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Tiagabine
📖 About
Always check the BNF link here before prescribing.
- 💊 Tiagabine is an anticonvulsant used as adjunctive therapy.
- Not used as monotherapy; reserved for partial seizures uncontrolled by first-line agents.
⚙️ Mode of Action
- Blocks neuronal GABA reuptake (GAT-1 inhibitor).
- ➡️ Increases extracellular GABA concentration → enhanced inhibitory neurotransmission.
📋 Indications
- Adjunctive treatment of partial seizures with or without secondary generalisation.
- Not licensed for primary generalised epilepsy.
💊 Dose
- Start: 4–5 mg OD, increase gradually every 1–2 weeks.
- Maintenance: 15–30 mg/day in divided doses (usually TDS).
- Higher doses may be required in patients on enzyme inducers (e.g. carbamazepine, phenytoin).
🔄 Interactions
- See BNF for full list.
- Metabolised by CYP3A4 → levels affected by inducers/inhibitors.
- Other CNS depressants (benzodiazepines, alcohol) → additive sedation, dizziness.
⛔ Contraindications / Cautions
- Not recommended in absence or myoclonic seizures (may worsen).
- Caution in hepatic impairment (hepatic metabolism).
- Psychiatric history – can exacerbate depression, psychosis, or suicidal ideation.
⚠️ Side Effects
- 🌀 Dizziness, ataxia, tremor.
- 🛌 Tiredness, somnolence, confusion.
- 🧠 Depression, anxiety, irritability (psychiatric symptoms more common than with many other antiepileptics).
- Rare: non-convulsive status epilepticus, worsening of seizures.
📝 Clinical Pearls
- Not a first-line drug; consider in refractory partial epilepsy only.
- Titrate dose slowly to reduce risk of CNS and psychiatric side effects.
- Always monitor mood and mental health during treatment.
- Avoid abrupt withdrawal – risk of rebound seizures/status epilepticus.
📚 References
- BNF – Tiagabine
- NICE Epilepsy Guidance (NG217)
| The content on this website is provided for educational and informational purposes only to support exam preparation (e.g., MLA, MRCP, USMLE) and learning. This is NOT medical advice, diagnosis, treatment, or professional guidance. It does not replace consultation with a qualified healthcare professional, official guidelines (e.g., NICE, GMC, BNF), or supervised clinical practice. Always verify information with current, authoritative sources. Makindo and its contributors accept no liability for any reliance on this content, including errors, omissions, or any resulting harm, loss, or consequences. By using this site, you agree to these terms. |
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