PARENTERAL ANTIEPILEPTIC ANTICONVULSANT DRUGS

A large number of drugs can be given parenterally for the control of a cute seizures, although many of these compounds are associated with se rious adverse effects. Phenobarbital, the first antiepileptic drug (AE D), has long been available in an injectable formulation. The sodium s alt of phenobarbital is water soluble, and its parenteral formulation can be given for maintenance therapy or treatment of acute seizures. T he introduction of phenytoin in 1938, and its subsequent parenteral fo rmulation, represented a significant advance in AED therapy owing to i ts relative absence of sedation. However, the risk of adverse effects necessitates that the rate of phenytoin administration usually be limi ted to 50 mg/min. IV valproate has been used extensively but has not b een approved for use in the United States, and its value for treating acute seizures is unclear. Several benzodiazepines have been used as a djunctive drugs for the treatment of epilepsy; given parenterally, the y provide rapid CNS entry and prompt control of seizures, but their ef fect is short lived. Agents that have more hypnotic anesthetic propert ies are often used when the benzodiazepines or phenytoin alone or in c ombination fails.