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Nav spike-suppressor blocker

• Use-dependent block of fast transient sodium currents
• ➔ more firing produces more block — the antiepileptic mechanism

Drugs with this mechanism (22)

• Carbamazepine — Anticonvulsant/mood stabilizer and potent autoinducer; HLA-B*1502 rash risk.
• Carbamazepine ER capsules — Bead-filled extended-release carbamazepine capsule that can be opened and sprinkled.
• Carbamazepine ER (Equetro) — Carbamazepine ER capsule - the only carbamazepine approved for acute bipolar mania.
• Eslicarbazepine — Once-daily sodium-channel anticonvulsant related to oxcarbazepine.
• Lamotrigine XR — Extended-release lamotrigine for seizures; slow titration reduces serious-rash risk.
• Lamotrigine — Well-tolerated mood stabilizer for bipolar depression; slow titration for rash risk.
• Oxcarbazepine — Carbamazepine analog with less enzyme induction; hyponatremia risk.
• Oxcarbazepine XR — Extended-release oxcarbazepine for focal seizures; hyponatremia and enzyme induction complicate use.
• Phenobarbital — Oldest barbiturate anticonvulsant; sedating, enzyme-inducing, largely historical.
• Phenytoin — Classic sodium-channel anticonvulsant with nonlinear kinetics and many interactions.
• Topiramate ER (sprinkle) — Sprinkle-capsule extended-release topiramate for epilepsy and migraine prevention.
• Rufinamide — Sodium-channel anticonvulsant for Lennox-Gastaut drop attacks; uniquely shortens QT.
• Safinamide — Reversible MAO-B inhibitor added to levodopa for Parkinson wearing-off; can worsen dyskinesia and has important serotonergic interactions.
• Carbamazepine XR — Extended-release carbamazepine for seizures and trigeminal neuralgia; potent enzyme inducer.
• Topiramate — Weight-reducing anticonvulsant for seizures and migraine; cognitive slowing limits it.
• Topiramate ER — Extended-release topiramate for seizures; cognitive slowing, kidney stones and fetal oral clefts.
• Valproic acid — Broad-spectrum anticonvulsant and mood stabilizer; highly teratogenic and metabolically burdensome.
• Divalproex DR — Delayed-release broad-spectrum antiseizure drug and mood stabilizer; highly teratogenic.
• Divalproex ER — Extended-release broad-spectrum antiseizure drug and mood stabilizer; highly teratogenic.
• Valproate sodium IV — Intravenous valproate for seizures when oral therapy is unavailable; broad-spectrum but highly teratogenic.
• Divalproex sprinkle — Valproate sprinkle capsule for seizures; useful when intact tablets cannot be swallowed.
• Zonisamide — Broad anticonvulsant associated with weight loss.

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