Dosing and uses of Peganone (ethotoin)
Tonic Clonic & Complex Partial Seizures
Initial: Up to 1 g/d PO in 4-6 divided doses;
Maint: 2-3 g/d
Administration
Take after food
Other Information
Monitor: CBC, LFTs
Other Indications & Uses
Tonic clonic (grand mal) & complex partial seizures
Pediatric dosage forms and strengths
Tonic Clonic & Complex Partial Seizures
Initial: Up to 750 mg/d PO in 4-6 divided doses;
Maint: Usual 500 mg-1 g/d PO; rarely 2 g/d or more
Administration
Take after food
Other Information
Monitor: CBC, LFTs
Peganone (ethotoin) adverse (side) effects
Frequency not defined
Dizziness
Fatigue
Headache
Insomnia
Numbness
Rash
Diarrhea
Mild nausea
Vomiting
Chest pain
Diplopia
Nystagmus
Rare
- Ataxia
- Stevens-Johnson syndrome
- Gum hypertrophy
- Lymphadenopathy
- Megaloblastic anemia
- Systemic lupus erythematosus
Warnings
Contraindications
Hepatic abnormalities
Blood dyscrasias
Cautions
Use during pregnancy may result in incr incidence of birth defects in offspring (fetal hydantoin syndrome); do not discontinue in pts with major seizures due to risk of status epilepticus with hypoxia & risk to mother & fetus
Possible risk of blood dyscrasias & lymphadenopathy
May interfere with folic acid metabolism, causing megaloblastic anemia
Check LFT's if indicated; monitor blood counts & UA at initiation & monthly for several months
Pregnancy and lactation
Pregnancy category: d
Lactation: enters breast milk/not recommended
Pregnancy categories
A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.
B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.
C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.
D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.
X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.
NA: Information not available.
Pharmacology of Peganone (ethotoin)
Half-Life: 3-9 hr
Metabolism: by liver to p-hydroxylated & m-hydroxylated derivatives following N-deethylation; these metabolites are conjugated with glucuronic acid
Excretion: urine, feces
Mechanism of action
Exerts an antiepileptic effect w/o causing general CNS depression. Mechanism of action probably similar to phenytoin but less effective & less toxic than phenytoin
