ANTICONVULSANTS - CHOICES AND COSTS

Epilepsy is not a single disease but a constellation of different synd romes and different seizure types. Consequently, establishing a diagno sis on which to base therapy can be complicated. The most commonly use d antiepileptic drugs (AEDs) fall into two bread categories: the elder AEDs introduced between 1912 and 1973 and the newer AEDs introduced s ince 1993. The older AEDs have many off-label uses, whereas the newer AEDs, with the exception of gabapentin and lamotrigine, are used exclu sively for the treatment of epilepsy. All AEDs are associated to varyi ng degrees with adverse effects on the central nervous system, gastroi ntestinal tract, blood, liver, and skin. The older AEDs are less expen sive than the newer AEDs, but because the newer agents are available i n both titration and maintenance-dose strengths, cost savings are poss ible. Use of the high-strength dose of a newer AED represents a huge c ost saving per day compared with using the low-strength dose. Further savings can be realized in the managed care arena if pharmacists are i nvolved in getting patients onto high-strength tablets as quickly as p ossible.