Vigabatrin
SABRIL
What it isIrreversible GABA transaminase inhibitor; infantile spasms and refractory focal seizures.
Why this oneIt is uniquely effective in the infantile spasms of tuberous sclerosis.
What limits it⚑ Permanent bilateral visual field loss in a third of patients, under a REMS with periodic perimetry. The benefit must be weighed against certain vision monitoring.
FDA-approved for
- infantile spasms (2009)
- refractory complex partial seizures (2009)
FDA label
Read the full label on DailyMed ↗
| FDA dosing | Population | Start | Target | Max |
|---|---|---|---|---|
| Refractory complex partial seizures | adult (≥17y) | 1000 mg/day (500 mg BID) | 3000 mg/day (1500 mg BID) | 3000 mg/day |
| Refractory complex partial seizures | pediatric 2-16y | weight-based, divided BID | weight-based (adult dosing if >60 kg) | weight-based |
| Infantile spasms | pediatric | 50 mg/kg/day (25 mg/kg BID) | titrate per response | 150 mg/kg/day (75 mg/kg BID) |
Titration CPS adults: increase weekly in 500 mg/day increments; infantile spasms: increase every 3 days
Renal Reduce dose: mild (CLcr >50-80) −25%, moderate (>30-50) −50%, severe (>10-30) −75%
Hepatic Undefined
Instructions
- Give orally with or without food
- Taper gradually on discontinuation to avoid withdrawal seizures
Cautions
- Permanent vision loss
- MRI abnormalities / intramyelinic edema in infants
- Suicidal behavior and ideation
- Withdrawal seizures (taper)
- Anemia
- Somnolence and fatigue
- Peripheral neuropathy
- Weight gain
- Edema
Adverse reactions
- Vision loss
- Somnolence
- Fatigue
- Weight gain
- Edema
- Peripheral neuropathy
- Anemia
Pregnancy May cause fetal harm (animal data); enroll in NAAED pregnancy registry
Lactation Vigabatrin is excreted in human milk
⚠ BOXED WARNING
- Permanent vision loss
Cost, est. cash$10–$500/month
Generic entry2017
Classes and tags
Clinical profile
Legacy pregnancy categoryC
Defining liabilityPermanent concentric visual-field loss requires structured ophthalmic monitoring.
Mechanism of action: Vigabatrin ballicule
Open Vigabatrin in the interactive console ↗
Memory aids: mascots and interaction avatars
Viga → “Vision Gone” - concentric peripheral visual field deficits
GABA transaminase inhibitor with GABA in its name
¡Viva GABA!
