Names and pronunciation
(stir-i-pen′tol) Diacomit
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Drug reference
(stir-i-pen′tol) Diacomit
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Func. class.: Anticonvulsant—miscel- laneous
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ACTION: Several possible mecha- nisms of action, including effects on the gamma-aminobutyric acid (GABA) A receptor and novel inhibition of lactate dehydrogenase
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USES: Seizures associated with Dravet syndrome in patients taking clobazam
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CONTRAINDICATIONS: Hyper- sensitivity Precautions: Abrupt discontinuation, breastfeeding, children, depression, driv- ing or operating machinery, growth inhi- bition, hepatic disease, neutropenia, PKU, pregnancy, renal disease, suicidal ideation, thrombocytopenia
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SIDE EFFECTS CNS: Suicidal ideation, depression, drowsiness, dizziness, ataxia, tremor, agitation, fatigue, insomnia, fever GI: Anorexia, weight loss or gain, nausea, vomiting HEMA: Neutropenia, thrombocytopenia MISC: Infection, hypersalivation
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INTERACTIONS None known
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DOSAGE AND ROUTES • Adult/adolescent/child 12-17 yr: PO 50 mg/kg/day in 2 or 3 divided doses; round to nearest possible dosage, which is usually within 50 to 150 mg of the recommended 50 mg/kg/day. Max 3000 mg/day
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Available forms: Caps 250, 500 mg
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Administer: • Use seizure precautions • Give during a meal, swallow whole with glass of water; do not break or open capsules • Take missed doses as soon as possible; if it is almost time for the next dose, take only that dose, do not take double doses
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Assess: • Monitor weight for increase or de- crease; nausea, vomiting, anorexia; closely monitor growth rate, weight in pediatric patients • Depression, suicidal ideation: assess for depression, suicidal thoughts and be- haviors any time during treatment; monitor mental status (orientation, mood, behavior) baseline and often during treatment • Pregnancy/breastfeeding: encourage pregnant patients to enroll in the North American Antiepileptic Drug (NAAED) Pregnancy Registry by calling 1-888-233- 2334; no data on breastfeeding • Monitor CBC baseline and periodically during treatment; significant neutropenia and thrombocytopenia may occur
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Evaluate: • Therapeutic response: lessening amount and duration of seizures with minimal sedation
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CLINICAL CONSIDERATIONS
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Patient and caregiver information: • To take only as prescribed, not to skip or double doses, to take at the same times of the day • To notify all professional health care pro- viders of products used, including OTC, Rx, herbals, and supplements; not to change products unless approved by prescriber • To notify health care providers before surgery of product use • Depression, suicidal thoughts/behav- iors: that suicidal thoughts and behaviors that may increase with use of this product • Pregnancy/breastfeeding: to inform health care provider if pregnancy is planned or suspected or if breastfeeding • To avoid driving or hazardous activities until reaction is known; dizziness, drows- iness may occur; resume driving only with prescriber clearance • That exams and blood work will be needed throughout treatment • To report excessive sedation, severe nausea/vomiting, depression, suicidal thoughts and behaviors
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PHARMACOKINETICS Protein binding 99%, half-life 4.5-15 hr, peak 2-3 hr
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• Adult/adolescent/child 12-17 yr: PO 50 mg/kg/day in 2 or 3 divided doses; round to nearest possible dosage, which is usually within 50 to 150 mg of the recommended 50 mg/kg/day. Max 3000 mg/day
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