Tiagabine
GABITRIL
Pronunciation: tye-AG-a-been
“Tiger beans (on the) GABA trail”
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
Available strengths
- tab 2, 4, 12, 16 mg
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
Cost
Generic entry2011
NO BOXED WARNINGS
Principal riskIt provokes seizures in people without epilepsy
Classes and tags
Clinical profile
Legacy pregnancy categoryC
Defining liabilitySedation, dizziness and agent-specific rash, behavioral, hepatic, hematologic or teratogenic toxicity.
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