Epilan is the grouping of two structurally associated time-proven antiepileptic drugs with different action mechanisms. This grouping of Phenobarbitone and Phenytoin sodium is used for providing enough seizure control with the patients having epileptic seizures may not be controlled through either drug alone.
Epilan is designated for the seizure control in the patients having generalized tonic-clonic seizures or grand mal seizures as well as the complex partial seizures for which mono therapy is not enough.
For Adults: 1 tablet 3-4 times per day.
For Children: Dosage individualized, according to the body weight, in range of the phenytoin 4 to 8 mg per kg per day and phenobarbitone 3 to 5 mg per kg per day in 2-3 evenly divided doses.
Therapeutic rationale of combination of Phenobarbitone and Phenytoin sodium is relied on following advantages.
As the use of drug groupings is accepted to be perfect for the diseases, which need long-term management with multiple drug therapy, anti-epileptic grouping of Phenobarbitone + Phenytoin sodium has been made to counter disadvantages of the mono therapy and noncompliance inadequacy in getting total seizure control.
Some patients of epilepsy may not react adequately to mono therapy in the recommended dosage; it may justify higher drug dosage that might source unwanted side effects. All these patients react adequately when the two drugs with diverse action and mechanisms are used in tandem. Phenytoin has soothing influence on the neuronal membrane. It slows down the channels of voltage dependent Na+ like a part of the main action mode; maybe of greater significance is its capability of facilitating the Na+ extrusion through nerve cells and preventing intracellular accumulation for this action during the repetitive stimulation. Therefore, it selectively reduces the high frequency discharges through some effect on the usual neuronal discharges. It also reduces the Ca+ influx during the neuronal depolarization. The Phenobarbitone has precise anticonvulsant activity that is not completely dependent on its common CNS depression outcome. It mainly helps the GABA – intervened inhibition of the nerve cell movement through binding to the GABA receptor or the chloride-ionophore macromolecular-complex. In addition, the Phenobarbitone also reduces the nerve cell stimulation through showing anti-glutamate activity. It overall increases seizure threshold as well as also limits spread of the seizure discharge. Provided the different mechanisms for the action of Phenobarbitone and Phenytoin, their collective usage provides benefit of outline of the therapeutic effects, which is a pharmacodynamic advantage.
The outline of the popular therapeutic effects is more strengthened with the fact that it is a satisfied risk-proneness for development of unwanted drug effects. It is so as such combined use of the Phenobarbitone and Phenytoin does not need higher doses of individual drugs; therefore the toxic effects, which are attributable for the high doses are avoided.
In the multiple drug routines when the drugs are utilized separately, there is constantly the risk of skipping and forgetting doses of valuable antiepileptic. In those situations of the poor compliance not enough seizure control is unlucky consequence. The worse scenario is that the patient unsuspectingly compensates for missed dose through doubling the subsequent dose. It might result into increased incidence of the toxic effects. Those undesirable situations in the antiepileptic therapy may be averted through combined use of Phenobarbitone and Phenytoin which undoubtedly advances the overall safety and efficacy of the drug combination.
Phenytoin is generally administered to the adults in 100 mg dose, with up to 400mg/day maximum. The daily dose for usual adult of Phenobarbitone is 60 to 180 mg in separated doses. The dosage range from both Phenobarbitone and Phenytoin, drug combination of the Phenytoin sodium 100 mg and Phenobarbitone 30 mg is conscientiously combined for meeting the criterion of therapeutic safety and efficacy. As this approach may not need higher doses of the individual drugs, opposite to mono therapy, their overall mutual usage favors safety, efficacy, and patient compliance.
Epilan is very effective with in the desirable tolerability patients. Drug interactions may happen with the other antiepileptic as well as other medications. It is contra indicated with the patients, having history of drug hypersensitivity, restlessness, abnormal reactions, or porphyria to the phenobarbitone or the other barbiturates, severe hepatic and renal impairment with ruthless myocardial dysfunction. The caution advised in pregnancy, severely ill or elderly patients, mild to moderate hepatic or renal dysfunction or in drug addicts and alcoholics.
Use in pregnancy
Congenital deformities can happen to various anticonvulsants. On other hand, preventing the anticonvulsant treatment throughout the pregnancy can result into abortion, increased convulsions, and status epilepticus. The result of stopping or continuing Epilan during the pregnancy must be taken on the individual patient based after the appropriately weighing risk-benefit proportion. Irritation, sedation, depression, aggressiveness, rash, confusion, anemia, dyskinesia, and hepatitis are recognized to occur with the Epilan rarely. Gum hyperplasia can happen particularly in children. The CNS effects incorporate ataxia, vertigo, double vision, and nystagmus. Severe hepatitis, agranulocytosis, and severe skin reactions can happen very rarely.
Epilan is accessible in the tablets of 50, 150, and 1000 tablets in plastic bottle.
Each uncoated Epilan tablet contains:
Phenytoin sodium 100 mg
Phenobarbitone 30 mg
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