Wikipedia preview

出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2015/10/28 16:08:58」(JST)

wiki en

Felbamate (marketed under the brand name Felbatol by MedPointe) is an anticonvulsant^[1] used in the treatment of epilepsy. It is used to treat partial seizures^[2]^[3] (with and without generalization) in adults and partial and generalized seizures associated with Lennox-Gastaut syndrome in children. However, an increased risk of potentially fatal aplastic anemia and/or liver failure limit the drug's usage to severe refractory epilepsy.

Mechanism of action

Felbamate has been proposed to a unique dual mechanism of action as a positive modulator of GABA_A receptors^[4]^[5] and as a blocker of NMDA receptors, particularly isoforms containing the NR2B subunit. ^[6] ^[7] ^[8] ^[9] Although it is clear that felbamate does cause pharmacological inhibition of NMDA receptors, the relevance of NMDA receptor blockade as a strategy for the treatment of human epilepsy has been questioned. ^[10] Therefore, the importance of the effects of felbamate on NMDA receptors to its therapeutic action in epilepsy is uncertain.

Approval history

United States

August 1993. Felbamate was approved for partial seizures with and without secondary generalization in adults and for Lennox-Gastaut Syndrome, a serious form of childhood epilepsy. Over the following year 150,000 people were started on felbamate therapy and a third of these became established.
August 1, 1994. It was urgently withdrawn after 10 cases of aplastic anemia.^[11] A "Dear Doctor" letter was sent to 240,000 physicians.
September 27, 1994. Felbamate had a limited redemption in another "Dear Doctor" letter sent to 260,000 physicians. It was recommended that the drug remain available only for patients with severe epilepsy for whom the benefits outweigh the risks, and that changes be made to the product's labelling to reflect the newly recognized risk.^[12] This redemption came with an additional warning since there had been 10 cases acute liver failure (4 of which were fatal). At this point, 10,000 to 12,000 people remained on the drug.

United Kingdom

The drug is only available on a limited named-patient basis.

Indications and usage

Adults: Monotherapy or adjunctive therapy in the treatment of partial seizures, with and without generalization.
Children: Adjunctive therapy in the treatment of partial and generalized seizures associated with Lennox-Gastaut syndrome.

Dosing

Felbamate is available in tablets (400 mg and 600 mg) and as a peach-coloured oral suspension (600 mg/5 mL).

Adults (> 14 years): begin with 1,200 mg daily given every 6 to 8 hours
Children (2 > 14 years): 15 to 45 mg per kg per day given every 6 to 8 hours

Side effects

Adverse reactions include decreased appetite, vomiting, insomnia, nausea, dizziness, somnolence, and headache. Many patients report increased alertness with the drug. Two rare but very serious effects include aplastic anemia and hepatic (liver) failure. The risk of aplastic anemia is between 1:3,600 and 1:5,000, of which 30% of cases are fatal. The risk of hepatic failure is between 1:24,000 to 1:34,000, of which 40% of cases are fatal.

Drug interactions

Felbamate is an inhibitor of CYP2C19, an isoenzyme of the cytochrome P450 system involved in the metabolism of several commonly used medications.^[13] Felbamate interacts with several other AEDs, including phenytoin, valproate, and carbamazepine; dosage adjustments may be necessary to avoid adverse effects. Concomitant administration of felbamate and carbamazepine decreases blood levels of both drugs, while increasing the level of carbamazepine-10,11 epoxide, the active metabolite of carbamazepine.^[14]

References

^ Rho JM, Donevan SD, Rogawski MA (March 1997). "Barbiturate-like actions of the propanediol dicarbamates felbamate and meprobamate". J. Pharmacol. Exp. Ther. 280 (3): 1383–91. PMID 9067327.
^ Leppik IE, Dreifuss FE, Pledger GW; et al. (November 1991). "Felbamate for partial seizures: results of a controlled clinical trial". Neurology 41 (11): 1785–9. doi:10.1212/wnl.41.11.1785. PMID 1944909.
^ Devinsky O, Faught RE, Wilder BJ; et al. (March 1995). "Efficacy of felbamate monotherapy in patients undergoing presurgical evaluation of partial seizures". Epilepsy Res. 20 (3): 241–6. doi:10.1016/0920-1211(94)00084-A. PMID 7796796.
^ Rho JM, Donevan SD, Rogawski MA (Feb 1994). "Mechanism of action of the anticonvulsant felbamate: opposing effects on N-methyl-D-aspartate and gamma-aminobutyric acidA receptors". Annals of Neurology 35 (2): 229–234. doi:10.1002/ana.410350216. PMID 8109904.
^ Kume A, Greenfield LJ, Macdonald RL, Albin RL (June 1996). "Felbamate inhibits [3H]t-butylbicycloorthobenzoate (TBOB) binding and enhances Cl- current at the gamma-aminobutyric AcidA (GABAA) receptor". J. Pharmacol. Exp. Ther. 277 (3): 1784–92. PMID 8667250.
^ Subramaniam S, Rho JM, Penix L, Donevan SD, Fielding RP, Rogawski MA (May 1995). "Felbamate block of the N-methyl-D-aspartate receptor". The Journal of pharmacology and experimental therapeutics 273 (2): 878–886. PMID 7752093.
^ Kleckner NW, Glazewski JC, Chen CC, Moscrip TD (May 1999). "Subtype-selective antagonism of N-methyl-D-aspartate receptors by felbamate: insights into the mechanism of action". The Journal of pharmacology and experimental therapeutics 289 (2): 886–894. PMID 10215667.
^ Harty TP,Rogawski MA (March 2000). "Felbamate block of recombinant N-methyl-D-aspartate receptors: selectivity for the NR2B subunit". Epilepsy research 39 (1): 47–55. doi:10.1016/s0920-1211(99)00108-4. PMID 10690753.
^ Chang H-R, Chung-Chin Kuo C-C (March 2008). "Molecular determinants of the anticonvulsant felbamate binding site in the N-methyl-D-aspartate receptor". Journal of Medicinal Chemistry 51 (6): 1534–1545. doi:10.1021/jm0706618. PMID 18311896.
^ Rogawski MA (March 2011). "Revisiting AMPA receptors as an antiepileptic drug target". Epilepsy currents 11 (2): 56–63. doi:10.5698/1535-7511-11.2.56. PMC 3117497. PMID 21686307.
^ "www.fda.gov". Retrieved 2008-11-15. ^{[dead link]}
^ "www.fda.gov". Retrieved 2008-11-15. ^{[dead link]}
^ Flockhart DA (2007). "Drug Interactions: Cytochrome P450 Drug Interaction Table". Indiana University School of Medicine. Retrieved on December 25, 2008.
^ Curry WJ, Kulling DL (February 1998). "Newer antiepileptic drugs: gabapentin, lamotrigine, felbamate, topiramate and fosphenytoin". Am Fam Physician 57 (3): 513–20. PMID 9475899.

External links

Felbatol: Prescribing Information
RxList: Felbamate contains extensive information including the patient warning and a sample consent form.
Hard Choices with Felbamate
Newer Antiepileptic Drugs: Gabapentin, Lamotrigine, Felbamate, Topiramate and Fosphenytoin
MedPonte Pharmaceuticals

UpToDate Contents

全文を閲覧するには購読必要です。 To read the full text you will need to subscribe.

1. Antiepileptic drugs: Mechanism of action, pharmacology, and adverse effects
2. 成人におけるてんかんのマネージメントの概要 overview of the management of epilepsy in adults
3. 再生不良性貧血：病因、臨床症状および診断 aplastic anemia pathogenesis clinical manifestations and diagnosis
4. 成人におけるてんかんの初期治療 initial treatment of epilepsy in adults
5. 律動眼振 jerk nystagmus

English Journal

The cost effectiveness of newer epilepsy treatments: a review of the literature on partial-onset seizures.

Bolin K, Forsgren L.SourceDepartment of Economics, Lund University, Lund, Sweden.
PharmacoEconomics.Pharmacoeconomics.2012 Oct 1;30(10):903-23. doi: 10.2165/11597110-000000000-00000.
Background and Objective: Epilepsy is one of the most common neurological disorders, affecting more than 3 million people in Europe. This paper reviews the published evidence regarding the cost effectiveness of second-generation antiepileptic drugs (AEDs). Methods: A systematic literature search was
PMID 22924967

Insights into the Novel Hydrolytic Mechanism of a Diethyl 2-Phenyl-2-(2-arylacetoxy)methyl Malonate Ester-Based Microsomal Triglyceride Transfer Protein (MTP) Inhibitor.

Ryder T, Walker GS, Goosen TC, Ruggeri RB, Conn EL, Rocke BN, Lapham K, Steppan CM, Hepworth D, Kalgutkar AS.SourcePharmacokinetics, Dynamics, and Metabolism-New Chemical Entities, Pfizer Worldwide Research and Development , Groton, Connecticut 06340, United States.
Chemical research in toxicology.Chem Res Toxicol.2012 Sep 27. [Epub ahead of print]
Inhibition of intestinal and hepatic microsomal triglyceride transfer protein (MTP) is a potential strategy for the treatment of dyslipidemia and related metabolic disorders. Inhibition of hepatic MTP, however, results in elevated liver transaminases and increased hepatic fat deposition consistent w
PMID 22989032

Japanese Journal

Rapid and sensitive LC-MS/MS method for determination of felbamate in mouse plasma and tissues and human plasma

HANSEN Ryan J.,SAMBER Bradley J.,GUSTAFSON Daniel L.
Journal of chromatography. B, Analytical technologies in the biomedical and life sciences 878(32), 3432-3436, 2010-12-15
NAID 10028045217

Simultaneous HPLC-UV analysis of rufinamide, zonisamide, lamotrigine, oxcarbazepine monohydroxy derivative and felbamate in deproteinized plasma of patients with epilepsy

CONTIN Manuela,MOHAMED Susan,CANDELA Carmina,ALBANI Fiorenzo,RIVA Roberto,BARUZZI Agostino
Journal of chromatography. B, Analytical technologies in the biomedical and life sciences 878(3), 461-465, 2010-02-01
NAID 10028032569

Simultaneous liquid chromatographic determination of lamotrigine, oxcarbazepine monohydroxy derivative and felbamate in plasma of patients with epilepsy

CONTIN Manuela,BALBONI Monica,CALLEGATI Erica,CANDELA Carmina,ALBANI Fiorenzo,RIVA Roberto,BARUZZI Agostino
Journal of chromatography. B, Analytical technologies in the biomedical and life sciences 828(1), 113-117, 2005-12-15
NAID 10017192264

Related Pictures

★リンクテーブル★

リンク元

「フェルバメート」

Felbamate
Systematic (IUPAC) name
	(3-carbamoyloxy-2-phenylpropyl) carbamate
Clinical data
Trade names	Felbatol
AHFS/Drugs.com	monograph
MedlinePlus	a606011
Pregnancy; category	US: C (Risk not ruled out);
Legal status	US: ℞-only;
Routes of; administration	Oral
Pharmacokinetic data
Bioavailability	> 90%
Metabolism	Hepatic
Biological half-life	20-23 hours
Excretion	?
Identifiers
CAS Registry Number	25451-15-4
ATC code	N03AX10
PubChem	CID: 3331
IUPHAR/BPS	5473
DrugBank	DB00949
ChemSpider	3214
UNII	X72RBB02N8
KEGG	D00536
ChEBI	CHEBI:4995
ChEMBL	CHEMBL1094
Chemical data
Formula	C11H14N2O4
Molecular mass	238.24
	SMILES O=C(OCC(c1ccccc1)COC(=O)N)N ;
	InChI InChI=1S/C11H14N2O4/c12-10(14)16-6-9(7-17-11(13)15)8-4-2-1-3-5-8/h1-5,9H,6-7H2,(H2,12,14)(H2,13,15) ; Key:WKGXYQFOCVYPAC-UHFFFAOYSA-N ;
(what is this?) (verify)

　　[★]

英: felbamate
商: Felbatol

[pmid9067327-1] Rho JM, Donevan SD, Rogawski MA (March 1997). "Barbiturate-like actions of the propanediol dicarbamates felbamate and meprobamate". J. Pharmacol. Exp. Ther. 280 (3): 1383–91. PMID 9067327.

[pmid1944909-2] Leppik IE, Dreifuss FE, Pledger GW; et al. (November 1991). "Felbamate for partial seizures: results of a controlled clinical trial". Neurology 41 (11): 1785–9. doi:10.1212/wnl.41.11.1785. PMID 1944909.

[pmid7796796-3] Devinsky O, Faught RE, Wilder BJ; et al. (March 1995). "Efficacy of felbamate monotherapy in patients undergoing presurgical evaluation of partial seizures". Epilepsy Res. 20 (3): 241–6. doi:10.1016/0920-1211(94)00084-A. PMID 7796796.

[pmid8109904-4] Rho JM, Donevan SD, Rogawski MA (Feb 1994). "Mechanism of action of the anticonvulsant felbamate: opposing effects on N-methyl-D-aspartate and gamma-aminobutyric acidA receptors". Annals of Neurology 35 (2): 229–234. doi:10.1002/ana.410350216. PMID 8109904.

[pmid8667250-5] Kume A, Greenfield LJ, Macdonald RL, Albin RL (June 1996). "Felbamate inhibits [3H]t-butylbicycloorthobenzoate (TBOB) binding and enhances Cl- current at the gamma-aminobutyric AcidA (GABAA) receptor". J. Pharmacol. Exp. Ther. 277 (3): 1784–92. PMID 8667250.

[6] Subramaniam S, Rho JM, Penix L, Donevan SD, Fielding RP, Rogawski MA (May 1995). "Felbamate block of the N-methyl-D-aspartate receptor". The Journal of pharmacology and experimental therapeutics 273 (2): 878–886. PMID 7752093.

[7] Kleckner NW, Glazewski JC, Chen CC, Moscrip TD (May 1999). "Subtype-selective antagonism of N-methyl-D-aspartate receptors by felbamate: insights into the mechanism of action". The Journal of pharmacology and experimental therapeutics 289 (2): 886–894. PMID 10215667.

[8] Harty TP,Rogawski MA (March 2000). "Felbamate block of recombinant N-methyl-D-aspartate receptors: selectivity for the NR2B subunit". Epilepsy research 39 (1): 47–55. doi:10.1016/s0920-1211(99)00108-4. PMID 10690753.

[9] Chang H-R, Chung-Chin Kuo C-C (March 2008). "Molecular determinants of the anticonvulsant felbamate binding site in the N-methyl-D-aspartate receptor". Journal of Medicinal Chemistry 51 (6): 1534–1545. doi:10.1021/jm0706618. PMID 18311896.

[10] Rogawski MA (March 2011). "Revisiting AMPA receptors as an antiepileptic drug target". Epilepsy currents 11 (2): 56–63. doi:10.5698/1535-7511-11.2.56. PMC 3117497. PMID 21686307.

[urlwww.fda.gov-11] "www.fda.gov". Retrieved 2008-11-15. ^{[dead link]}

[urlwww.fda.gov2-12] "www.fda.gov". Retrieved 2008-11-15. ^{[dead link]}

[Flockhart-13] Flockhart DA (2007). "Drug Interactions: Cytochrome P450 Drug Interaction Table". Indiana University School of Medicine. Retrieved on December 25, 2008.

[Curry-14] Curry WJ, Kulling DL (February 1998). "Newer antiepileptic drugs: gabapentin, lamotrigine, felbamate, topiramate and fosphenytoin". Am Fam Physician 57 (3): 513–20. PMID 9475899.

匿名

検索

案内

案内

felbamate