UMEM Educational Pearls

Category: Toxicology

Title: SUICIDE RISK WITH ANTIEPILEPTICS

Keywords: antiepileptics, suicide, carbamezepine, felbamate, gabapentin, lamotrigine, levetiracetam, valproate, pregabalin (PubMed Search)

Posted: 4/3/2008 by Ellen Lemkin, MD, PharmD (Updated: 7/4/2022)
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SUICIDE RISK WITH ANTIEPILEPTICS

  • On January 31st, the FDA released a warning about an increased risk of suicidality in patients recently started on antiepileptics
  • They analyzed data across 199 placebo controlled trials, looking at 11 agents in a total of 43,892 patients
  • Patients taking antiepileptics were found to have twice the suicide ideations and attempts as those on placebo.
  • Although the overall risk was very small (0.43% vs 0.22%), it is consistent across the board, and particularly evident in those with epilepsy.

Drugs in the analysis included:
Carbamazepine (Carbatrol, Equetro, Tegretol, Tegretol XR)
Felbamate (Felbatol)
Gabapentin (Neurontin)
Lamotrigine (Lamictal)
Levetiracetam (Keppra)
Oxcarbazepine (Trileptal)
Pregabalin (Lyrica)
Tiagabine (Gabitril)
Topiramate (Topamax)
Valproate (Depakote, Depakote ER, Depakene, Depacon)
Zonisamide (Zonegran)

Interestingly, other agents including varenicline (a partial nicotinic antagonist, for smoking cessation), levetiracetam (Keppra), zolpidem (Ambien), oseltamivir (Tamiflu), isotretinoin (Accutane), and other agents have been noted to have an increased rate of bizarre and aggressive behavior.  

References

http://www.fda.gov/cder/drug/InfoSheets/HCP/antiepilepticsHCP.htm