Tiagabine

INTRODUCTION

Indications

Adjunctive treatment of partial seizures.

Action

Enhances the activity of gamma-aminobutyric acid, an inhibitory neurotransmitter. Therapeutic Effects: ↓ frequency of seizures.

Adverse Reactions/Side Effects

CNS: dizziness, drowsiness, nervousness, weakness, cognitive impairment, confusion, difficulty concentrating, hallucinations, headache, mental depression, personality disorder. EENT: abnormal vision, ear pain, tinnitus. Resp: dyspnea, epistaxis. CV: chest pain, edema, hypertension, palpitations, syncope, tachycardia. GI: abdominal pain, gingivitis, nausea, stomatitis. GU: dysmenorrhea, dysuria, metrorrhagia, urinary incontinence. Derm: alopecia, dry skin, rash, sweating. Metab: weight gain, weight loss. MS: arthralgia, neck pain. Neuro: ataxia, tremors. Misc: allergic reactions, chills, lymphadenopathy.

PHYSICAL THERAPY IMPLICATIONS

Examination and Evaluation

• Document the number, duration, and severity of seizures to help determine if this drug is effective in reducing seizure activity.

• Assess dizziness, ataxia, or tremors that might affect gait, balance, and other functional activities (See Appendix C). Report balance problems and functional limitations to the physician, and caution the patient and family/caregivers to guard against falls and trauma.

• Monitor daytime drowsiness, confusion, hallucinations, cognitive impairment, concentration problems, mental depression, or other changes in personality. Repeated or excessive symptoms may require change in dose or medication.

• Monitor signs of allergic reactions, including pulmonary symptoms (tightness in the throat and chest, wheezing, cough, dyspnea) or skin reactions (rash, pruritus, urticaria). Notify physician if these reactions occur.

• Assess blood pressure (BP) and compare to normal values (See Appendix F). Report a sustained increase in BP (hypertension).

• Assess heart rate, ECG, and heart sounds, especially during exercise (See Appendices G, H). Report rapid heart rate (tachycardia) or signs of other arrhythmias, including palpitations, chest discomfort, shortness of breath, fainting, and fatigue/weakness.

• Assess peripheral edema using girth measurements, volume displacement, and measurement of pitting edema (See Appendix N). Report increased swelling in feet and ankles or a sudden increase in body weight due to fluid retention.

• Assess any joint pain or neck pain to rule out musculoskeletal pathology; that is, try to determine if pain is drug induced rather than caused by anatomic or biomechanical problems.

• Periodically assess body weight and other anthropometric measures (body mass index, body composition). Report a rapid or unexplained weight loss or weight gain.

Interventions

• Guard against falls and trauma (hip fractures, head injury, and so forth), especially if dizziness or ataxia affect gait and balance. Implement fall-prevention strategies, especially if balance is impaired (See Appendix E).

Patient/Client-Related Instruction

• Advise patient to avoid alcohol and other CNS depressants because of the increased risk of sedation and adverse effects.

• Advise patients on prolonged antiseizure therapy not to discontinue medication without consulting ...