Abstracts

Patients with epilepsy are at high risk for anxiety. Antiepileptic drugs that have antianxiety properties are highly desirable since both anxiety and epilepsy can be treated with a single drug. Clorazepate dipotassioum (Tranxene) is a prodrug that is converted to the active antiepileptic drug N-desmethyldiazepam. Clorazepate has been used since the mid 1960s as an antianxiety agent and as adjunctive therapy for management of partial seizures. The past few years has seen the introduction of eight new antiepileptic drugs and the vagal nerve stimulator. Whether clorazepate dipotassium continues to be useful in this new new era of antiepileptic therapy remains unclear. The purpose of this study was to re-examine the efficacy and safety of clorazepate in 2005. Medical records of 12 patients (mean age = 22.4 years) taking clorazepate dipotassium were retrospectively reviewed. Records were reviewed for patient[apos]s age, dose of clorazepate dipotassium, duration of treatment. efficacy, and side effects. Clorazepate dipotassium was used to treat complex partial seizures in 7 patients, myoclonic seizures in 3 patients , and a mixed seizure disorder in 2 patients. Dosage varied from 0.5 to 3 mg/kg/day. Clorazepate dipotassium resulted in a seizure reduction of [gt]50% in 8 of 12 (66.7%). In all 12 patients clorazepate dipotassium was well tolerated and felt to be a mood stabilizer in 6 of 12 (50%). Side effects were minimal, and when reported consisted primarily of letheragy. In 10 of 12 (83.3%) of patients clorazepate dipotassium was continued for [gt] 1 year without development of tolerance. None of the patients were taken off clorazepate because of side effects. The drug was particularly useful in patients who complained of insomnia. Despite the introduction of many new antiepileptic drugs, clorazepate dipotassium (Tranxene) remains a very useful antiepileptic drug in patients with poorly controlled seizures. The antianxiety features of the drug makes this an appealing choice in patients who have the co-morbid condition of anxiety. Unlike other benzodiazepines, the drug has few adverse side effects. While tolerance can occur, it appears less commonly than with other benzodiazepines. Clorazepate dipotassium should be considered as potential therapy in patients with pharmacoresistant epilepsy and anxiety disorders. (Supported by Ovation Pharmaceuticals.)