Antiparkinson's Agents
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Zonegran, INN-Zonisamide
SCIENTIFIC DISCUSSION 1. Introduction Many patients (30 to 40% of the overall population with epilepsy) continue to have seizures in spite of receiving antiepileptic drug (AED) treatment. The prevalence of active epilepsy, 5-10/1000, is one of the highest among serious neurological disorders with more than 50 million people affected worldwide. Two peaks of incidence are observed, in early childhood and among elderly people. Some patients will have life-long epilepsy. International classifications, such as the International League Against Epilepsy (ILAE) classification recognise many epileptic diseases or syndromes and each of them can be expressed clinically by one or several seizure groupings. Partial epilepsies (localisation related) are the more frequent, accounting for more than 60% of the epilepsies, and they include most of the difficult-to-treat patients. In terms of seizure types, partial epilepsies include simple partial seizures (without impairment of consciousness), complex partial seizures (with impairment of consciousness and often more disabling) and secondarily generalized tonic-clonic seizures. The symptoms are a function of the localisation of the site of seizure onset in the brain (epileptogenic zone) and of the propagation pathways of the abnormal discharge. Therapeutic management usually follows a staged approach with newly diagnosed patients starting prophylactic treatment with a single drug, and several alternative drugs may be tried in the event of lack of efficacy or poor tolerability. For patients not responding to several attempts of monotherapy, combinations of antiepileptic drugs are generally employed early in the management process. Uncontrolled epilepsy is associated with cognitive deterioration, psychosocial dysfunction, dependent behaviour, restricted lifestyle, poor quality of life and excess mortality, in particular from sudden unexpected death in epilepsy patients (SUDEP). -
210913Orig1s000 CLINICAL PHARMACOLOGY REVIEW(S)
CENTER FOR DRUG EVALUATION AND RESEARCH APPLICATION NUMBER: 210913Orig1s000 CLINICAL PHARMACOLOGY REVIEW(S) Office of Clinical Pharmacology Review NDA Number 212489 Link to EDR \\cdsesub1\evsprod\nda212489 Submission Date 04/26/2019 Submission Type 505(b)(1) NME NDA (Standard Review) Brand Name ONGENTYS Generic Name opicapone Dosage Form/Strength and Capsules: 25 mg and 50 mg Dosing Regimen 50 mg administered orally once daily at bedtime Route of Administration Oral Proposed Indication Adjunctive treatment to levodopa/carbidopa in patients with Parkinson’s Disease experiencing “OFF” episodes Applicant Neurocrine Biosciences, Inc. (NBI) Associated IND IND (b) (4) OCP Review Team Mariam Ahmed, Ph.D. Atul Bhattaram, Ph.D. Sreedharan Sabarinath, Ph.D. OCP Final Signatory Mehul Mehta, Ph.D. 1 Reference ID: 4585182 Table of Contents 1. EXECUTIVE SUMMARY .............................................................................................................................................................. 4 1.1 Recommendations ..................................................................................................................................................... 4 1.2 Post-Marketing Requirements and Commitments ......................................................................................... 6 2. SUMMARY OF CLINICAL PHARMACOLOGY ASSESSMENT ............................................................................................. 6 2.1 Pharmacology and Clinical Pharmacokinetics .................................................................................................. -
Changes to the Highmark Drug Formularies
AUGUST 2020 JULY/AUGUST 2020 UPDATE CHANGES TO THE HIGHMARK DRUG FORMULARIES Following is the update to the Highmark Drug Formularies and pharmaceutical management procedures for July/August 2020. The formularies and pharmaceutical management procedures are updated on a bimonthly basis, and the following changes reflect the decisions made in June 2020 by our Pharmacy and Therapeutics Committee. These updates are effective on the dates noted throughout this document. Please reference the guide below to navigate this communication: Section I. Highmark Commercial and Healthcare Reform Formularies A. Changes to the Highmark Comprehensive Formulary and the Highmark Comprehensive Healthcare Reform Formulary B. Changes to the Highmark Progressive Formulary and the Highmark Progressive Healthcare Reform Formulary C. Changes to the Highmark Healthcare Reform Essential Formulary D. Changes to the Highmark Core Formulary E. Changes to the Highmark National Select Formulary F. Updates to the Pharmacy Utilization Management Programs 1. Prior Authorization Program 2. Managed Prescription Drug Coverage (MRxC) Program 3. Formulary Program 4. Quantity Level Limit (QLL) Programs Section II. Highmark Medicare Part D Formularies A. Changes to the Highmark Medicare Part D 5-Tier Incentive Formulary B. Changes to the Highmark Medicare Part D 5-Tier Closed Formulary C. Additions to the Specialty Tier D. Updates to the Pharmacy Utilization Management Programs 1. Prior Authorization Program 2. Managed Prescription Drug Coverage (MRxC) Program 3. Quantity Level Limit (QLL) Program As an added convenience, you can also search our drug formularies and view utilization management policies on the Provider Resource Center (accessible via NaviNet® or our website). Click the Pharmacy Program/Formularies link from the menu on the left. -
Chapter 25 Mechanisms of Action of Antiepileptic Drugs
Chapter 25 Mechanisms of action of antiepileptic drugs GRAEME J. SILLS Department of Molecular and Clinical Pharmacology, University of Liverpool _________________________________________________________________________ Introduction The serendipitous discovery of the anticonvulsant properties of phenobarbital in 1912 marked the foundation of the modern pharmacotherapy of epilepsy. The subsequent 70 years saw the introduction of phenytoin, ethosuximide, carbamazepine, sodium valproate and a range of benzodiazepines. Collectively, these compounds have come to be regarded as the ‘established’ antiepileptic drugs (AEDs). A concerted period of development of drugs for epilepsy throughout the 1980s and 1990s has resulted (to date) in 16 new agents being licensed as add-on treatment for difficult-to-control adult and/or paediatric epilepsy, with some becoming available as monotherapy for newly diagnosed patients. Together, these have become known as the ‘modern’ AEDs. Throughout this period of unprecedented drug development, there have also been considerable advances in our understanding of how antiepileptic agents exert their effects at the cellular level. AEDs are neither preventive nor curative and are employed solely as a means of controlling symptoms (i.e. suppression of seizures). Recurrent seizure activity is the manifestation of an intermittent and excessive hyperexcitability of the nervous system and, while the pharmacological minutiae of currently marketed AEDs remain to be completely unravelled, these agents essentially redress the balance between neuronal excitation and inhibition. Three major classes of mechanism are recognised: modulation of voltage-gated ion channels; enhancement of gamma-aminobutyric acid (GABA)-mediated inhibitory neurotransmission; and attenuation of glutamate-mediated excitatory neurotransmission. The principal pharmacological targets of currently available AEDs are highlighted in Table 1 and discussed further below. -
Therapeutic Drug Monitoring of Antiepileptic Drugs by Use of Saliva
REVIEW ARTICLE Therapeutic Drug Monitoring of Antiepileptic Drugs by Use of Saliva Philip N. Patsalos, FRCPath, PhD*† and Dave J. Berry, FRCPath, PhD† INTRODUCTION Abstract: Blood (serum/plasma) antiepileptic drug (AED) therapeu- Measuring antiepileptic drugs (AEDs) in serum or tic drug monitoring (TDM) has proven to be an invaluable surrogate plasma as an aid to personalizing drug therapy is now a well- marker for individualizing and optimizing the drug management of established practice in the treatment of epilepsy, and guidelines patients with epilepsy. Since 1989, there has been an exponential are published that indicate the particular features of epilepsy and increase in AEDs with 23 currently licensed for clinical use, and the properties of AEDs that make the practice so beneficial.1 recently, there has been renewed and extensive interest in the use of The goal of AED therapeutic drug monitoring (TDM) is to saliva as an alternative matrix for AED TDM. The advantages of saliva ’ fl optimize a patient s clinical outcome by supporting the man- include the fact that for many AEDs it re ects the free (pharmacolog- agement of their medication regimen with the assistance of ically active) concentration in serum; it is readily sampled, can be measured drug concentrations/levels. The reason why TDM sampled repetitively, and sampling is noninvasive; does not require the has emerged as an important adjunct to treatment with the expertise of a phlebotomist; and is preferred by many patients, AEDs arises from the fact that for an individual patient -
Membrane Stabilizer Medications in the Treatment of Chronic Neuropathic Pain: a Comprehensive Review
Current Pain and Headache Reports (2019) 23: 37 https://doi.org/10.1007/s11916-019-0774-0 OTHER PAIN (A KAYE AND N VADIVELU, SECTION EDITORS) Membrane Stabilizer Medications in the Treatment of Chronic Neuropathic Pain: a Comprehensive Review Omar Viswanath1,2,3 & Ivan Urits4 & Mark R. Jones4 & Jacqueline M. Peck5 & Justin Kochanski6 & Morgan Hasegawa6 & Best Anyama7 & Alan D. Kaye7 Published online: 1 May 2019 # Springer Science+Business Media, LLC, part of Springer Nature 2019 Abstract Purpose of Review Neuropathic pain is often debilitating, severely limiting the daily lives of patients who are affected. Typically, neuropathic pain is difficult to manage and, as a result, leads to progression into a chronic condition that is, in many instances, refractory to medical management. Recent Findings Gabapentinoids, belonging to the calcium channel blocking class of drugs, have shown good efficacy in the management of chronic pain and are thus commonly utilized as first-line therapy. Various sodium channel blocking drugs, belonging to the categories of anticonvulsants and local anesthetics, have demonstrated varying degrees of efficacy in the in the treatment of neurogenic pain. Summary Though there is limited medical literature as to efficacy of any one drug, individualized multimodal therapy can provide significant analgesia to patients with chronic neuropathic pain. Keywords Neuropathic pain . Chronic pain . Ion Channel blockers . Anticonvulsants . Membrane stabilizers Introduction Neuropathic pain, which is a result of nervous system injury or lives of patients who are affected. Frequently, it is difficult to dysfunction, is often debilitating, severely limiting the daily manage and as a result leads to the progression of a chronic condition that is, in many instances, refractory to medical This article is part of the Topical Collection on Other Pain management. -
Comparison of the Effects of Zonisamide, Ethosuximide and Pregabalin in the Chronic Constriction Injury Induced Neuropathic Pain in Rats
[Downloaded free from http://www.amhsr.org] Original Article Comparison of the Effects of Zonisamide, Ethosuximide and Pregabalin in the Chronic Constriction Injury Induced Neuropathic Pain in Rats Goyal S, Singla S, Kumar D, Menaria G Department of Pharmacology, Pacific College of Pharmacy, Pacific University, Udaipur, Rajasthan, India Address for correspondence: Dr. Sachin Goyal, Abstract Department of Pharmacology, Background: Evidence has been generated that various anticonvulsant agents provide relief Pacific College of Pharmacy, Pacific University, of several chronic pain syndromes and therefore as an alternative to opioids, nonsteroidal Udaipur ‑ 313 024, Rajasthan, India. anti‑inflammatory, and tricyclic antidepressant drugs in the treatment of neuropathic pain. The E‑mail: [email protected] results of these studies thus raise the question of whether all anticonvulsant drugs or particular mechanistic classes may be efficacious in the treatment of neuropathic pain syndromes. Aim: The aim was to compare the clinically used anticonvulsant drugs which are differ in their mechanism of action in a chronic pain model, the chronic constriction injury, in order to determine if all anticonvulsants or only particular mechanistic classes of anticonvulsants are analgesic. Materials and Methods: The study included zonisamide, ethosuximide and pregabalin. All compounds were anticonvulsant with diverse mechanism of actions. The peripheral neuropathic pain was induced by chronic constriction injury of the sciatic nerve in male Sprague‑Dawley rats. Zonisamide (80 and 40 mg/kg), ethosuximide (300 and 100 mg/kg), pregabalin (50 and 20 mg/kg), and saline was administered intraperitoneally in respective groups in a blinded, randomized manner from postoperative day (POD) 7‑13. Paw withdrawal duration to spontaneous pain, chemical allodynia and mechanical hyperalgesia and paw withdrawal latency to mechanical allodynia and thermal hyperalgesia were tested before drug administration on POD7 and after administration on POD 7, 9, 11 and 13. -
Current Status of Antiepileptic Drugs As Preventive Migraine Therapy Simy K
Curr Treat Options Neurol (2019) 21: 16 DOI 10.1007/s11940-019-0558-1 Headache (JR Couch, Section Editor) Current Status of Antiepileptic Drugs as Preventive Migraine Therapy Simy K. Parikh, MD Stephen D. Silberstein, MD* Address *Jefferson Headache Center, Thomas Jefferson University, Suite 200, Philadel- phia, PA, 19107, USA Email: [email protected] Published online: 18 March 2019 * Springer Science+Business Media, LLC, part of Springer Nature 2019 This article is part of the Topical Collection on Headache Keywords Migraine I Headache I Preventive therapy I Pharmacology I Antiepileptic drugs I Anticonvulsants Abstract Background Antiepileptic drugs (AEDs) are an important class of agents used in the treatment of migraine, a neurological disorder that imparts significant socioeconomic burden. It is important for neurologists to understand the rationale for AEDs in migraine- preventive treatment, as well as each agent’s efficacy and tolerability profile, in order to best determine clinical care. Purpose of this review This article specifically provides the following: (1) a review of the mechanism of action, efficacy, and tolerability of topiramate and divalproex sodium/ sodium valproate, the most widely used AEDs for migraine prevention, (2) a discussion on emerging evidence regarding the efficacy of zonisamide and levetiracetam, and (3) comments on gabapentin, pregabalin, carbamazepine, oxcarbazepine, and lamotrigine, AEDs which have insufficient evidence for use in migraine prevention. Recent findings The potential role for new extended-release formulations of topiramate in migraine prevention is discussed. Summary There is substantial evidence supporting the use of AEDs in migraine prevention. Specific agents should be chosen based on their efficacy and tolerability profiles. -
UNDERSTANDING PHARMACOLOGY of ANTIEPILEPTIC DRUGS: Content
UNDERSTANDING PHARMACOLOGY OF ANTIEPILEPTIC DRUGS: PK/PD, SIDE EFFECTS, DRUG INTERACTION THANARAT SUANSANAE, BPharm, BCPP, BCGP Assistance Professor of Clinical Pharmacy Faculty of Pharmacy, Mahidol University Content Mechanism of action Pharmacokinetic Adverse effects Drug interaction 1 Epileptogenesis Neuronal Network Synaptic Transmission Stafstrom CE. Pediatr Rev 1998;19:342‐51. 2 Two opposing signaling pathways for modulating GABAA receptor positioning and thus the excitatory/inhibitory balance within the brain Bannai H, et al. Cell Rep 2015. doi: 10.1016/j.celrep.2015.12.002 Introduction of AEDs in the World (US FDA Registration) Mechanism of action Pharmacokinetic properties Adverse effects Potential to develop drug interaction Formulation and administration Rudzinski LA, et al. J Investig Med 2016;64:1087‐101. 3 Importance of PK/PD of AEDs in Clinical Practice Spectrum of actions Match with seizure type Combination regimen Dosage regimen Absorption Distribution Metabolism Elimination Drug interactions ADR (contraindications, cautions) Mechanisms of Neuronal Excitability Voltage sensitive Na+ channels Voltage sensitive Ca2+ channels Voltage sensitive K+ channel Receptor‐ion channel complex Excitatory amino acid receptor‐cation channel complexes • Glutamate • Aspartate GABA‐Cl‐ channel complex 4 Mechanism of action of clinically approved anti‐seizure drugs Loscher W, et al. CNS Drugs 2016;30:1055‐77. Summarize Mechanisms of Action of AEDs AED Inhibition of Increase in Affinity to Blockade of Blockade of Activation of Other glutamate GABA level GABAA sodium calcium potassium excitation receptor channels channels channels Benzodiazepines + Brivaracetam + + Carbamazepine + + (L) Eslicarbazepine + Ethosuximide + (T) Felbamate +(NMDA) + + + + (L) + Gabapentin + (N, P/Q) Ganaxolone + Lacosamide + Lamotrigine + + + + (N, P/Q, R, T) + inh. GSK3 Levetiracetam + + (N) SV2A, inh. -
Health Plan Insights
Health Plan Insights January 2020 Updates from December 2019 800.361.4542 | envisionrx.com Confidential - Document has confidential information and may not be copied, published or distributed, in whole or in part, in any form or medium, without EnvisionRxOptions’ prior written consent. Recent FDA Approvals New Medications TRADE NAME DOSAGE FORM APPROVAL MANUFACTURER INDICATION(S) (generic name) STRENGTH DATE Avsola Amgen Inc. Injection, Biosimilar to Remicade. For the treatment December 6, 2019 (infliximab-axxq) 100 mg/20 mL of/reducing the signs and symptoms of: Crohn’s disease, pediatric Crohn’s disease, ulcerative colitis, rheumatoid arthritis in combination with methotrexate, psoriatic arthritis, and plaque psoriasis. Vyondys 53 Sarepta Intravenous Solution, For the treatment of Duchenne muscular December 12, (golodirsen) Therapeutics, Inc. 50 mg/mL dystrophy (DMD) in patients who have a 2019 confirmed mutation of the DMD gene that is amenable to exon 53 skipping. Padcev Astellas Injection, For the treatment of adult patients with locally December 18, (enfortumab 20 mg/vial and 30 advanced or metastatic urothelial cancer who 2019 vedotin-ejfv) mg/vial have previously received a programmed death receptor-1 (PD-1) or programmed death-ligand 1 (PD-L1) inhibitor, and a platinum-containing chemotherapy in the neoadjuvant/adjuvant, locally advanced or metastatic setting. Conjupri CSPC Ouyi Tablets, For use alone or in combination with other (levamlodipine) Pharmaceutical 1.25 mg, 2.5 mg, and antihypertensive agents for the treatment of December 19, Co., Ltd. 5 mg hypertension, to lower blood pressure. 2019 Caplyta Intra-Cellular Capsules, For the treatment of schizophrenia in adults. December 20, (lumateperone) Therapies, Inc. -
I. Protocol Information
I. Protocol Information Title: Zonisamide in addition to Enhanced Cognitive Processing Therapy-C (E-CPT-C) for Veterans with PTSD and Comorbid Alcohol Dependence Proposal number: 102450059 Phase: II Version/Date of Protocol: 11/24/15 II. Sponsor Information This study is being sponsored by the Department of Defense (DOD) Telemedicine and Advanced Technology Research Center (TATRC). III. Principal Investigator’s Information P.I. Name: Ismene Petrakis, M.D. Research Institution: Yale University/Veterans’ Affairs Connecticut Healthcare System Phone: (203) 932-5711 ext. 2244 Fax: (203) 479-8136 Email: [email protected] IV. Roles and Responsibilities The P.I. will be responsible for making eligibility/termination decisions, obtaining informed consent, evaluating adverse events, making data entries or corrections, and seeing protected health information (PHI). Provide oversight on all aspects of the research study. The Study Coordinator will be responsible for study recruitment, collection of the assessments, data management, and regulatory correspondence. Assist in preparing data for presentations and publications. Prepare records for the Data Safety Monitoring Board. Co-investigators will be responsible for medical coverage, medical supervision and physical examinations. They will also be part of the data analysis, summary reports, interpreting results, preparation of scientific manuscripts. Study nurses will be responsible for meeting with subjects weekly to follow their response and side effects to the medication. Maintain all appropriate nursing documentation according to the Good Clinical Practice and VA Connecticut Healthcare System Nursing Procedures. Study clinicians will be responsible for conducting the E-CPT-C therapy. Laboratory Technician will be responsible for running EtG and urinary cotinine levels and will coordinate about issues related to organizing sample collection. -
Opicapone for the Management of End-Of-Dose Motor Fluctuations in Patients with Parkinson’S Disease Treated with L-DOPA
Opicapone for the management of end-of-dose motor fluctuations in patients with Parkinson’s disease treated with L-DOPA Andrew J. Lees MD1, Joaquim Ferreira MD2, Olivier Rascol MD3, Heinz Reichmann MD,4 Fabrizio Stocchi MD,5 Eduardo Tolosa MD,6 Werner Poewe MD7 1. University College London, Reta Lila Weston Institute, London, UK 2. Hospital de Santa Maria, Centro de Estudos Egas Moniz, Lisbon, Portugal 3. Departments of Clinical Pharmacology and Neurosciences, Clinical Investigation Center CIC 1436, NS-Park/FCRIN network and NeuroToul COEN Center, INSERM, Toulouse University Hospital and Toulouse3 University, Toulouse, France 4. Department of Neurology, Technische Universitaet Dresden, Dresden, Germany 5. Institute of Neurology, IRCCS San Raffaele Pisana, Rome, Italy 6. Neurology Service, Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Hospital Clínic, IDIBAPS, Universitat de Barcelona, Spain. 7. Department of Neurology, Innsbruck Medical University, Innsbruck, Austria Corresponding author Professor Andrew Lees University College London, Reta Lila Weston Institute, 1 Wakefield Street London WC1N 1PJ London, UK Email: [email protected] Direct telephone: + 44 20 7xxxxxxx Fax: +44 20 7xxxxxxx 1 Joaquim Ferreira [email protected] Olivier Rascol [email protected] Eduardo Tolosa [email protected] Fabrizio Stocchi [email protected] Heinz Reichmann [email protected] Werner Poewe [email protected] 2 Summary Introduction: Opicapone is a third generation, highly potent and effective catechol O‑methyltransferase (COMT) inhibitor that optimizes the pharmacokinetics and bioavailability of L- DOPA therapy. Areas covered: In this review, we describe the preclinical and clinical development of opicapone.