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Tegretol vs Keppra
Introduction
For patients with epilepsy or other types of seizure disorders, certain medications that influence the electrical activity in the brain can help manage symptoms and reduce seizure frequency. Tegretol (Carbamazepine) and Keppra (Levetiracetam) are two such drugs commonly prescribed for these conditions. Each medication has a different mechanism of action but both aim to stabilize abnormal electrical activity in the brain that leads to seizures. Tegretol is classified as an anticonvulsant and mood-stabilizing drug, thought to work by decreasing nerve impulses causing seizures and pain. Keppra, on the other hand, also an antiepileptic drug works differently from many other seizure medications, its exact mechanism isn't well-understood but it's known not to interact with existing enzymes or receptors common within anti-epileptic treatments.
Tegretol vs Keppra Side By Side
| Attribute | Tegretol | Keppra |
|---|---|---|
| Brand Name | Tegretol | Keppra |
| Contraindications | Should not be taken with certain antidepressants like MAOIs. Stopping Tegretol suddenly can cause a significant increase in seizure frequency. | People with kidney disease might require dose adjustment. |
| Cost | For brand name, around $300 for 60 tablets of 200 mg. Generic versions can cost from $0.15 to about $1.50 per day depending on dosage. | For brand name, about $850 for 60 tablets of 500 mg. Generic versions can cost roughly $0.25 to about $3.00 per day depending on dosage. |
| Generic Name | Carbamazepine | Levetiracetam |
| Most Serious Side Effect | Serious skin reactions, blood disorders | Signs of a severe allergic reaction, suicidal thoughts or behaviors, severe nervous system reaction |
| Severe Drug Interactions | MAOIs | Not specified as having severe interactions with other drugs, but monitoring is advised when used in polytherapy. |
| Typical Dose | Adults: 200–400 mg/day initially, up to 800–1200 mg/day. Maximum daily dose should not exceed 1600 mg for adults. | Adults and adolescents over 16: 500 mg twice a day, up to a maximum of 3000 mg per day. |
What is Tegretol?
Carbamazepine (the generic name for Tegretol) was one of the first drugs in the class of antiepileptic medications, which marked a significant advancement from previous classes of antiepileptic drugs. Carbamazepine was first approved by FDA in 1965 and has been used as a cornerstone medication for seizures ever since. Tegretol works by reducing abnormal electrical activity in the brain, thus decreasing the occurrence and intensity of seizures. It is primarily prescribed for epilepsy treatment but also finds use in treating trigeminal neuralgia and bipolar disorder.
Levetiracetam (the generic name for Keppra), on other hand, represents another generation of antiepileptic drugs that came into prominence much later than Carbamazepine. Approved by FDA in 1999, this drug also works to decrease seizure occurrences but does so through different mechanisms than those employed by carbamazepine - it functions by slowing down impulses within nerves that may cause seizures.
While both these drugs are effective against various forms of epileptic disorders, they differ significantly when it comes to side-effects profile -- with levetiracetam generally considered safer due to lesser impact on liver function compared to carbamazepine.
What conditions is Tegretol approved to treat?
Tegretol is approved for the management of various types of neurological and psychiatric disorders:
- Epilepsy, including partial seizures, generalized tonic-clonic seizures (grand mal), and mixed seizure patterns
- Trigeminal neuralgia (tic douloureux) and glossopharyngeal neuralgia
- Acute manic or mixed episodes associated with bipolar I disorder
How does Tegretol help with these illnesses?
Tegretol helps manage epilepsy by limiting excessive electrical activity in the brain. It does this by blocking sodium channels, which are responsible for the electric signal necessary for seizures to occur. By reducing these signals, Tegretol can prevent seizure episodes and stabilize nerve activity. Sodium is a critical element in neurons that plays an important role in generating and transmitting electrical signals needed for normal function of the nervous system, including cognition, coordination, sensation amongst other things. It is observed that individuals with certain types of epilepsy have irregularities related to sodium channels which result in uncontrolled neuron firing leading to seizures. Therefore, by controlling sodium channel activities, Tegretol can limit negative effects of epilepsy and help patients manage their condition.
On the other hand, Keppra also manages epilepsy but it works through a different mechanism - it binds to SV2A protein on neurons affecting neurotransmitter release thereby modifying neuronal hyperexcitability and hence suppressing seizures.
What is Keppra?
Keppra is the brand name for levetiracetam, an anticonvulsant drug used in managing epileptic seizures. Its mechanism of action primarily involves dampening neuronal hyperactivity by modulating neurotransmitter release through binding to synaptic vesicle protein SV2A. Unlike Tegretol (carbamazepine), Keppra does not work by blocking voltage-gated sodium channels, a common method of seizure prevention in other antiepileptics.
Keppra received FDA approval in 1999 and its unique mode of action results in a different side-effect profile compared to traditional antiepileptic drugs like Tegretol. For instance, it does not generally cause drowsiness or unsteadiness—common side effects associated with Tegretol use—and tends not to interact with other medications, making it more feasible for patients on multiple treatment regimens.
Furthermore, Keppra's influence on neurotransmitter release may be beneficial beyond epilepsy management; there is ongoing research into its potential uses treating conditions such as Alzheimer's disease and anxiety disorders.
What conditions is Keppra approved to treat?
Keppra, also known by its generic name Levetiracetam, is approved for the treatment of a variety of seizure disorders including:
- Partial onset seizures in individuals over one month old
- Myoclonic seizures in patients 12 years and older with juvenile myoclonic epilepsy
- Primary generalized tonic-clonic seizures in individuals six years and older with idiopathic generalized epilepsy
How does Keppra help with these illnesses?
Levetiracetam, commonly known as Keppra, is a type of anticonvulsant medication often used to control seizures in people with epilepsy. It works by affecting the transmission of nerve signals in the brain. Similar to how Wellbutrin increases levels of norepinephrine, Keppra influences neurotransmitter function but doesn't entirely follow traditional anticonvulsant mechanisms. Instead, it binds to SV2A protein which is believed to contribute in modulating synaptic neurotransmission, thereby assisting with seizure control and decreasing their frequency. Unlike Tegretol that can alter sodium channels and inhibit repetitive neuronal firing extensively impacting other body functions due to its broad spectrum effects, Keppra specifically focuses on stabilizing electrical activity only within the brain making it more tolerable for some patients who might not respond well or have adverse reactions from other typical anti-seizure medications such as Tegretol.
How effective are both Tegretol and Keppra?
Both carbamazepine (Tegretol) and levetiracetam (Keppra) have established histories of success in treating patients with epilepsy, and they were initially approved by the FDA about 20 years apart. Since they act on different mechanisms within the nervous system, they may be prescribed under different circumstances. The effectiveness of carbamazepine and levetiracetam in controlling seizures was directly studied in a double-blind clinical trial in 2007; the two drugs exhibited similar efficacy managing seizure activity as well as similar safety profiles.
A 2010 review demonstrated that Tegretol is effective at reducing symptoms of epilepsy from the first week of treatment, has minimal side effects compared to other antiepileptic medications, and is well-tolerated even for long-term use. Further, it has been used for decades globally making it one of the most widely-used epileptic drugs.
On the other hand, Keppra seems to be more effective than placebo in treating partial-onset seizures as per a meta-analysis conducted in 2014. It's generally considered alongside or after treatments like Tegretol due to its newer arrival on market but boasts fewer drug interactions making it safer for polytherapy regimes. While data confirming its efficacy as a stand-alone treatment are less robust than those for Tegretol due to being relatively new on market, initial studies suggest promising results particularly among individuals who did not respond well or had intolerable side effects with older antiepileptics such as Carbamazepine.
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At what dose is Tegretol typically prescribed?
Oral dosages of Tegretol for adults initially range from 200–400 mg/day and may be increased gradually to achieve optimal response, typically within the range of 800–1200 mg/day. For children under the age of 12, dosage needs to be determined by a doctor. Dosage can be adjusted after a few weeks based on individual response and tolerance. The maximum daily dose should not exceed 1600 mg for adults or up to 35mg/kg (or as prescribed) for children in any case.
On the other hand, Keppra intake starts at lower doses; adult patients with epilepsy usually start with an initial dose of 500 mg twice per day which can be increased up to a maximum daily dose of 3000 mg if necessary. Similar adjustments are made for children aged one month and older but vary according to body weight.
Always consult your healthcare provider before making changes in medication or dosage.
At what dose is Keppra typically prescribed?
Keppra treatment typically begins with a dosage of 500 mg twice a day for adults and adolescents over the age of 16. The dose can then be increased to 1000 mg twice a day, spaced roughly 12 hours apart. In certain cases where response to treatment is not satisfactory, the dosage may be further adjusted up to a maximum of 3000 mg per day, divided into two doses of 1500 mg each and taken approximately every twelve hours. It's important that this adjustment process occurs over several weeks under medical supervision.
What are the most common side effects for Tegretol?
Common side effects of Tegretol and Keppra can vary, but most frequently include:
- Dizziness
- Fatigue (general weakness and tiredness)
- Nausea
- Vomiting
- Tremor (involuntary shaking or trembling)
- Coordination difficulties
- Somnolence (sleepiness/drowsiness)
- Headache
Tegretol may also cause skin rashes, while Keppra has been linked to changes in mood or behavior. Both medications could potentially lead to more serious side effects that require immediate medical attention such as difficulty breathing, severe rash, jaundice (yellowing of the skin or eyes), unusual bleeding, suicidal thoughts, worsening seizures etc. Always consult with a healthcare professional when starting new medication.
Are there any potential serious side effects for Tegretol?
Keppra, like Tegretol, can also lead to some serious side effects, although these are not common. If you notice any of the following symptoms after starting Keppra medication, seek immediate medical attention:
- Suicidal thoughts or behaviors
- Signs of a severe allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat.
- Changes in vision including double vision or blurred vision
- Irregular heartbeats leading to palpitations or chest pain
- Shortness of breath and feelings similar to fainting (as if you might pass out)
- Low red blood cell count - pale skin, unusual tiredness, feeling light-headed or short of breath -Severe nervous system reaction: extreme muscle stiffness/rigidity; high fever; sweating excessively; confusion/disorientation
- Symptoms related to changes in mood and behavior such as aggression/agitation/anger/anxiety/depression/hallucinations/hostility/irritability/panic attacks/restlessness/suicidal ideation
If any other unexplained signs occur such as rash with fever/muscle pains/joint pain/inflammation/swelling etc., it's important that you contact your healthcare provider immediately.
What are the most common side effects for Keppra?
Keppra, while generally well-tolerated, can produce the following side effects:
- Sleepiness or unusual drowsiness
- Weakness or loss of energy
- Unsteadiness or clumsiness
- Anxiety or irritability
- Nausea and vomiting
- Muscle aches or pains
- Difficulty with coordination
- Change in personality (hostility)
Are there any potential serious side effects for Keppra?
Keppra, while generally safe and widely prescribed to manage seizures, can also potentially cause serious side effects in rare cases. Please watch for the following symptoms if you're on this drug:
- Signs of a severe allergic reaction such as hives; difficulty breathing; swelling of your face, lips, tongue or throat
- Hallucinations, unusual thoughts or behavior
- Changes in mood or mental health (such as depression, suicidal thoughts)
- Severe weakness or tiredness
- Problems with muscle movement
- Bruising easily or bleeding that doesn't stop
- Unusual changes in mood or behavior (e.g., aggression, agitation) Remember: If any of these side effects are noticed after starting Keppra medication therapy it is important to contact your healthcare provider immediately.
Contraindications for Tegretol and Keppra?
Like all anti-seizure medications, both Tegretol and Keppra may increase the risk of suicidal thoughts or behavior in some individuals. If you notice any new or worsening symptoms such as mood swings, anxiety, depression, panic attacks, trouble sleeping or if you have thoughts about self-harm or suicide while taking these medications please seek immediate medical attention.
Tegretol should not be taken if you are using certain antidepressants like MAOIs (monoamine oxidase inhibitors) due to potential drug interactions that could lead to serious side effects. Furthermore, it's important to note that stopping Tegretol suddenly can cause a significant increase in seizure frequency - do not discontinue this medication without talking with your doctor first.
Keppra has its own set of precautions; for instance, people with kidney disease might require an adjustment in their dose. Always disclose your full medical history and current medication regimen to your physician when discussing treatment options with either Tegretol or Keppra.
How much do Tegretol and Keppra cost?
For the brand name versions of these drugs:
- The price of 60 tablets of Tegretol (200 mg) averages around $300, which works out to $10–20/day, depending on your dose.
- The price of 60 tablets of Keppra (500 mg) is about $850, working out to approximately $28/day.
Thus, if you are in the higher dosage range for Tegretol (i.e., 800 mg/day or higher), then brand-name Keppra is less expensive on a per-day treatment basis. Please note that cost should not be a primary consideration in determining which one of these drugs is right for you.
As far as generic versions go:
- Carbamazepine (Tegretol’s active ingredient) can be available in packs from 30 up to 180 tablets with approximate costs starting from $0.15 per day for dosages at the lower end or up to about $1.50 per day if you're taking more typical dosages between 400 and 1200 mg/day.
- Levetiracetam (Keppra's active ingredient) can come in packs ranging from 30 up to several hundred with prices starting as low as roughly $0.25 per day but may reach up towards ~$3.00 daily depending on your required dosage.
Popularity of Tegretol and Keppra
Carbamazepine, available under the brand name Tegretol, was prescribed to approximately 1.5 million individuals in the United States in 2020. This medication accounted for about 10% of prescriptions related to anticonvulsant drugs in the U.S. Carbamazepine has been a consistent presence among epilepsy medications since its approval by FDA and appears to be more commonly used among patients with trigeminal neuralgia or bipolar disorder.
Levetiracetam, often known by its brand name Keppra, saw around 7.4 million prescriptions filled within the same year. Levetiracetam claims a significant proportion of anticonvulsant prescriptions in the US market - nearly 40%. Its use has been steadily rising due to its good efficacy-to-side effect ratio as well as broad spectrum activity against various types of seizures.
Conclusion
Tegretol (carbamazepine) and Keppra (levetiracetam) are both widely used in the treatment of epilepsy, with a substantial body of clinical trials and research supporting their efficacy over placebo. In some instances, these drugs may be prescribed together, but this is subject to careful consideration by a physician as they can interact with each other. Their mechanisms of action differ; Tegretol primarily works by reducing the activity of sodium channels thereby decreasing abnormal electrical activity in the brain, while Keppra's mechanism isn't fully understood but it seems to operate on SV2A proteins that affect neurotransmitter release.
Typically, Tegretol has been considered a first-line treatment for partial seizures and certain types of generalized seizures whereas Keppra is often utilized as an add-on therapy or for patients who haven’t responded well to initial antiepileptic drugs.
Both medications are available in generic forms which benefit cost-conscious patients or those paying out-of-pocket. The therapeutic effects might not be immediately noticeable for both Tegretol and Keppra; it may take time for optimal benefits to manifest.
The side effect profile between these two drugs varies somewhat but generally, they're well-tolerated. However, compared to Tegretol which could cause serious skin reactions or blood disorders among others - risks that require monitoring -, Keppra tends more towards behavioral side effects such as irritability or aggression. As with any medication treating neurological conditions like epilepsy where mood changes could indicate seizure activity or adverse drug reaction – close monitoring is necessary especially when initiating therapy.
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Refrences
- Kaminski, R. M., Matagne, A., Patsalos, P. N., & Klitgaard, H. (2009, March). Benefit of combination therapy in epilepsy: A review of the preclinical evidence with levetiracetam. Epilepsia. Wiley.http://doi.org/10.1111/j.1528-1167.2008.01713.x
- Suresh, S. H., Chakraborty, A., Virupakshaiah, A., & Kumar, N. (2015, December 20). Efficacy and Safety of Levetiracetam and Carbamazepine as Monotherapy in Partial Seizures. Epilepsy Research and Treatment. Hindawi Limited.http://doi.org/10.1155/2015/415082
- Silpakit, O., Amornpichetkoon, M., & Kaojarern, S. (1997, May). Comparative Study of Bioavailability and Clinical Efficacy of Carbamazepine in Epileptic Patients. Annals of Pharmacotherapy. SAGE Publications.http://doi.org/10.1177/106002809703100504