Tiagabine
GABITRIL
What it isGAT-1 GABA-reuptake inhibitor; adjunctive treatment of focal seizures.
Why this oneNo other marketed antiepileptic uses selective GABA-transporter blockade.
What limits it⚑ It can provoke seizures or nonconvulsive status in people without epilepsy; dizziness, tremor, and CYP3A4 interactions also matter.
FDA-approved for
- seizures (1997)
FDA label
Read the full label on DailyMed ↗
| FDA dosing | Population | Start | Target | Max |
|---|---|---|---|---|
| Partial seizures, adjunctive (enzyme-inducing AEDs) | Adults | 4 mg QD | 32-56 mg/day divided BID-QID | 56 mg/day |
| Partial seizures, adjunctive (enzyme-inducing AEDs) | Adolescents 12-18 yr | 4 mg QD | divided BID-QID | 32 mg/day |
Titration Increase by 4 mg at start of week 2, then by 4-8 mg at weekly intervals
Renal Undefined
Hepatic Undefined
Instructions
- Take with food
- Do not use a loading dose
- Do not make up a missed dose by increasing the next dose
- Non-induced patients (on non-enzyme-inducing AEDs) require lower doses and slower titration
- Adjust dose when enzyme-inducing status changes
Cautions
- Seizures and status epilepticus in patients without epilepsy (off-label use)
- Suicidal behavior and ideation with AEDs
- CNS depression: dizziness, somnolence, impaired concentration
- Cognitive/neuropsychiatric symptoms
- Sudden unexplained death in epilepsy (SUDEP)
Adverse reactions
- Dizziness/lightheadedness
- Asthenia/lack of energy, somnolence
- Nausea
- Nervousness/irritability, tremor
- Abdominal pain, difficulty with concentration/attention
Pregnancy Animal studies show teratogenicity; use in pregnancy only if clearly needed; encourage NAAED Pregnancy Registry enrollment
Lactation Undefined
NO BOXED WARNINGS
Principal riskIt provokes seizures in people without epilepsy
Cost, est. cash$10–$300/month
Generic entry2011
Classes and tags
Clinical profile
Legacy pregnancy categoryC
Defining liabilitySedation, dizziness and agent-specific rash, behavioral, hepatic, hematologic or teratogenic toxicity.
Mechanism of action: Tiagabine ballicule
Open Tiagabine in the interactive console ↗
Memory aids: mascots and interaction avatars
