Gabitril

US Brand Name: Gabitril
Other Brand Names: Gabatril (Mexico)

Generic Name: tiagabine hydrochloride

Other Forms:

What is Gabitril?: Gabitril is an anticonvulsant
Read up on these sections if you haven’t done so already, because they cover a lot of information about multiple medications that I’m not going to repeat on many pages.  I’m just autistic that way about not repeating myself.

FDA Approved Use of Gabitril: Adjunctive treatment (i.e. you must use another drug along with it) for types of partial epileptic seizures in adults and kids over 12.

Better know partial seizures are:

  • Simple partial seizures – you’re still awake (more or less), with symptoms such as one or two limbs spazzing out or wacky visual or other sensory distortions.  Think Alice in Wonderland, as Lewis Carroll must have had some serious temporal lobe issues.  The fist link will take you to a better explanation.  For a really detailed explanation of what a simple partial seizure is, click here.
  • Complex partial seziures – the people around you think you’re just acting out to get attention.  In reality you have no control over what’s happening.  Again, click there for the basics, click here for what neurologists think about this type of seizure.

Off-Label Uses of Gabitril: Monotherapy (used by itself) treatment of epilepsy that doesn’t respond to other meds.  PTSD. Generalized Anxiety Disorder (with or without comorbid depression, compared well with Paxil (paroxetine)).  Cocaine abuse.  Impulse Control Disorder.  Neuropathy.  Bipolar Disorder – it’s typically a bust.  More on that in the comments section.

Gabitril’s pros and cons:

Pros: It might make you feel like you’ve had a margarita for breakfast, butapparently you can safely drink while taking it.  It doesn’t have much in the way of drug-drug interactions (just a slight lowering of the valproate medications (Depakene (valproic acid), Depakote (divalproex sodium) or Depacon (valproate sodium) plasma levels).  It also doesn’t mess with oral contraceptives.  Like Neurontin (gabapentin) the side effect profile is generally low. 

Cons: If the side effects do hit you this is a stupid pill that ranks up there with Topamax (topiramate) and Zonegran (zonisamide).  Can work for a week or two for some off-label uses, then just quit on you.

Gabitril’s Typical Side Effects: The usual for anticonvulsants. Nausea, diarrhea and other tummy troubles, which are usually short term.  Feeling drunk.  There’s no other way to describe it, the first week on Gabitril (tiagabine) is like drinking good Scotch for breakfast.  Eventually it wore down to a pleasant beer buzz, but when that wore off, so did all of its beneficial effects.  An intense lethargy and sedation that’s proven to be short-term for the vast majority of people, but lingering lethargy and sedation may or may not stick around for you.

 Gabitril’s Not So Common Side Effects: Gabitril (tiagabine) can make you stupid like you can’t imagine.  Mouse forgot where we lived.  I had to talk her home, street by street, from ten blocks away.  Add that to the feeling drunk and you can see why “accidental injury” is in the PI sheet.
These may or may not happen to you don’t, so don’t be surprised one way or the other.

Gabitril’s Freaky Rare Side Effects: Loss of taste – it happened to me.  There’s one freaky rare side effect that everyone with epilepsy needs to discuss with their neurologist: non-convulsive status epilepticus.  It’s freaky, it’s rare but not one-in-a-million rare, and Gabitril (tiagabine) can trigger it.  As of February 2005 Cephalon finally added a warning about patients non-convulsive non-convulsive status epilepticus to the Gabitril PI Sheet.  You may not have read about it here first, but we were on the case long before Cephalon came clean with this information.

Interesting Stuff Your Doctor Probably Won’t Tell You: I seriously doubt that your doctor will tell you that, unlike most other anticonvulsants, it seems to be OK to mix booze and Gabitril (tiagabine).  But who knows?Gabitril (tiagabine) works better in the daytime than at night.  No, really.  It’s in the PI sheet.  “A diurnal effect on the pharmacokinetics of tiagabine was observed. Mean steady-state Cmin values were 40% lower in the evening than in the morning. Tiagabine steady-state AUC values were also found to be 15% lower following the evening tiagabine dose compared to the AUC following the morning dose”  If you’re subject to nocturnal seizures (or if taking it off-label and whatever you’re treating gets worse at night, as some stuff does) discuss with your doctor adjusting your dosage schedule so you take a little more in the evening and at night than in the day.

 Gabitril’s Dosage and How to Take Gabitril: As usual I’m going to deal only with adults.

The published dosage schedule was based upon patients taking an enzyme-inducing anticonvulsant such as Trileptal (oxcarbazepine), Tegretol(carbamazepine USP),  Dilantin (phenytonin) or good old phenobarbital.  If you’re not taking one of these meds Cephalon recommends “lower doses or a slower titration of tiagabine for clinical response.”  Hey, how about both!

So instead of starting at 4mg and increasing by 4-8mg a week, you might consider starting at 2mg, and increasing by 2-4mg every two weeks to start.

Gabitril (tiagabine) should be taken with food.  Divide the doses into 2-4 doses a day.

The maximum dosage is 56mg a day.

Days to Reach a Steady State: Two days. When you’re fully saturated with the medication and less prone to peaks and valleys of effects. You still might have peaks of effect after taking many meds, but with a lot of the meds you’ll have fewer valleys after this point. In theory anyway.

How Long Gabitril Takes to Work: Like all anticonvulsants it works best once you reach the proper dosage.  That’s usually in the range of 32-56mg a day.  But you might be getting relief at lower dosages, especially for off-label uses.

Gabitril’s Half-Life & Average Time to Clear Out of Your System:  7-9 hours if you’re not taking an enzyme-inducing anticonvulsant such as Trileptal (oxcarbazepine), Tegretol (carbamazepine USP),  Dilantin (phenytonin) or phenobarbital.  Otherwise the half-life is 3-4.5 hours.  So it’s out of your system in either 2 days or 1 day.  Either way, it’s gone pretty quickly.

How to Stop Taking Gabitril: Your doctor should be recommending that you reduce your dosage by 4mg a day every  other day.

Cephalon is vague, like most drug companies, on how you should discontinue an anticonvulsant.  They tested doing so over a four week period.  From 56mg a day that would be stepping down 4mg a day every  other day.  Works for me!

Like any anticonvulsant, if you’ve been taking Gabitril (tiagabine) for more than a couple months and you’re up to or above 16mg a day (give or take, depending on other meds you might be taking) you just can’t stop cold turkey if you’re not at the therapeutic dosage for another anticonvulsant that you know works for you, otherwise you risk partial-complex, absence seizures or even tonic-clonic grand mals, despite your never having had a seizure disorder before!  The risk is worse if you’re taking a lithium variant, and/or any antidepressant, especially Wellbutrin (bupropion hydrochloride).  Anyone with a history of a seizure disorder who needs to stop taking an anticonvulsant cold turkey needs to be discussing that with two neurologists and not getting your information from some stupid web site. Get off your computer and start making appointments!

If you’ve worked your way up to a particular dosage, it’s usually best to spend this many days at the next lowest dosage before going down the next lowest dosage before that and so forth. This is the least sucky way to avoid problems when stopping any psychiatric medication. Presuming you have the option of slowly tapering off them.
Comments: Be sure to read the section on anticonvulsants if you haven’t done so already.
Approved by the FDA to treat epilepsy in September 1997.

“Gabitril is a fucking tease,” says Cynthia Heimel, and in a way she is correct. Gabitril (tiagabine) will work wonders for comorbid panic/anxiety and/or PTSD and be a decent mood stabilizer for about a week, and then suddenly stop with some rebound anxiety that is all the worse.

Why?

I found one study that may shed some light on that. I don’t like animal studies, but when it’s all there is, I’ll take what I can get. A day after 21 days of heavy administration of tiagabine the sedative and ataxic (normally a bad effect) effects wore off in mice. But it still worked as an anticonvulsant. So maybe whatever was making the mice sedated (and whatever it is that makes people feel drunk the first week or so) is what works as a mood stabilizers for a big part of the population.

But there’s still an odd thing about it as an anticonvulsant. Every anticonvulsant has its particular rare, but nasty, adverse reaction. Lamictal (lamotrigine) is known for The Rash. The valproate medications will eat your liver. With Gabitril (tiagabine) the problem is non-convulsive status epilepticus. From the referenced review, “Nonconvulsive status epilepticus has been reported frequently with tiagabine, although there are insufficient data at present to identify risk factors for this adverse drug reaction.” I’ve found case history after case history involving non-convulsive status epilepticus and Gabitril (tiagabine). Now is that because it does something weird, or is it because it just poops out and it really is a fucking tease? I honestly don’t know. For every case history there’s another study showing that it works just fine over the long term.

So I’ve been pointing this out for over a year now. The studies above have been published for a lot longer. The FDA finally got Cephalon to put a warning on the latest PI Sheet. Including something that was, in fact, news to me – that these seizures can even hit the non-epileptic while taking Gabitril. That a med like Wellbutrin (bupropion) can induce seizures – sure. That the non-epileptic get seizures from stopping anticonvulsants or taking way too high a dosage – OK. But an anticonvulsant causing a form of status epilepticus in the non-epileptic population is downright freaky. The rarity of it is probably why it’s just a warning and not a black box.

For bipolar disorder Gabitril (tiagabine) turns out to be less than effective. One small study had no positive results. In another only 3 of the 13 patients able to put up with the side effects had positive results. The rest had no results or their symptoms got worse. A couple had seizures. Ouch! And another had 8 out of 22 patients respond positively to Gabitril (tiagabine) with one case of absence seizures. The problem here may not be Gabitril (tiagabine) per se, but that pure GABA may not be an effective way of treating affective disorders. Just as Neurontin (gabapentin) is a GABA analogue and isn’t all that effective for bipolar disorder, Gabitril’s pure GABA enhancement may be just as ineffective. Every other anticonvulsant that hits GABA does something else, they mess with your voltage channels, they hit glutamate, they do something. Even Neurontin (gabapentin) might do something else, being a GABA analogue and all. But all Gabitril (tiagabine) does is enhance your GABA uptake. Even benzodiazepines touch non-GABA receptors! So while the pure GABA route is fine for some forms of epilepsy and the various off-label uses listed above, bipolar disorder and depression aren’t among them.

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