Primidone - Indications - Epilepsy

Epilepsy

Licensed for generalized tonic-clonic and complex partial seizures in the United Kingdom. In the United States, primidone is approved for adjunctive (in combination with other drugs) and monotherapy (by itself) use in generalized tonic-clonic seizures, simple partial seizures, and complex partimple partial seizures, and myoclonic seizures. In juvenile myoclonic epilepsy (JME), it is a second-line therapy, reserved for when the valproates and/or lamotrigine do not work and when other second-line therapies—acetazolamid work either.

Open-label case series have suggested that primidone is effective in the treatment of epilepsy. Primidone has been compared to carbamazepine, phenytoin, phenobarbital, mephobarbital, ethotoin, metharbital, and mephenytoin. Compared to carbamazepine, primidone has been found to be equally effective, less effective at controlling partial seizures but just as effective at controlling generalized tonic-clonics, less likely to cause side effects but more likely to cause side effects requiring withdrawal of the drug, half as likely to reduce seizures in patients being considered for surgery by at least 80%, more likely to cause depression, significantly more likely cause intolerable side effects, more likely to cause impotence and decreased libido, and cause more adverse effects on motor performance and attention/concentration tests. In adult comparison trials, primidone had a higher incidence of intolerable side effects than phenytoin, a higher incidence of decreased libido and impotence, similar control of tonic-clonic seizures, more likely to cause nausea, vomiting, dizziness, and sedation; twice as likely to be effective in controlling seizures in epilepsy surgery candidates, more acute effects such as nausea, vomiting, dizziness, and sedation, and to be just as effective.

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