Safety and efficacy of anticonvulsants in elderly patients with psychiatric disorders: oxcarbazepine, topiramate and gabapentin.
Few controlled studies are available to guide the clinician in treating potentially assaultive elderly individuals with psychiatric disorders. Safety concerns limit the use of benzodiazepines and antipsychotic medications in the elderly individual, making anticonvulsants an attractive alternative. This paper reviews three specific anticonvulsants for this purpose: gabapentin, oxcarbazepine and topiramate, describing safety and efficacy in elderly patients with severe agitation from psychosis or dementia. Gabapentin, renally excreted, with a half-life of 6.5-10.5 h, may cause ataxia. Oxcarbazapine, hepatically reduced, may cause hyponatremia, and topiramate may cause significant cognitive impairment. Nonetheless, these are important medications to consider in the treatment of agitation.
Sommer
Barbara R
BR
Stanford University School of Medicine, Department of Psychiatry, Stanford, CA 94305-5723, USA. brsommer@stanford.edu
Fenn
Howard H
HH
Ketter
Terence A
TA
D000368:Aged; D000588:Amines / Q000009:adverse effects / Q000493:pharmacokinetics / Q000627:therapeutic use; D000927:Anticonvulsants / Q000009:adverse effects / Q000493:pharmacokinetics / Q000627:therapeutic use; D002220:Carbamazepine / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000493:pharmacokinetics / Q000627:therapeutic use; D003509:Cyclohexanecarboxylic Acids / Q000009:adverse effects / Q000493:pharmacokinetics / Q000627:therapeutic use; D005632:Fructose / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000493:pharmacokinetics / Q000627:therapeutic use; D000077206:Gabapentin; D006801:Humans; D001523:Mental Disorders / Q000188:drug therapy* / Q000378:metabolism / Q000523:psychology*; D000078330:Oxcarbazepine; D000077236:Topiramate; D005680:gamma-Aminobutyric Acid / Q000009:adverse effects / Q000493:pharmacokinetics / Q000627:therapeutic use
D000588:Amines; D000927:Anticonvulsants; D003509:Cyclohexanecarboxylic Acids; D000077236:Topiramate; D005632:Fructose; D002220:Carbamazepine; D005680:gamma-Aminobutyric Acid; D000077206:Gabapentin; D000078330:Oxcarbazepine