activity and talking, other unusual changes in behavior or mood occur.
  • Advise patient to notify health care professional of all Rx or OTC medications, vitamins, or herbal products being taken and to consult with health care professional before taking other medications.
  • Instruct patient to notify health care professional of medication regimen prior to treatment or surgery.
  • Advise patient to carry identification describing disease process and medication regimen at all times.
  • Advise patient to notify health care professional if pregnancy is planned or suspected or if breast feeding.

Evaluation/Desired Outcomes

  • Decrease in the frequency or cessation of seizures.

tiagabine

/ti·ag·a·bine/ (ti-ag´ah-bēn) an anticonvulsant agent used as the hydrochloride salt as an adjunct in the treatment of partial seizures.

tiagabine

an anticonvulsant.
indication It is used as an adjunct treatment for partial seizures.
contraindication Known hypersensitivity to this prohibits its use.
adverse effects Adverse effects include dizziness, anxiety, somnolence, ataxia, amnesia, unsteady gait, depression, vasodilation, nausea, vomiting, diarrhea, pruritus, rash, pharyngitis, and coughing. Abrupt discontinuation of this drug can cause sudden onset of seizures. Simultaneous use of the herb ginkgo may decrease anticonvulsant effectiveness.
References in periodicals archive ?
Tiagabine increases cocaine-free urines in cocaine-dependent methadone-treated patients: results of a randomized pilot study.
An open pilot study of tiagabine in alcohol dependence: tolerability and clinical effects.
Zonisamide has shown great benefit for individuals in need of mood stabilization, and tiagabine has demonstrated beneficial outcomes for the use with major depression (Thompson et al.
Research also suggests that adding desipramine or high-dose tiagabine to an opioid agonist maintenance regimen can be helpful.
Comparison of Antiepileptic Drugs Oral Affected Drug absorption(1) Dosaging(2) Kinetics(3) Phenytoin 2 3,2 1 Carbamazepine 3 3,2 1 Valproic Acid 3 3,2 1 Ethosuximide 3 2 3 Primidone 3 2 3 Phenobarbital 2 2 3 Vigabatrin 3 3 3 Gabapentin 3 2 2 Topiramate 2 3 3 Lamotrigine 3 3 3 Tiagabine 2 2 3 Felbamate 3 3 3 Affects by other Other Drug AEDs(4) AEDs(5) Metabolism(6) Phenytoin 1 1 1 Carbamazepine 1 1 1 Valproic Acid 1 1 1 Ethosuximide 1 1 1 Primidone 1 1 2 Phenobarbital 1 1 1 Vigabatrin 3 2 3 Gabapentin 3 3 3 Topiramate 3 3 3 Lamotrigine 1 1 1 Tiagabine 2 2 1 Felbamate 2 1 2 Protein Drug Binding(7) Phenytoin 1 Carbamazepine 1 Valproic Acid 1 Ethosuximide 3 Primidone 2 Phenobarbital 2 Vigabatrin 3 Gabapentin 3 Topiramate 3 Lamotrigine 2 Tiagabine 1 Felbamate 2
Twenty-eight percent of cases of depression that are comorbid with epilepsy have an iatrogenic basis, and can be induced by barbiturates, topiramate, vigabatrin, tiagabine, and levetiracetam.
Tiagabine for posttraumatic stress disorder: Effects of open-label and double-blind discontinuation treatment.
The AEDs in this category are: levetiracetam, lacosamide, tiagabine, gabapentin, pregabalin, ethosuximide, vigabatrin.
A placebo-controlled screening trial of tiagabine, sertraline, and donepezil as cocaine dependence treatments.
Tiagabine and vigabatrin are examples of the first category, and lamotrigine an example of the second.
The drugs that were included in this analysis were carbamazepine, gabapentin, lamotrigine, levetiracetam, oxcarbazepine, pregabalin, tiagabine, topiramate, valproate, and zonisamide.
The link between anticonvulsant agents and suicidal acts or violent death--first revealed in a Food and Drug Administration meta-analysis in 2008--appears to have been confirmed for four of the drugs: gabapentin, lamotrigine, oxcarbazepine, and tiagabine, according to a new report.