Home Drug Guide Felbamate

Drug Guide

Generic Name

Felbamate

Brand Names Felbatol

Classification

Therapeutic: Anticonvulsant

Pharmacological: N-Acetyl-β-aminobenzamide derivative

FDA Approved Indications

  • Adjunctive therapy for partial seizures in adults and children with epilepsy; Lennox-Gastaut syndrome in children aged 2 years and older

Mechanism of Action

The exact mechanism is not fully understood, but felbamate appears to enhance GABA-mediated inhibition and inhibit NMDA receptor activity, contributing to its anticonvulsant effects.

Dosage and Administration

Adult: Initial dose: 1200 mg/day divided in 2-4 doses; titrate gradually based on response and tolerability.

Pediatric: Start at lower doses, typically 15-20 mg/kg/day divided in 2-4 doses; titrate as tolerated.

Geriatric: Use with caution; start at lower doses due to potential for increased adverse effects.

Renal Impairment: Adjust dose based on severity of impairment.

Hepatic Impairment: Use with caution; no specific adjustments established.

Pharmacokinetics

Absorption: Well absorbed orally.

Distribution: Widely distributed; crosses the placenta and blood-brain barrier.

Metabolism: Partially metabolized in the liver; some metabolites may be active.

Excretion: Primarily excreted unchanged in the urine.

Half Life: Approximately 8-19 hours.

Contraindications

  • Known hypersensitivity to felbamate.
  • Patients with hepatic impairment or history of hepatic disease.

Precautions

  • Risk of aplastic anemia and hepatic failure; monitor liver function tests regularly.
  • Use cautiously in patients with blood dyscrasias or a history of blood dyscrasias.
  • Psychiatric adverse effects, including depression or agitation, should be monitored.

Adverse Reactions - Common

  • Sedation, dizziness (Frequent)
  • Nausea, vomiting (Common)

Adverse Reactions - Serious

  • Aplastic anemia (Rare)
  • Hepatotoxicity (Rare)
  • Mood changes, depression, suicidal thoughts (Rare)

Drug-Drug Interactions

  • Valproic acid (may increase felbamate levels),
  • Other CNS depressants (additive sedation)

Drug-Food Interactions

N/A

Drug-Herb Interactions

N/A

Nursing Implications

Assessment: Monitor seizure activity, liver function tests, complete blood counts.

Diagnoses:

  • Risk for bleeding related to blood dyscrasias.
  • Risk for hepatic toxicity.

Implementation: Administer with food if gastrointestinal upset occurs, monitor for adverse effects.

Evaluation: Assess seizure control and observe for signs of adverse reactions.

Patient/Family Teaching

  • Do not abruptly discontinue without consulting healthcare provider.
  • Report any signs of infection, fatigue, jaundice, or mood changes immediately.
  • Use caution when operating machinery or driving until response is known.

Special Considerations

Black Box Warnings:

  • Aplastic anemia and severe hepatic failure have been reported; use only when clearly indicated and monitor closely.

Genetic Factors: Genetic variation in drug metabolism may influence efficacy and toxicity.

Lab Test Interference: May interfere with certain laboratory tests related to blood and liver functions.

Overdose Management

Signs/Symptoms: Drowsiness, dizziness, vomiting, coma, or hepatic failure.

Treatment: Supportive care, monitor hepatic function and blood counts, provide symptomatic treatment as needed.

Storage and Handling

Storage: Store at room temperature away from moisture and light.

Stability: Stable under recommended storage conditions.

🛡️ 5 Critical Medication Safety Tips for Nurses

1

Triple-Check High-Risk Medications

Always have another nurse verify insulin, heparin, warfarin, and chemotherapy drugs. These "high-alert" medications cause the most serious errors. Check concentration, dose calculation, and pump settings twice.

2

Know Look-Alike, Sound-Alike Drugs

Common mix-ups: hydromorphone/morphine, Celebrex/Celexa, Zyprexa/Zyrtec. Always use BOTH generic and brand names, read labels twice, and use barcode scanning when available. One wrong letter can be fatal.

3

Assess Before AND After Giving Meds

Check vitals before cardiac meds, pain levels before analgesics, and blood glucose before insulin. Always reassess within 30 minutes to evaluate effectiveness and watch for adverse reactions.

4

Watch for Drug Interactions

Common dangerous combinations: warfarin + aspirin (bleeding), ACE inhibitors + potassium (hyperkalemia), digoxin + diuretics (toxicity). Always check drug interactions before administering new medications.

5

Educate Your Patients

Teach patients medication names, purposes, major side effects, and what to report. Informed patients catch errors and improve compliance. Always encourage questions - an educated patient is a safer patient.

⚡ Remember: When in doubt, don't give it out! It's always safer to double-check than regret later.

⚠️ Medical Disclaimer

This drug guide is for educational purposes only and is NOT intended for clinical use. Always consult current prescribing information, healthcare providers, and institutional protocols before administering any medication. Do not use this information for patient care decisions.