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: Anticonvulsant

or [[:Category:Anxiolytics|Anxiolytic]]

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Aptiom (1) · Ativan (oral, injectable), Loreev XR (1) · Banzel (1) · Briviact (1) · Buspar (US brand discontinued; generic widely available) (1) · Cerebyx (1) · Depakote (1) · Diacomit (1) · Dilantin (1) · Effexor XR, Effexor IR (discontinued in US, generic widely available) (1) · Epidiolex (1) · Felbatol (1) · Fintepla (1) · Fycompa (1) · Gabitril (1) · Klonopin (1) · Lexapro (1) · Luminal (1) · Luvox (US brand discontinued; generic widely available), Luvox CR, Faverin (other markets) (1) · Onfi (1) · Paxil (IR), Paxil CR (controlled-release), Brisdelle (low-dose for menopausal vasomotor symptoms), Pexeva (paroxetine mesylate) (1) · Prozac (1) · Sabril (1) · Valium (oral, IV/IM, rectal), Diastat (rectal gel for breakthrough seizures), Valtoco (nasal spray for breakthrough seizures), Libervant (buccal film) (1) · Vimpat (1) · Vistaril (pamoate), Atarax (HCl, discontinued in US as brand) (1) · Xcopri (1) · Zarontin (1) · Zonegran (1)

None (7) · AMPA receptor antagonist (1) · GABA enhancer; sodium channel blocker; histone deacetylase inhibitor (1) · GABA reuptake inhibitor (GAT-1 blocker) (1) · GABAA positive allosteric modulator (1) · GABAA positive allosteric modulator; lactate dehydrogenase inhibitor (1) · GABAA potentiator and direct activator (1) · Irreversible GABA-T inhibitor (1) · Multiple mechanisms; GPR55 antagonist; TRPV1 agonist (1) · NMDA antagonist; GABAA potentiator (1) · Prodrug of phenytoin; sodium channel blocker (1) · Serotonin releaser; sigma-1 agonist (1) · Slow-inactivation sodium channel enhancer; CRMP-2 ligand (1) · Sodium channel blocker (2) · Sodium channel blocker; GABAA positive allosteric modulator (1) · Sodium channel modulator (1) · Sodium/T-type calcium channel blocker; carbonic anhydrase inhibitor (1) · SV2A ligand (higher affinity than levetiracetam) (1) · T-type calcium channel blocker (1) · TrkB/BDNF'"`UNIQ--ref-00000040-QINU`"' '"`UNIQ--vote-00000041-QINU`"' (1) · '"`UNIQ--vote-0000001D-QINU`"' '''QT prolongation''' risk at high doses prompted the FDA's 2015 caution against use in patients with prolonged QT or with concurrent QT-prolonging medicines'"`UNIQ--ref-0000001E-QINU`"'. (1) · '"`UNIQ--vote-0000001D-QINU`"' CYP2C19 + CYP3A4 metabolism, with CPIC PGx guidance: poor CYP2C19 metabolizers have ~3-fold higher exposure and benefit from a lower starting dose; ultrarapid metabolizers may have inadequate response'"`UNIQ--ref-0000001E-QINU`"'. (1)

None (19) · 10 mg (1) · 10 mg PO once daily; titrate to 20 mg/day after 1-2 weeks if needed (1) · 5 mg PO TID or 7.5 mg PO BID; titrate by 5 mg every 2-3 days to clinical effect, commonly 30-60 mg/day divided BID-TID (1) · 50 mg PO at bedtime; titrate by 50 mg every 4-7 days to clinical effect. Total daily doses >100 mg divided BID. Luvox CR: 100 mg PO once daily, may titrate to 300 mg/day (1) · Anxiety: 0.25 mg PO BID, titrate by 0.125-0.25 mg every 3 days to target 1-4 mg/day divided. Seizures: 1.5 mg/day divided TID, titrate by 0.5-1 mg every 3 days (1) · Anxiety: 0.5-1 mg PO BID-TID. Insomnia: 1-2 mg PO at bedtime. Status epilepticus: 4 mg IV (adult), repeat after 5-10 minutes if needed. Acute agitation: 1-2 mg IM (1) · Anxiety: 2-10 mg PO 2-4 times daily. Alcohol withdrawal: 10-20 mg PO/IV every 4-6 hours, symptom-triggered. Status epilepticus: 5-10 mg IV. Breakthrough seizures: Diastat rectal 0.2-0.5 mg/kg or Valtoco intranasal 5-20 mg (1) · Anxiety: 25-50 mg PO QID. Pruritus: 25 mg PO TID-QID. Insomnia: 25-50 mg PO at bedtime. Pediatric: 50-100 mg/day divided (1) · MDD/GAD: 20 mg PO once daily. Panic disorder: 10 mg titrating to 40 mg. OCD: 20 mg titrating to 40-60 mg. CR: 25 mg/day. Brisdelle: 7.5 mg at bedtime for hot flashes (1) · XR 37.5 mg PO once daily for 4-7 days, then 75 mg/day; titrate by 75 mg every ≥4 days to clinical effect. IR 25-37.5 mg BID-TID (1)

None (19) · 10 mg, 20 mg, 40 mg caps (1) · IR tablets 10, 20, 30, 40 mg; CR tablets 12.5, 25, 37.5 mg; oral suspension 10 mg/5 mL; Brisdelle capsules 7.5 mg (1) · IR tablets 25, 37.5, 50, 75, 100 mg; XR capsules 37.5, 75, 150, 225 mg (1) · IR tablets 25, 50, 100 mg; Luvox CR capsules 100, 150 mg (1) · Tablets 0.5, 1, 2 mg; oral concentrate 2 mg/mL; injection 2 mg/mL and 4 mg/mL; Loreev XR capsules 1, 2, 3 mg (1) · Tablets 0.5, 1, 2 mg; orally disintegrating tablets 0.125, 0.25, 0.5, 1, 2 mg (1) · Tablets 10, 25, 50 mg (HCl); capsules 25, 50, 100 mg (pamoate); oral suspension 25 mg/5 mL; injection 25, 50 mg/mL (IM only, never IV) (1) · Tablets 2, 5, 10 mg; oral solution 1, 5 mg/mL; injection 5 mg/mL; Diastat rectal gel 2.5, 5, 10, 20 mg; Valtoco nasal spray 5, 7.5, 10 mg/dose; Libervant buccal film (1) · Tablets 5, 10, 20 mg; oral solution 1 mg/mL (1) · Tablets 5, 7.5, 10, 15, 30 mg (the 15 and 30 mg tablets are scored for halving and quartering) (1)

None (19) · 10 mg/day (anxiety, oral) (1) · 20 mg/day (adult); 10 mg/day in elderly and in hepatic impairment (1) · 20 mg/day (seizures); commonly limited to 4 mg/day for anxiety in current practice (1) · 225 mg/day outpatient (XR); 375 mg/day inpatient (IR divided TID); 75 mg/day in moderate hepatic impairment (1) · 300 mg/day (IR or CR) (1) · 40 mg/d (1) · 40 mg/day (oral, anxiety) (1) · 400 mg/day theoretical; in practice rarely exceeds 200 mg/day (1) · 50 mg/day (IR); 62.5 mg/day (CR); 60 mg/day (OCD) (1) · 60 mg/day (1)

None (19) · buccal (1) · IM (1) · intramuscular (2) · intranasal (1) · intravenous (1) · IV (1) · Oral (10) · rectal (1)

None (20) · '''Anxiolytic effect emerges over 2-4 weeks'''; buspirone does NOT work for acute anxiety, which is the central teaching point and the most common cause of treatment failure (1) · 15-30 minutes (oral) (1) · 15-60 minutes (oral); 1-5 minutes (IV); 4-10 minutes (rectal or intranasal) (1) · 20-60 minutes (1) · 30-60 minutes (oral); 5 minutes (IV); 15-30 minutes (IM) (1) · Antidepressant effect emerges over 1-2 weeks (1) · Antidepressant effect emerges over 1-2 weeks; full clinical effect 4-6 weeks (1) · Antidepressant effect over 1-2 weeks; anxiolytic effect over 4-6 weeks (1) · OCD effect over 1-2 weeks initial, with full effect typically 6-12 weeks; among the slowest SSRIs for OCD response (1)

None (19) · 24 hours (once-daily dosing) (2) · 24 hours (XR); 12 hours (IR) (1) · 4-6 hours (1) · 6-12 hours (long-acting among benzodiazepines) (1) · 6-24 hours (parent); much longer when accounting for the long-lived active metabolites (1) · 6-8 hours (1) · BID at higher doses (IR); once-daily (CR) (1) · Very long (1) · ~8 hours (TID dosing) (1)

None (19) · 12-15 hours (intermediate); '''no active metabolites''' (key clinical feature)'"`UNIQ--ref-00000023-QINU`"' (1) · 14-25 hours (longer in elderly and hepatic impairment)'"`UNIQ--ref-00000026-QINU`"' (1) · 1–4 days (7–15 days for norfluoxetine) (1) · 27-32 hours'"`UNIQ--ref-00000026-QINU`"' (1) · 30-40 hours (long; accumulates with chronic dosing)'"`UNIQ--ref-00000026-QINU`"' (1) · Buspirone 2-3 hours; 1-PP active metabolite 4-6 hours'"`UNIQ--ref-0000001D-QINU`"' (1) · Diazepam 20-50 hours; '''N-desmethyldiazepam (nordazepam) 30-200 hours''' is the major active metabolite and accumulates substantially with chronic dosing'"`UNIQ--ref-00000026-QINU`"' (1) · Venlafaxine 5 hours; desvenlafaxine active metabolite 11 hours'"`UNIQ--ref-00000026-QINU`"' (1) · ~15 hours (IR)'"`UNIQ--ref-00000023-QINU`"' (1) · ~21 hours (with nonlinear pharmacokinetics from CYP2D6 autoinhibition)'"`UNIQ--ref-0000002B-QINU`"' (1)

None (19) · 70–90% (oral) (1) · Highly variable due to saturable first-pass metabolism'"`UNIQ--ref-0000002C-QINU`"' (1) · ~4% (extensive first-pass metabolism)'"`UNIQ--ref-0000001E-QINU`"' (1) · ~45%'"`UNIQ--ref-00000027-QINU`"' (1) · ~53% (oral)'"`UNIQ--ref-00000024-QINU`"' (1) · ~80% (oral)'"`UNIQ--ref-00000027-QINU`"' (2) · ~90% (oral)'"`UNIQ--ref-00000024-QINU`"' (1) · ~90% (oral)'"`UNIQ--ref-00000027-QINU`"' (1) · ~93% (oral); ~90% (rectal)'"`UNIQ--ref-00000027-QINU`"' (1)

None (20) · '''Among the least preferred SSRIs in pregnancy.''' Observational signal for cardiac malformations (atrial and ventricular septal defects) with first-trimester exposure, and the most severe neonatal adaptation syndrome of any SSRI with third-trimester exposure'"`UNIQ--ref-0000002D-QINU`"' (1) · Category C'"`UNIQ--ref-00000045-QINU`"' (1) · Limited human data; older agent with substantial use experience and no clear teratogenic signal.[[[Pharmacopedia:Citation needed|citation needed]]] (1) · Limited human data; older agent with substantial use experience; some signal for first-trimester exposure but not conclusive.[[[Pharmacopedia:Citation needed|citation needed]]] (1) · Limited human data; some signal for cleft palate with first-trimester exposure (debated); neonatal sedation and withdrawal with third-trimester exposure.[[[Pharmacopedia:Citation needed|citation needed]]] (1) · Observational signal for neonatal adaptation syndrome with late-pregnancy exposure; weigh against the risks of untreated maternal depression.[[[Pharmacopedia:Citation needed|citation needed]]] (1) · Observational signal for neonatal adaptation syndrome with third-trimester exposure (SSRI class effect).[[[Pharmacopedia:Citation needed|citation needed]]] (1) · Some signal for cleft lip/palate with first-trimester exposure (debated); neonatal sedation and withdrawal with third-trimester exposure.[[[Pharmacopedia:Citation needed|citation needed]]] (1) · Some signal for cleft palate with first-trimester exposure (debated); neonatal sedation and withdrawal with third-trimester exposure.[[[Pharmacopedia:Citation needed|citation needed]]] (1)

None (19) · [[USLegal:Prescription only|Rx-only]] in US (1) · [[USLegal:Prescription only|Rx-only]] in US. Carries the antidepressant '''Boxed Warning''' for suicidality in children, adolescents, and young adults'"`UNIQ--ref-00000025-QINU`"' (1) · [[USLegal:Prescription only|Rx-only]] in US. Carries the antidepressant '''Boxed Warning''' for suicidality in children, adolescents, and young adults'"`UNIQ--ref-00000028-QINU`"' (2) · [[USLegal:Prescription only|Rx-only]] in US. Carries the antidepressant '''Boxed Warning''' for suicidality in children, adolescents, and young adults'"`UNIQ--ref-0000002E-QINU`"' (1) · [[USLegal:Prescription only|Rx-only]] in US. Not a controlled substance, which is a meaningful clinical advantage over benzodiazepine alternatives for chronic anxiety'"`UNIQ--ref-0000001F-QINU`"' (1) · [[USLegal:Prescription only|Rx-only]] in US. Not a controlled substance, which is a meaningful clinical advantage over the benzodiazepine alternatives for short-term anxiety'"`UNIQ--ref-00000028-QINU`"' (1) · [[USLegal:Schedule IV|Schedule IV controlled substance]] in US. Carries the benzodiazepine class '''Boxed Warning''' for risk of fatal respiratory depression, coma, and death when combined with opioids'"`UNIQ--ref-00000025-QINU`"' (1) · [[USLegal:Schedule IV|Schedule IV controlled substance]] in US. Carries the benzodiazepine class '''Boxed Warning''' for risk of fatal respiratory depression, coma, and death when combined with opioids'"`UNIQ--ref-00000028-QINU`"' (2)