MedClass.APClasses History

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* Latuda (lurasidone)
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* [[Meds/Latuda|Latuda]] (lurasidone)
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* [[Meds.Thorazine|Thorazine]] (chlorpromazine HCl)
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* [[Meds/Thorazine|Thorazine]] (chlorpromazine HCl)
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* [[Meds.Thorazine|Thorazine]] (chlorpromazine HCl)
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* [[Meds/Thorazine|Thorazine]] (chlorpromazine HCl)
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* [[Meds.Zyprexa|Zyprexa]] (olanzapine)
* [[Meds.Seroquel|Seroquel]] (quetiapine)
* [[Meds.Geodon|Geodon]] (ziprasidone)
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* [[Meds/Zyprexa|Zyprexa]] (olanzapine)
* [[Meds/Seroquel|Seroquel]] (quetiapine)
* [[Meds/Geodon|Geodon]] (ziprasidone)
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* [[Meds.Risperdal|Risperdal]] (risperidone)
* [[Meds.Invega|Invega]] (paliperidone)
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* [[Meds/Risperdal|Risperdal]] (risperidone)
* [[Meds/Invega|Invega]] (paliperidone)
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* [[Meds.Asendin|Asendin]] (amoxapine) - See below
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* [[Meds/Asendin|Asendin]] (amoxapine) - See below
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* [[Meds.Abilify|Abilify]] (aripiprazole)
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* [[Meds/Abilify|Abilify]] (aripiprazole)
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* [[Meds/Zyprexa]] (olanzapine)
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* [[Meds.Zyprexa|Zyprexa]] (olanzapine)
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* [[Meds/Thorazine]] (chlorpromazine HCl)
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* [[Meds.Thorazine|Thorazine]] (chlorpromazine HCl)
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* [[Meds/Thorazine]] (chlorpromazine HCl)
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* [[Meds.Thorazine|Thorazine]] (chlorpromazine HCl)
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* [[Meds/Seroquel]] (quetiapine)
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* [[Meds.Seroquel|Seroquel]] (quetiapine)
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* [[Meds/Risperdal]] (risperidone)
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* [[Meds.Risperdal|Risperdal]] (risperidone)
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* [[Meds/Invega]] (paliperidone)
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* [[Meds.Invega|Invega]] (paliperidone)
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* [[Meds/Geodon]] (ziprasidone)
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* [[Meds.Geodon|Geodon]] (ziprasidone)
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* [[Meds/Asendin]] (amoxapine) - See below
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* [[Meds.Asendin|Asendin]] (amoxapine) - See below
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* [[Meds/Abilify]] (aripiprazole)
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* [[Meds.Abilify|Abilify]] (aripiprazole)
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* [[Thorazine]] (chlorpromazine HCl)
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* [[Meds/Thorazine]] (chlorpromazine HCl)
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* [[Thorazine]] (chlorpromazine HCl)
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* [[Meds/Thorazine]] (chlorpromazine HCl)
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* [[Zyprexa]] (olanzapine)
* [[Seroquel]] (quetiapine)
* [[Geodon]] (ziprasidone)
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* [[Meds/Zyprexa]] (olanzapine)
* [[Meds/Seroquel]] (quetiapine)
* [[Meds/Geodon]] (ziprasidone)
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* [[Risperdal]] (risperidone)
* [[Invega]] (paliperidone)
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* [[Meds/Risperdal]] (risperidone)
* [[Meds/Invega]] (paliperidone)
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* [[Asendin]] (amoxapine) - See below
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* [[Meds/Asendin]] (amoxapine) - See below
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* [[Abilify]] (aripiprazole)
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* [[Meds/Abilify]] (aripiprazole)
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(:Description Updated {*$LastModified}. Classifications of Antipsychotic Drugs. :)
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(:Description {*$LastModified}. Antipsychotic medications grouped by when they were developed, mechanism of action, chemical structure, and potency.:)
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Like [[MedClass/Antidepressants|antidepressants (ADs)]] and [[MedClass/AntiEpilepticDrugs|anticonvulsants / antiepileptic drugs (AEDs)]], antipsychotics (APs) are broken up into different classes based upon things like chemical structure and how they work in your brain.  Like AEDs there is some overlapping membership.  Currently the primary classification of APs is a combination of age and how they work (pharmacodynamics). 
to:
Like [[MedClass/Antidepressants|antidepressants (ADs)]] and [[MedClass/AntiEpilepticDrugs|anticonvulsants / antiepileptic drugs (AEDs)]], antipsychotics (APs) are broken up into different classes based upon things like chemical structure and how they work in your brain.  Like AEDs there is some overlapping membership.  Currently the primary classification of APs is a combination of when they were developed and how they work (pharmacodynamics). 
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[--Author: (=html=)<span itemprop="author">(=htmlend=)Jerod Poore(=html=)</span>(=htmlend=)  Date Modified: (=html=)<span itemprop="dateModified">(=htmlend=) {(ftime fmt %F {*$LastModified})} (=html=)</span>(=htmlend=) Date Published: (=html=)<span itemprop="datePublished">(=htmlend=)2010-12-31(=html=)</span>(=htmlend=) (:drugclass: [[MedClass/Antipsychotics|Antipsychotic Drugs]]:)--] (=html=)</div>(=htmlend=)
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With the exception of lithium carbonate and Haldol (haloperidol), all first generation antipsychotic agents (FGAs), also known as standard antipsychotics and typical antipsychotics, were thought to work in the exact same way - binding to D2 dopamine, M1 muscarine, H1 histamine, and maybe even a little alpha-1 noradrenergic receptors to interfere with the reception of those neurotransmitters (D2, M1, H1 and &#945;1 antagonists).  The only differences being chemical structure, potency at the various receptors, where in your brain this would happen, and each drug's [[MedInfo/PK|pharmacokinetics.]]  Haldol is different in that it doesn't do much as far as M1 and H1 are concerned, and is a lot more potent in binding to alpha-1, so its side effect profile is somewhat different.
to:
With the exception of lithium carbonate and Haldol (haloperidol), all first generation antipsychotic agents (FGAs), also known as standard antipsychotics and typical antipsychotics, were thought to work in the exact same way - binding to D2 dopamine, M1 muscarine, H1 histamine, and maybe even a little alpha-1 noradrenergic receptors to interfere with the reception of those neurotransmitters (D2, M1, H1 and &#945;1 antagonists).  The only differences being chemical structure, potency at the various receptors, where in your brain this would happen, and each drug's [[MedInfo/PK|pharmacokinetics.]]  Haldol is different in that it doesn't do much as far as M1 and H1 are concerned, and is a lot more potent in binding to alpha-1, so its side effect profile is somewhat different.(=html=)</span></div>(=htmlend=)
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Page design and explanatory material by Jerod Poore, copyright © 2004 - 2012.  All rights reserved.  Don't automatically believe everything you read on teh Intergoogles. [[<<]]
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Page design and explanatory material by Jerod Poore, copyright © 2004 - 2013.  All rights reserved.  Don't automatically believe everything you read on teh Intergoogles. [[<<]]
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%white%[-- (=html=)<span itemprop="breadcrumb">(=htmlend=){$DefaultName} -> {$Group} -> Alphabetical Lists of Antipsychotic Drugs (APs) -> {$Title} -> Common Uses of Antipsychotic Drugs (APs) (=html=)</span></div>(=htmlend=) --]
May 14, 2013, at 10:42 AM by Jerod Poore -
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Second generation antipsychotic agents (SGAs), AKA atypical APs (AAPs) do a hell of a lot more than most FGAs.  They are broad-spectrum antagonists of dopamine, alpha-noradrenergic, and serotonin receptors.  Except for [[Risperdal]] (risperidone) and [[Invega]] (paliperidone) - which is Risperdal's active metabolite (i.e. predigested Risperdal) in pill form - no two of them work the exact same way, hence the term "atypical".  Clozaril (clozapine), [[Zyprexa]] (olanzapine) and Saphris (asenapine) are fairly close in pharmacodynamics, and they bind to practically every neurotransmitter receptor you've got, while [[Risperdal]] / [[Invega]] don't do much more than Haldol (haloperidol) does.  Since they are now prescribed far more often than FGAs, the term "atypical" to describe them, and "standard" to describe the older APs, is counterintuitive.  So FGA and SGA are the preferred terms among researchers.  On most consumer-oriented mental health sites the term "atypical antipsychotic" (AAP) is still used far more often.
to:
Second generation antipsychotic agents (SGAs), AKA atypical APs (AAPs) do a hell of a lot more than most FGAs.  They are broad-spectrum antagonists of dopamine, alpha-noradrenergic, and serotonin receptors.  Except for [[Risperdal]] (risperidone) and [[Invega]] (paliperidone) - which is Risperdal's active metabolite (i.e. predigested Risperdal) in pill form - no two of them work the exact same way, hence the term "atypical".  Although it's now unclear if [[Invega]] does a little more than [[Risperdal]], or maybe they missed something that [[Risperdal]] does.  Clozaril (clozapine), [[Zyprexa]] (olanzapine) and Saphris (asenapine) are fairly close in pharmacodynamics, and they bind to practically every neurotransmitter receptor you've got, while [[Risperdal]] / [[Invega]] don't do much more than Haldol (haloperidol) does.  Since they are now prescribed far more often than FGAs, the term "atypical" to describe them, and "standard" to describe the older APs, is counterintuitive.  So FGA and SGA are the preferred terms among researchers.  On most consumer-oriented mental health sites the term "atypical antipsychotic" (AAP) is still used far more often.
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* [[Seroquel]] (quetiapine fumarate)
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* [[Seroquel]] (quetiapine)
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* Latuda (lurasidone HCl)
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* Latuda (lurasidone)
April 04, 2013, at 12:52 PM by Jerod Poore -
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Second generation antipsychotic agents (SGAs), more commonly known as atypical APs (AAPs), are APs that do a lot more than FGAs.  I.e. they are broad-spectrum antagonists of dopamine, alpha-noradrenergic, and serotonin receptors.  Except for Risperdal (risperidone) and Invega (paliperidone) - which is Risperdal's active metabolite (i.e. predigested Risperdal) in pill form - no two of them work the same way.  Clozaril (clozapine), Zyprexa (olanzapine) and Saphris (asenapine) are fairly close in pharmacodynamics, and they bind to practically every neurotransmitter receptor you've got, while [[Risperdal]] / [[Invega]] don't do much more than Haldol.
to:
Second generation antipsychotic agents (SGAs), AKA atypical APs (AAPs) do a hell of a lot more than most FGAs.  They are broad-spectrum antagonists of dopamine, alpha-noradrenergic, and serotonin receptors.  Except for [[Risperdal]] (risperidone) and [[Invega]] (paliperidone) - which is Risperdal's active metabolite (i.e. predigested Risperdal) in pill form - no two of them work the exact same way, hence the term "atypical".  Clozaril (clozapine), [[Zyprexa]] (olanzapine) and Saphris (asenapine) are fairly close in pharmacodynamics, and they bind to practically every neurotransmitter receptor you've got, while [[Risperdal]] / [[Invega]] don't do much more than Haldol (haloperidol) does.  Since they are now prescribed far more often than FGAs, the term "atypical" to describe them, and "standard" to describe the older APs, is counterintuitive.  So FGA and SGA are the preferred terms among researchers.  On most consumer-oriented mental health sites the term "atypical antipsychotic" (AAP) is still used far more often.
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While officially classified as a [[TCA|tetracyclic antidepressant]] (TCA), [[Asendin]] (amoxapine) is being unofficially classified as an [[MedClass/APClasses#toc5|atypical antipsychotic]] by Stahl and other pharmacologists, based upon its [[http://www.nature.com/npp/journal/v30/n12/full/1300796a.html|efficacy in treating schizophrenia]] and [[http://www.ncbi.nlm.nih.gov/pubmed/10331115|mechanism of action]].
to:
While officially classified as a [[TCA|tetracyclic antidepressant]] (TCA), [[Asendin]] (amoxapine) is being unofficially classified as an [[MedClass/APClasses#toc5|SGA]] by Stahl and other pharmacologists, based upon its [[http://www.nature.com/npp/journal/v30/n12/full/1300796a.html|efficacy in treating schizophrenia]] and [[http://www.ncbi.nlm.nih.gov/pubmed/10331115|mechanism of action]].
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!!!APs Categorized by Potency
Regardless of generation,
APs are also categorized by how strong they are.  Remember: potency does not equal efficacy.
!!!!List of high-potency antipsychotics / neuroleptics

!!!!List of low-potency antipsychotics / neuroleptics

!!!AP Equivalents

!!!Which Is Better, Standard APs or Atypical APs (AAPs)?
The simple answer: whichever one works for you, and in a perfect world you wouldn't need an AP in the first place.  Generally speaking if an AP is the appropriate drug and your symptoms aren't particularly complicated, good old [[Thorazine]] (chlorpromazine HCl
) would probably be the way to go.  On the flipside, if you're so batshit crazy that someone else is reading this page[^##batshit^], then something like [[Zyprexa]], Saphris, or even Clozaril (clozapine) might be needed.[[<<]]
to:
!!!Which Is Better, First-Generation / Standard APs or Second-Generation / Atypical APs?
The simple answer: whichever one works for you, and in a perfect world you wouldn't need an AP in the first place.  Generally speaking if an AP is the appropriate drug and your symptoms aren't particularly complicated, good old [[Thorazine]] (chlorpromazine HCl) or Haldol (haloperidol)
would probably be the way to go.  On the flipside, if you're so batshit crazy that someone else is reading this page[^##batshit^], then something like [[Zyprexa]], Saphris, or even Clozaril (clozapine) might be needed.[[<<]]
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Page created by: Jerod Poore.  Date created: 31 December 2010  Last edited by: {$LastModifiedBy}
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Page created by: Jerod Poore.  Date created: 31 December 2010  Last edited by: {$LastModifiedBy} on {*$LastModified}
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[[Sources.Copyright|Full copyright notice]].  [[Sources.Disclaimer|Our big-ass disclaimer]].
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[[Sources/Copyright|Full copyright notice]].  [[Sources/Disclaimer|Our big-ass disclaimer]].
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* Geodon (ziprasidone)
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* [[Geodon]] (ziprasidone)
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Page created by: Jerod Poore.  Date created: 31 December 2010  Last edited by: {$Author}
''Classifications of Antipsychotic Drugs'' is copyright 2011 Jerod Poore
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Page design and explanatory material by Jerod Poore, copyright © 2004 - 2012.  All rights reserved.  Don't automatically believe everything you read on teh Intergoogles. [[<<]]
[[Sources.Copyright|Full copyright notice]].  [[Sources.Disclaimer|Our big-ass disclaimer]].
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Page design and explanatory material copyright © 2004 - 2012 Jerod Poore. All rights reserved.  Don't automatically believe everything you read on teh Intergoogles. [[<<]]
[[Sources.Copyright|Full copyright notice]].  [[Sources.Disclaimer|Our big-ass disclaimer]].
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(:Description Updated {*$LastModified}. An overview of the different classifications of Antipsychotic Drugs. :)
%comment%(:if expr ( auth admin || {$Author} {$$author} ):) {[foxedit form=Meds.NewArticle]} (:if:)%
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(:Description Updated {*$LastModified}. Classifications of Antipsychotic Drugs. :)
(:keywords antipsychotic classes,antipsychotic classifications,first generation antipsychotics,atypical antipsychotics,types of antipsychotics
:)
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%right%<|[[MedClass/AP | AP Topic Index]]|> [[<<]]
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%right%<|[[MedClass/Antipsychotics|AP Topic Index]]|> [[<<]]
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Like [[MedClass/AD | antidepressants (ADs)]] and [[MedClass/AED | anticonvulsants / antiepileptic drugs (AEDs),]] antipsychotics (APs) are broken up into different classes based upon things like chemical structure and how they work in your brain.  Like AEDs there is some overlapping membership.  Currently the primary classification of APs is a combination of age and how they work (pharmacodynamics). 
to:
Like [[MedClass/Antidepressants|antidepressants (ADs)]] and [[MedClass/AntiEpilepticDrugs|anticonvulsants / antiepileptic drugs (AEDs)]], antipsychotics (APs) are broken up into different classes based upon things like chemical structure and how they work in your brain.  Like AEDs there is some overlapping membership.  Currently the primary classification of APs is a combination of age and how they work (pharmacodynamics). 
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!!!!List of high-potency antipscyhotics / neuroleptics

!!!!List of low-potency antipscyhotics / neuroleptics

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!!!!List of high-potency antipsychotics / neuroleptics

!!!!List of low-potency antipsychotics / neuroleptics
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With the exception of lithium carbonate and Haldol (haloperidol), all first generation antipsychotic agents (FGAs), also known as standard antipsychotics and typical antipsychotics, were thought to work in the exact same way - binding to D2 dopamine, M1 muscarine, H1 histamine, and maybe even a little alpha-1 noradrenergic receptors to interfere with the reception of those neurotransmitters (D2, M1, H1 and &#945;1 antagonists).  The only differences being chemical structure, potency at the various receptors, where in your brain this would happen, and each drug's [[MedInfo.PK|pharmacokinetics.]]  Haldol is different in that it doesn't do much as far as M1 and H1 are concerned, and is a lot more potent in binding to alpha-1, so its side effect profile is somewhat different.
to:
With the exception of lithium carbonate and Haldol (haloperidol), all first generation antipsychotic agents (FGAs), also known as standard antipsychotics and typical antipsychotics, were thought to work in the exact same way - binding to D2 dopamine, M1 muscarine, H1 histamine, and maybe even a little alpha-1 noradrenergic receptors to interfere with the reception of those neurotransmitters (D2, M1, H1 and &#945;1 antagonists).  The only differences being chemical structure, potency at the various receptors, where in your brain this would happen, and each drug's [[MedInfo/PK|pharmacokinetics.]]  Haldol is different in that it doesn't do much as far as M1 and H1 are concerned, and is a lot more potent in binding to alpha-1, so its side effect profile is somewhat different.
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%right%<|[[MedClass.AP | AP Topic Index]]|> [[<<]]
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%right%<|[[MedClass/AP | AP Topic Index]]|> [[<<]]
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Like [[MedClass.AD | antidepressants (ADs)]] and [[MedClass.AED | anticonvulsants / antiepileptic drugs (AEDs),]] antipsychotics (APs) are broken up into different classes based upon things like chemical structure and how they work in your brain.  Like AEDs there is some overlapping membership.  Currently the primary classification of APs is a combination of age and how they work (pharmacodynamics). 
to:
Like [[MedClass/AD | antidepressants (ADs)]] and [[MedClass/AED | anticonvulsants / antiepileptic drugs (AEDs),]] antipsychotics (APs) are broken up into different classes based upon things like chemical structure and how they work in your brain.  Like AEDs there is some overlapping membership.  Currently the primary classification of APs is a combination of age and how they work (pharmacodynamics). 
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Page created by: Jerod Poore.  Date created: 31 December 2010  Last edited by: {$Author}
''Classifications of Antipsychotic Drugs'' is copyright 2011 Jerod Poore
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Page design and explanatory material copyright © 2004 - 2012 Jerod Poore. All rights reserved.  Don't automatically believe everything you read on teh Intergoogles. [[<<]]
[[Sources.Copyright|Full copyright notice]].  [[Sources.Disclaimer|Our big-ass disclaimer]].
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(:Description An overview of the different classifications of Antipsychotic Drugs. :)
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(:Description Updated {*$LastModified}. An overview of the different classifications of Antipsychotic Drugs. :)
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* [[Asendin]] (amoxapine) - See below
While officially classified as a [[TCA|tetracyclic antidepressant]] (TCA), [[Asendin]] (amoxapine) is being unofficially classified as an [[MedClass/APClasses#toc5|atypical antipsychotic]] by Stahl and other pharmacologists, based upon its [[http://www.nature.com/npp/journal/v30/n12/full/1300796a.html|efficacy in treating schizophrenia]] and [[http://www.ncbi.nlm.nih.gov/pubmed/10331115|mechanism of action]].
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* Thorazine (chlorpromazine HCl)
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* [[Thorazine]] (chlorpromazine HCl)
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* Thorazine (chlorpromazine HCl)
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* [[Thorazine]] (chlorpromazine HCl)
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Second generation antipsychotic agents (SGAs), more commonly known as atypical APs (AAPs), are APs that do a lot more than FGAs.  I.e. they are broad-spectrum antagonists of dopamine, alpha-noradrenergic, and serotonin receptors.  Except for Risperdal (risperidone) and Invega (paliperidone) - which is Risperdal's active metabolite (i.e. predigested Risperdal) in pill form - no two of them work the same way.  Clozaril (clozapine), Zyprexa (olanzapine) and Saphris (asenapine) are fairly close in pharmacodynamics, and they bind to practically every neurotransmitter receptor you've got, while Risperdal / Invega don't do much more than Haldol.
to:
Second generation antipsychotic agents (SGAs), more commonly known as atypical APs (AAPs), are APs that do a lot more than FGAs.  I.e. they are broad-spectrum antagonists of dopamine, alpha-noradrenergic, and serotonin receptors.  Except for Risperdal (risperidone) and Invega (paliperidone) - which is Risperdal's active metabolite (i.e. predigested Risperdal) in pill form - no two of them work the same way.  Clozaril (clozapine), Zyprexa (olanzapine) and Saphris (asenapine) are fairly close in pharmacodynamics, and they bind to practically every neurotransmitter receptor you've got, while [[Risperdal]] / [[Invega]] don't do much more than Haldol.
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* Zyprexa (olanzapine)
* Seroquel (quetiapine fumarate)
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* [[Zyprexa]] (olanzapine)
* [[Seroquel]] (quetiapine fumarate)
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* Risperdal (risperidone)
* Invega (paliperidone)
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* [[Risperdal]] (risperidone)
* [[Invega]] (paliperidone)
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(:GoogleAPs:)
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!!!APs Categorized by Potency
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(:GoogleAPs:)
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!!!AP equivalents
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!!!AP Equivalents


!!!Which Is Better, Standard APs or Atypical APs (AAPs)?
The simple answer: whichever one works for you, and in a perfect world you wouldn't need an AP in the first place.  Generally speaking if an AP is the appropriate drug and your symptoms aren't particularly complicated, good old [[Thorazine]] (chlorpromazine HCl) would probably be the way to go.  On the flipside, if you're so batshit crazy that someone else is reading this page[^##batshit^], then something like [[Zyprexa]], Saphris, or even Clozaril (clozapine) might be needed.[[<<]]
In general AAPs tend to suck less, but that is at such an actuarial level (i.e. from the point of view of insurance companies and HMOs dealing with thousands of people]], there's no way you can determine which class of med will suck less for you unless you already have a medical history.

[^##batshit Any way you want to interpret that will work.^]
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Third generation antipsychotic agents (TGAs) are APs that are both dopamine antagonists (interfering with dopamine reception) and partial agonists (stabilizing dopamine reception).  Abilify (aripiprazole) is the first TGA on the market, several more are under development / in various clinical trial phases.
* Abilify (aripiprazole)
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Third generation antipsychotic agents (TGAs) are APs that are both dopamine antagonists (interfering with dopamine reception) and partial agonists (stabilizing dopamine reception).  [[Abilify]] (aripiprazole) is the first TGA on the market, several more are under development / in various clinical trial phases.
* [[Abilify]] (aripiprazole)
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(:GoogleAPs:)
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[[#FGAs]]
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[[#AAPs]]
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* Abilify (aripiprazole)
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!!!AP equivalences
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!!!AP equivalents
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>>font-family:arial font-size:3<<
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''Classifications of Antipsychotic Drugs'' is copyright 2011 Jerod Poore
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* Latuda (lurasidone HCl)
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Given how there are so few AEDs in each class it's little wonder few of them work the same way.  Many people ask about AEDs/ACs that are equivalent, the way SSRIs are.  Very few AEDs are: 
* The valproates are essentially interchangeable, there are some dosage adjustments required, as well as getting used to different side effects.  More information on [[valproates | the valproates page]].
* Trileptal is a derivative of Tegretol.  They aren't exactly alike, but they are close enough that switching from one to the other can be done without titration if absolutely necessary.  300mg of Trileptal (oxcarbazepine) = 200mg of Tegretol (carbamazepine USP).  The US PI sheets ([[http://crazymeds.us/TrileptalPI.pdf | Trileptal's prescribing information]] [[http://crazymeds.us/TegretolPI.pdf | Tegretol's prescribing information]]) are full of information about switching between the two.
* Lyrica isn't derived from Neurontin, but they probably have the same mechanism of action.
* Diamox and sultiame
* Zonegran and Topamax have a vaguely similar chemical structure and a very similar mechanism of action.
May 03, 2011, at 01:47 PM by JerodPoore - Changed the title.
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(:Title Classifications of Antiepileptic Drugs / Anticonvulsants :)
(:Description An overview of the different classifications of Antiepileptic Drugs / Anticonvulsants. :)
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(:Title Classifications of Antipsychotic Drugs (APs) :)
(:Description An overview of the different classifications of Antipsychotic Drugs. :)
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[[#FGAs]]
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%right%<|[[MedClass.AED | AED Topic Index]]|> [[<<]]
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%right%<|[[MedClass.AP | AP Topic Index]]|> [[<<]]
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Like [[MedClass.AD | antidepressants]] anticonvulsants (ACs), or antiepileptic drugs (AEDs) - the terms are nearly interchangeable[^##aedac^] - are broken up into different classes based upon things like how your liver deals with them, chemical structure, and even how they work in your brain.  Unlike antidepressants there is overlapping membership, classes that consist of a single drug, or a drug and subsequent drugs derived from it, and existing anticonvulsants will be added or removed from categories as the understanding of their pharmacodynamics and/or pharmacokinetics improved.  Thus the taxonomy of AEDs is as complex and fungible as that of mushrooms.
[^##aedac Because some benzodiazepines aren't approved, and rarely, if ever prescribed off-label to treat epilepsy, not all anticonvulsants are AEDs.  Similarly not all AEDs are in the anticonvulsant class of drugs, but only because they are being prescribed off-label.  E.g. progesterone-based birth control.^]

The primary classifications of anticonvulsants are if they are [[MedClass.Benzo | benzodiazepines]] or non-benzodiazepine anticonvulsants.  While some are used as AEDs, most benzos are prescribed only for anxiety and other conditions these days, so they get their own pages.  Some, like Xanax (alprazolam), are not even approved by the FDA to treat epilepsy or any kind of seizure disorder.  Unless otherwise specified the terms "antiepileptic drug" and "anticonvulsant" will refer to non-benzodiazepine anticonvulsants.

The next classifications are based on [[MedInfo.PK | pharmacokinetics]].

!!!!Enzyme-inducing AEDs
The first is which AEDs induce CYP450 and/or UGT enzymes.  Enzyme-inducing AEDs (EIAEDs) can have numerous drug-drug interactions, as well as deplete your body of vitamin D'_3_'.  EIAEDs include:   
* Tegretol (carbamazapine)
* Dilantin (phenytoin)
* phenobarbital
* primidone
* Trileptal (oxacarbazepine)
* Topamax (topiramate)
* Sabril (vigabatrin)

Most of the time EIAEDs refers only to Tegretol, Dilantin, and phenobarbital, because:
* primidone is converted to phenobarbital.
* Trileptal's induction of UGT enzymes is only moderate and it doesn't do much in the way of CYP3A4/5 induction like Tegretol does.
* Topamax induces some enzymes, but only at higher dosages.
* Lamictal barely induces UGT enzymes, so it rarely makes a difference.
* Why Sabril speeds up the clearance of some meds hasn't been identified.  Enzyme induction is assumed.
* Anything else that may induce CYP or UGT enzymes is so rarely prescribed these days that any doctor who prescribes it had better know everything there is about that med.

Lots of other medications, both crazy and non-crazy meds, induce CYP450 and UGT enzymes.  AEDs are singled out because epileptics have been given more than one med to control their seizures for over 150 years;[^##poly^] so neurologists as a group are more aware of drug-drug interactions and how the slightest change in dosage can affect their patients' symptoms than most other doctors.
[^##poly Most modern AEDs are approved by the FDA to be used only with other AEDs.  Topamax was the first AED in a long time to receive FDA approval to be used all by itself (monotherapy) to treat both partial and generalized seizures.[[<<]]Potassium bromide is still in use after 150 years, although it is the final straw you'd ever want to grasp at.  Phenobarbital is over 100 years old and may be in front of some newer meds to try if you're running out of options.^]

!!!!Enzyme-inhibiting AEDs
Some doctors, researchers, et al. lump remaining AEDs into a category called non-EIAED, but the true flipside of enzyme induction is [[MedInfo.PK | enzyme inhibition or suppression]].  There is only one group of commonly-prescribed AEDs that inhibits UGT (or any) enzymes involved in the metabolism of any medications to any meaningful extent, and that's [[Meds.valproates | the valproates]]:

* [[Meds.Depakote | Depakote (divalproex sodium)]]
* [[Meds.Depakene | Depakene (valproic acid)]]
* [[Meds.Depacon  | Depacon (valproate sodium or sodium valproate)]]

to:
Like [[MedClass.AD | antidepressants (ADs)]] and [[MedClass.AED | anticonvulsants / antiepileptic drugs (AEDs),]] antipsychotics (APs) are broken up into different classes based upon things like chemical structure and how they work in your brain.  Like AEDs there is some overlapping membership.  Currently the primary classification of APs is a combination of age and how they work (pharmacodynamics). 

!!!First Generation Antipsychotic Agents / Neuroleptics
With the exception of lithium carbonate and Haldol (haloperidol), all first generation antipsychotic agents (FGAs), also known as standard antipsychotics and typical antipsychotics, were thought to work in the exact same way - binding to D2 dopamine, M1 muscarine, H1 histamine, and maybe even a little alpha-1 noradrenergic receptors to interfere with the reception of those neurotransmitters (D2, M1, H1 and &#945;1 antagonists).  The only differences being chemical structure, potency at the various receptors, where in your brain this would happen, and each drug's [[MedInfo.PK|pharmacokinetics.]]  Haldol is different in that it doesn't do much as far as M1 and H1 are concerned, and is a lot more potent in binding to alpha-1, so its side effect profile is somewhat different.

With better technology and more competition for grant money, researchers are looking back at FGAs to see how they work.  Turns out they all don't work the same way after all and some (loxapine, chlorprothixene, e.g.) are like Haldol in that they are a lot more like [[#AAPs|atypical / second-generation antipsychotics]] than FGAs.
!!!! List of First Generation / Standard / Typical Antipsychotic Agents
* Thorazine (chlorpromazine HCl)
* fluphenazine decanoate
* Prolixin (fluphenazine HCl)
* Serentil (mesoridazine besylate)
* Trilafon (perphenazine)
* Compazine (prochlorperazine)
* Mellaril (thioridazine HCl)
* Stelazine trifluoperazine HCl
* Haldol (haloperidol)
* haloperidol decanoate
* Loxitane (loxapine succinate)
* Moban (molindone HCl)
* Orap (pimozide)
* Navane (thiothixene)
* Serpasil (reserpine)
* Taractan / Truxal (chlorprothixene)
* Sordinol (clopenthixol)
* Depixol / Fluanxol (flupentixol)
* flupentixol deconate
* Clopixol / Acuphase (zuclopenthixol)
* zuclopenthixol deconate

Subsets of FGAs:
!!!!Phenothiazines[^##pheno^]
* Thorazine (chlorpromazine HCl)
* fluphenazine decanoate
* Prolixin (fluphenazine HCl)
* Serentil (mesoridazine besylate)
* Trilafon (perphenazine)
* Compazine (prochlorperazine)
* Mellaril (thioridazine HCl)
* Stelazine trifluoperazine HCl
[^##pheno This class of meds also includes drugs with the same chemical structure that are not used as antipsychotics.  Most phenothiazines can be used to treat intense vomiting.  Phenothiazines that aren't classified as antipsychotics are popular as antiemetics in emergency rooms because they help to calm you the hell down.^]

!!!!Thioxanthenes
* Navane (thiothixene)
* Taractan / Truxal (chlorprothixene)
* Sordinol (clopenthixol)
* Depixol / Fluanxol (flupentixol)
* flupentixol deconate
* Clopixol / Acuphase (zuclopenthixol)
* zuclopenthixol deconate


[[#AAPs]]
!!!Second Generation Antipsychotic Agents / Neuroleptics
Second generation antipsychotic agents (SGAs), more commonly known as atypical APs (AAPs), are APs that do a lot more than FGAs.  I.e. they are broad-spectrum antagonists of dopamine, alpha-noradrenergic, and serotonin receptors.  Except for Risperdal (risperidone) and Invega (paliperidone) - which is Risperdal's active metabolite (i.e. predigested Risperdal) in pill form - no two of them work the same way.  Clozaril (clozapine), Zyprexa (olanzapine) and Saphris (asenapine) are fairly close in pharmacodynamics, and they bind to practically every neurotransmitter receptor you've got, while Risperdal / Invega don't do much more than Haldol.

!!!! List of Second Generation / Atypical Antipsychotic Agents
* Zyprexa (olanzapine)
* Seroquel (quetiapine fumarate)
* Geodon (ziprasidone)
* Fanapt (iloperidone)
* Saphris (asenapine)
* Risperdal (risperidone)
* Invega (paliperidone)
* Clozaril (clozapine)
* Solian (amisulpride)

!!!Third Generation Antipsychotic Agents / Neuroleptics
Third generation antipsychotic agents (TGAs) are APs that are both dopamine antagonists (interfering with dopamine reception) and partial agonists (stabilizing dopamine reception).  Abilify (aripiprazole) is the first TGA on the market, several more are under development / in various clinical trial phases.

Regardless of generation, APs are also categorized by how strong they are.  Remember: potency does not equal efficacy.
!!!!List of high-potency antipscyhotics / neuroleptics

!!!!List of low-potency antipscyhotics / neuroleptics
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(:GoogleAEDs:)
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(:GoogleAPs:)
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!!!!Aromatic Anticonvulsants
The next group is the aromatic anticonvulsants.  These meds don't help you smell purty.  Aromatic refers to aromatic hydroxylation, which is part of [[MedInfo.PK | the process when these drugs are metabolized.]]  With a very small percentage of people (somewhere between 1 in 1,500 or 1 in 10,000) the metabolism isn't done correctly and a toxic substance (arene oxides) is left over instead of getting cleaned up.  The leftover  triggers [[http://www.medscape.com/viewarticle/564608 | anticonvulsant hypersensitivity syndrome]], and that sucks donkey dong.  Anticonvulsants with a particular chemical structure (similar to [[MedClass.TCA | TCAs]], and [[http://www.ncbi.nlm.nih.gov/pubmed/17165282 | TCAs may trigger a similar reaction]]) are going to be converted into the problem toxin, but there's no way (yet) of telling if someone won't be able to properly metabolize the toxin once it is created.  While the odds are a bad reaction of one of these drugs means a bad reaction to one or more, if not all of the others, someone may have a problem with just one of them.[^##SJS^]  Or there may be one of them they can take.
* Lamictal (lamotrigine)
* Trileptal (oxcarbazepine)
* Zonegran (zonisamide)
* Tegretol (carbamazepine)
* Dilantin (phenytoin)
* phenobarbital (the data are mixed regarding primidone)
* Felbatol (felbamate)
[[http://emedicine.medscape.com/article/756523-overview | Stevens-Johnson Syndrome (SJS)]], a.k.a. The Lamictal Rash, is thought to be a component of anticonvulsant hypersensitivity syndrome.  So if you got SJS, or any rash scary enough that you and/or your doctor thought it best to discontinue one or more of the above meds, the odds are you'll get a rash from one or more of the others.
[^##SJS Cross-sensitivity, or in English, having the same sort of bad reaction to a similar substance, runs in the neighborhood of 40 to 80% when it comes to people who took one aromatic AC and had the same bad reaction to another one.^]


!!!!All other AED classes
Finally we come to classifications of AEDs that are chemically related and/or work in similar ways.  There may be only one drug per class because it is unique, or it is the only still on the market, or that ever made it to the market in the first place.[[<<]]
The classes Carbonic Anhydrase Inhibitors (CAI) and GABA Reuptake Inhibitors contain drugs that do ''only'' that, otherwise most AEDs would be classified as a GABA reuptake inhibitor, and Topamax and Zonegran would also be CAIs.

Barbiturates
* mephobarbital
* Nembutal (pentobarbital sodium)
* phenobarbital

Bromides
* potassium bromide

Carbamates
* Felbatol (felbamate)

Carbonic Anhydrase Inhibitors (CAIs)
* Diamox (acetazolamide)
* sultiame

Dibenzapine derivities (carboxamides)
* Tegretol (carbamazapine)
* Trileptal (oxacarbazepine)
* Banzel (rufinamide)
* eslicarbazepine

Fatty acid derivities
* valproates:
** [[Meds.Depakote | Depakote (divalproex sodium)]]
** [[Meds.Depakene | Depakene (valproic acid)]]
** [[Meds.Depacon  | Depacon (valproate sodium or sodium valproate)]]
* Gabatril (tiagabine)
* Gabrene (progabide)
* Sabril (vigabatrin)

GABA analogues
* Gabrene (progabide)
* Sabril (vigabatrin)
* Neurontin (gabapentin) and Lyrica (pregablain) were once considered GABA analogues.

GABA reuptake inhibitors
* Gabatril (tiagabine)
* Neurontin (gabapentin)
* Lyrica (pregablain) - although not everyone agrees on just how Neurontin and Lyrica work...

alpha 2 delta ligands
* Neurontin (gabapentin) - because they're also categorized as this
* Lyrica (pregablain)

Hydantoins
* Peganone (ethotoin)
* Mesantoin (fosphentyoin)
* Dilantin (phenytoin)

Oxazolidinediones
* trimethadione

Phenyltriazines / Triazines
* Lamictal (lamotrigine)

Pyrrolidines
* Keppra (levetiracetam)
* Keppra derivatives (e.g. brivaracetam) that UCB is working on.

Succinimides
* ethosuximide
* methsuximide
* phensuximide

Sulfamate-substituted monosaccharides / Fructose derivatives
* Topamax (topiramate)

Sulfonamides
* Diamox (acetazolamide)
* sulthiame
* Zonegran (zonisamide)

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!!!!AED equivalences
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!!!AP equivalences
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Page created by: Jerod Poore.  Date created: 21 November 2010  Last edited by: {$Author}
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Page created by: Jerod Poore.  Date created: 31 December 2010  Last edited by: {$Author}
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With better technology and more competition for grant money, researchers are looking back at FGAs to see how they work.  Turns out they all don't work the same way after all and some (loxapine, chlorprothixene, e.g.) are a lot more like atypical / second-generation antipsychotics than FGAs.
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With better technology and more competition for grant money, researchers are looking back at FGAs to see how they work.  Turns out they all don't work the same way after all and some (loxapine, chlorprothixene, e.g.) are like Haldol in that they are a lot more like [[#AAPs|atypical / second-generation antipsychotics]] than FGAs.
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[^## This class of meds also includes drugs with the same chemical structure that are not used as antipsychotics.  Most phenothiazines can be used to treat intense vomiting.  Phenothiazines that aren't classified as antipsychotics are popular as antiemetics in emergency rooms because they help to calm you the hell down.^]
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[^##pheno This class of meds also includes drugs with the same chemical structure that are not used as antipsychotics.  Most phenothiazines can be used to treat intense vomiting.  Phenothiazines that aren't classified as antipsychotics are popular as antiemetics in emergency rooms because they help to calm you the hell down.^]
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[[#AAPs]]
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!!!First Generation Antipsychotic Agents
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!!!First Generation Antipsychotic Agents / Neuroleptics
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!!!Second Generation Antipsychotic Agents
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!!!Second Generation Antipsychotic Agents / Neuroleptics
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!!!Third generation antipsychotic agents (TGAs) are APs that are both dopamine antagonists (interfering with dopamine reception) and partial agonists (stabilizing dopamine reception).  Abilify (aripiprazole) is the first TGA on the market, several more are under development / in various clinical trial phases.
to:
!!!Third Generation Antipsychotic Agents / Neuroleptics
Third generation antipsychotic agents (TGAs) are APs that are both dopamine antagonists (interfering with dopamine reception) and partial agonists (stabilizing dopamine reception).  Abilify (aripiprazole) is the first TGA on the market, several more are under development / in various clinical trial phases.
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!!!!AP equivalences
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!!!AP equivalences
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Second generation antipsychotic agents (SGAs), more commonly known as atypical APs (AAPs), are APs that do a lot more than FGAs.  I.e. they are broad-spectrum antagonists of dopamine, alpha-noradrenergic, and serotonin receptors.  Except for Risperdal (risperidone) and Invega (paliperidone) - which is Risperdal's active metabolite (i.e. predigested Risperdal) in pill form - no two of them work the same way.  Clozaril (clozapine), Zyprexa (olanzapine) and Saphris ( ) are fairly close in pharmacodynamics, and they bind to practically every neurotransmitter receptor you've got, while Risperdal / Invega don't do much more than Haldol.
to:
Second generation antipsychotic agents (SGAs), more commonly known as atypical APs (AAPs), are APs that do a lot more than FGAs.  I.e. they are broad-spectrum antagonists of dopamine, alpha-noradrenergic, and serotonin receptors.  Except for Risperdal (risperidone) and Invega (paliperidone) - which is Risperdal's active metabolite (i.e. predigested Risperdal) in pill form - no two of them work the same way.  Clozaril (clozapine), Zyprexa (olanzapine) and Saphris (asenapine) are fairly close in pharmacodynamics, and they bind to practically every neurotransmitter receptor you've got, while Risperdal / Invega don't do much more than Haldol.
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!!!!High-potency antipscyhotics / neuroleptics

!!!!Low-potency antipscyhotics / neuroleptics
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!!!!List of high-potency antipscyhotics / neuroleptics

!!!!List of low-potency antipscyhotics / neuroleptics
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FGAs are also categorized by how strong they are.  Remember: potency does not equal efficacy.
!!!!High-potency antipscyhotics / neuroleptics

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Regardless of generation, APs are also categorized by how strong they are.  Remember: potency does not equal efficacy.
!!!!High-potency antipscyhotics / neuroleptics

!!!!Low-potency antipscyhotics / neuroleptics
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Like [[MedClass.AD | antidepressants (ADs)]] and [[MedClass.AED | anticonvulsants / antiepileptic drugs (AEDs),]] antipsychotics (APs) are broken up into different classes based upon things like chemical structure and how they work in your brain.  Like AEDs there is some overlapping membership, and classes that consist of a single drug.  Currently the primary classification of APs is a combination of age and how they work (pharmacodynamics). 
to:
Like [[MedClass.AD | antidepressants (ADs)]] and [[MedClass.AED | anticonvulsants / antiepileptic drugs (AEDs),]] antipsychotics (APs) are broken up into different classes based upon things like chemical structure and how they work in your brain.  Like AEDs there is some overlapping membership.  Currently the primary classification of APs is a combination of age and how they work (pharmacodynamics). 
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FGAs are also categorized by how strong they are.  Remember: potency does not equal efficacy.
!!!!High-potency antipscyhotics / neuroleptics

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* Solian (amisulpride)
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With better technology and more competition for grant money, researchers are looking back at FGAs to see how they work.  Turns out they all don't work the same way after all.
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With better technology and more competition for grant money, researchers are looking back at FGAs to see how they work.  Turns out they all don't work the same way after all and some (loxapine, chlorprothixene, e.g.) are a lot more like atypical / second-generation antipsychotics than FGAs.
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!!!Third generation antipsychotic agents (TGAs) are APs that are both dopamine antagonists (interfering with dopamine reception) and partial agonist (stabilizing dopamine reception).  Abilify (aripiprazole) is the first TGA on the market, several more are under development / in various clinical trial phases.
to:
!!!Third generation antipsychotic agents (TGAs) are APs that are both dopamine antagonists (interfering with dopamine reception) and partial agonists (stabilizing dopamine reception).  Abilify (aripiprazole) is the first TGA on the market, several more are under development / in various clinical trial phases.
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With the exception of Haldol (haloperidol), all first generation antipsychotic agents (FGAs), also known as standard antipsychotics and typical antipsychotics, were thought to work in the exact same way - binding to D2 dopamine, M1 muscarine, H1 histamine, and maybe even a little alpha-1 noradrenergic receptors to interfere with the reception of those neurotransmitters (D2, M1, H1 and &#945;1 antagonists).  The only differences being chemical structure, potency at the various receptors, where in your brain this would happen, and each drug's [[MedInfo.PK|pharmacokinetics.]]  Haldol is different in that it doesn't do much as far as M1 and H1 are concerned, and is a lot more potent in binding to alpha-1, so its side effect profile is somewhat different.
to:
With the exception of lithium carbonate and Haldol (haloperidol), all first generation antipsychotic agents (FGAs), also known as standard antipsychotics and typical antipsychotics, were thought to work in the exact same way - binding to D2 dopamine, M1 muscarine, H1 histamine, and maybe even a little alpha-1 noradrenergic receptors to interfere with the reception of those neurotransmitters (D2, M1, H1 and &#945;1 antagonists).  The only differences being chemical structure, potency at the various receptors, where in your brain this would happen, and each drug's [[MedInfo.PK|pharmacokinetics.]]  Haldol is different in that it doesn't do much as far as M1 and H1 are concerned, and is a lot more potent in binding to alpha-1, so its side effect profile is somewhat different.
Changed lines 23-24 from:

!!!!Phenothiazines[^##pheno^], a subset of FGAs:
to:
* Haldol (haloperidol)
* haloperidol decanoate
* Loxitane (loxapine succinate)
* Moban (molindone HCl)
* Orap (pimozide)
* Navane (thiothixene)
* Serpasil (reserpine)
* Taractan / Truxal (chlorprothixene)
* Sordinol (clopenthixol)
* Depixol / Fluanxol (flupentixol)
* flupentixol deconate
* Clopixol / Acuphase (zuclopenthixol)
* zuclopenthixol deconate

Subsets of
FGAs:
!!!!Phenothiazines[^##pheno^]
Added lines 49-58:
!!!!Thioxanthenes
* Navane (thiothixene)
* Taractan / Truxal (chlorprothixene)
* Sordinol (clopenthixol)
* Depixol / Fluanxol (flupentixol)
* flupentixol deconate
* Clopixol / Acuphase (zuclopenthixol)
* zuclopenthixol deconate

Changed lines 60-61 from:
Second generation antipsychotic agents (SGAs), more commonly known as atypical APs (AAPs), are APs that do a lot more than FGAs.  Except for Risperdal (risperidone) and Invega (paliperidone) - which is Risperdal's active metabolite (i.e. predigested for you) in pill form - no two of them work the same way.  Clozaril (clozapine), Zyprexa (olanzapine) and Saphris ( ) are fairly close in pharmacodynamics, and they bind to practically every neurotransmitter receptor you've got, while Risperdal / Invega don't do much more than Haldol.
to:
Second generation antipsychotic agents (SGAs), more commonly known as atypical APs (AAPs), are APs that do a lot more than FGAs.  I.e. they are broad-spectrum antagonists of dopamine, alpha-noradrenergic, and serotonin receptors.  Except for Risperdal (risperidone) and Invega (paliperidone) - which is Risperdal's active metabolite (i.e. predigested Risperdal) in pill form - no two of them work the same way.  Clozaril (clozapine), Zyprexa (olanzapine) and Saphris ( ) are fairly close in pharmacodynamics, and they bind to practically every neurotransmitter receptor you've got, while Risperdal / Invega don't do much more than Haldol.
Changed lines 63-96 from:
Third generation antipsychotic agents (TGAs) are APs that are both dopamine antagonists (interfering with dopamine reception) and partial agonist (stabilizing dopamine reception).  Abilify (aripiprazole) is the first TGA on the market, several more are under development / in various clinical trial phases.

While some are used as AEDs, most benzos are prescribed only for anxiety and other conditions these days, so they get their own pages.  Some, like Xanax (alprazolam), are not even approved by the FDA to treat epilepsy or any kind of seizure disorder.  Unless otherwise specified the terms "antiepileptic drug" and "anticonvulsant" will refer to non-benzodiazepine anticonvulsants.

The next classifications are based on [[MedInfo.PK | pharmacokinetics]].

!!!!Enzyme-inducing AEDs
The first is which AEDs induce CYP450 and/or UGT enzymes.  Enzyme-inducing AEDs (EIAEDs) can have numerous drug-drug interactions, as well as deplete your body of vitamin D'_3_'.  EIAEDs include:   
* Tegretol (carbamazapine)
* Dilantin (phenytoin)
* phenobarbital
* primidone
* Trileptal (oxacarbazepine)
* Topamax (topiramate)
* Sabril (vigabatrin)

Most of the time EIAEDs refers only to Tegretol, Dilantin, and phenobarbital, because:
* primidone is converted to phenobarbital.
* Trileptal's induction of UGT enzymes is only moderate and it doesn't do much in the way of CYP3A4/5 induction like Tegretol does.
* Topamax induces some enzymes, but only at higher dosages.
* Lamictal barely induces UGT enzymes, so it rarely makes a difference.
* Why Sabril speeds up the clearance of some meds hasn't been identified.  Enzyme induction is assumed.
* Anything else that may induce CYP or UGT enzymes is so rarely prescribed these days that any doctor who prescribes it had better know everything there is about that med.

Lots of other medications, both crazy and non-crazy meds, induce CYP450 and UGT enzymes.  AEDs are singled out because epileptics have been given more than one med to control their seizures for over 150 years;[^##poly^] so neurologists as a group are more aware of drug-drug interactions and how the slightest change in dosage can affect their patients' symptoms than most other doctors.
[^##poly Most modern AEDs are approved by the FDA to be used only with other AEDs.  Topamax was the first AED in a long time to receive FDA approval to be used all by itself (monotherapy) to treat both partial and generalized seizures.[[<<]]Potassium bromide is still in use after 150 years, although it is the final straw you'd ever want to grasp at.  Phenobarbital is over 100 years old and may be in front of some newer meds to try if you're running out of options.^]

!!!!Enzyme-inhibiting AEDs
Some doctors, researchers, et al. lump remaining AEDs into a category called non-EIAED, but the true flipside of enzyme induction is [[MedInfo.PK | enzyme inhibition or suppression]].  There is only one group of commonly-prescribed AEDs that inhibits UGT (or any) enzymes involved in the metabolism of any medications to any meaningful extent, and that's [[Meds.valproates | the valproates]]:

* [[Meds.Depakote | Depakote (divalproex sodium)]]
* [[Meds.Depakene | Depakene (valproic acid)]]
* [[Meds.Depacon  | Depacon (valproate sodium or sodium valproate)]]

to:
* Zyprexa (olanzapine)
* Seroquel (quetiapine fumarate)
* Geodon (ziprasidone)
* Fanapt (iloperidone)
* Saphris (asenapine)
* Risperdal (risperidone)
* Invega (paliperidone)
* Clozaril (clozapine)

!!!Third generation antipsychotic agents (TGAs) are APs that are both dopamine antagonists (interfering with dopamine reception) and partial agonist (stabilizing dopamine reception).  Abilify (aripiprazole) is the first TGA on the market, several more are under development / in various clinical trial phases.

Changed line 76 from:
(:GoogleAEDs:)
to:
(:GoogleAPs:)
Changed lines 79-172 from:
!!!!Aromatic Anticonvulsants
The next group is the aromatic anticonvulsants.  These meds don't help you smell purty.  Aromatic refers to aromatic hydroxylation, which is part of [[MedInfo.PK | the process when these drugs are metabolized.]]  With a very small percentage of people (somewhere between 1 in 1,500 or 1 in 10,000) the metabolism isn't done correctly and a toxic substance (arene oxides) is left over instead of getting cleaned up.  The leftover  triggers [[http://www.medscape.com/viewarticle/564608 | anticonvulsant hypersensitivity syndrome]], and that sucks donkey dong.  Anticonvulsants with a particular chemical structure (similar to [[MedClass.TCA | TCAs]], and [[http://www.ncbi.nlm.nih.gov/pubmed/17165282 | TCAs may trigger a similar reaction]]) are going to be converted into the problem toxin, but there's no way (yet) of telling if someone won't be able to properly metabolize the toxin once it is created.  While the odds are a bad reaction of one of these drugs means a bad reaction to one or more, if not all of the others, someone may have a problem with just one of them.[^##SJS^]  Or there may be one of them they can take.
* Lamictal (lamotrigine)
* Trileptal (oxcarbazepine)
* Zonegran (zonisamide)
* Tegretol (carbamazepine)
* Dilantin (phenytoin)
* phenobarbital (the data are mixed regarding primidone)
* Felbatol (felbamate)
[[http://emedicine.medscape.com/article/756523-overview | Stevens-Johnson Syndrome (SJS)]], a.k.a. The Lamictal Rash, is thought to be a component of anticonvulsant hypersensitivity syndrome.  So if you got SJS, or any rash scary enough that you and/or your doctor thought it best to discontinue one or more of the above meds, the odds are you'll get a rash from one or more of the others.
[^##SJS Cross-sensitivity, or in English, having the same sort of bad reaction to a similar substance, runs in the neighborhood of 40 to 80% when it comes to people who took one aromatic AC and had the same bad reaction to another one.^]


!!!!All other AED classes
Finally we come to classifications of AEDs that are chemically related and/or work in similar ways.  There may be only one drug per class because it is unique, or it is the only still on the market, or that ever made it to the market in the first place.[[<<]]
The classes Carbonic Anhydrase Inhibitors (CAI) and GABA Reuptake Inhibitors contain drugs that do ''only'' that, otherwise most AEDs would be classified as a GABA reuptake inhibitor, and Topamax and Zonegran would also be CAIs.

Barbiturates
* mephobarbital
* Nembutal (pentobarbital sodium)
* phenobarbital

Bromides
* potassium bromide

Carbamates
* Felbatol (felbamate)

Carbonic Anhydrase Inhibitors (CAIs)
* Diamox (acetazolamide)
* sultiame

Dibenzapine derivities (carboxamides)
* Tegretol (carbamazapine)
* Trileptal (oxacarbazepine)
* Banzel (rufinamide)
* eslicarbazepine

Fatty acid derivities
* valproates:
** [[Meds.Depakote | Depakote (divalproex sodium)]]
** [[Meds.Depakene | Depakene (valproic acid)]]
** [[Meds.Depacon  | Depacon (valproate sodium or sodium valproate)]]
* Gabatril (tiagabine)
* Gabrene (progabide)
* Sabril (vigabatrin)

GABA analogues
* Gabrene (progabide)
* Sabril (vigabatrin)
* Neurontin (gabapentin) and Lyrica (pregablain) were once considered GABA analogues.

GABA reuptake inhibitors
* Gabatril (tiagabine)
* Neurontin (gabapentin)
* Lyrica (pregablain) - although not everyone agrees on just how Neurontin and Lyrica work...

alpha 2 delta ligands
* Neurontin (gabapentin) - because they're also categorized as this
* Lyrica (pregablain)

Hydantoins
* Peganone (ethotoin)
* Mesantoin (fosphentyoin)
* Dilantin (phenytoin)

Oxazolidinediones
* trimethadione

Phenyltriazines / Triazines
* Lamictal (lamotrigine)

Pyrrolidines
* Keppra (levetiracetam)
* Keppra derivatives (e.g. brivaracetam) that UCB is working on.

Succinimides
* ethosuximide
* methsuximide
* phensuximide

Sulfamate-substituted monosaccharides / Fructose derivatives
* Topamax (topiramate)

Sulfonamides
* Diamox (acetazolamide)
* sulthiame
* Zonegran (zonisamide)

----
(:GoogleAEDs:)
----

!!!!AED equivalences
to:
!!!!AP equivalences
Changed line 94 from:
Page created by: Jerod Poore.  Date created: 21 November 2010  Last edited by: {$Author}
to:
Page created by: Jerod Poore.  Date created: 31 December 2010  Last edited by: {$Author}
Changed lines 15-23 from:
 
to:
* Thorazine (chlorpromazine HCl)
* fluphenazine decanoate
* Prolixin (fluphenazine HCl)
* Serentil (mesoridazine besylate)
* Trilafon (perphenazine)
* Compazine (prochlorperazine)
* Mellaril (thioridazine HCl)
* Stelazine trifluoperazine HCl

Changed lines 25-33 from:
Thorazine (chlorpromazine HCl)
fluphenazine decanoate
Prolixin (fluphenazine HCl)
Serentil (mesoridazine besylate)
Trilafon (perphenazine)
prochlorperazine
promazine HCl
thioridazine HCl
trifluoperazine
HCl
to:
* Thorazine (chlorpromazine HCl)
* fluphenazine decanoate
* Prolixin (fluphenazine HCl)
* Serentil (mesoridazine besylate)
* Trilafon (perphenazine)
* Compazine (prochlorperazine)
* Mellaril (thioridazine HCl)
* Stelazine
trifluoperazine HCl
Changed lines 8-13 from:
Like [[MedClass.AD | antidepressants (ADs)]] and [[MedClass.AED | anticonvulsants / antiepileptic drugs (AEDs),]] antipsychotics (APs) are broken up into different classes based upon things like chemical structure and how they work in your brain.  Like AEDs there is some overlapping membership, and classes that consist of a single drug.

Currently
the primary classification of APs is a combination of age and how they work (pharmacodynamics).  With the exception of Haldol (haloperidol), all first generation antipsychotic agents (FGAs), also known as standard antipsychotics and typical antipsychotics, were thought to work in the exact same way - binding to D2 dopamine, M1 muscarine, H1 histamine, and maybe even a little alpha-1 noradrenergic receptors to interfere with the reception of those neurotransmitters (D2, M1, H1 and &#945;1 antagonists).  The only differences being chemical structure, potency at the various receptors, where in your brain this would happen, and each drug's [[MedInfo.PK|pharmacokinetics.]]  Haldol is different in that it doesn't do much as far as M1 and H1 are concerned, and is a lot more potent in binding to alpha-1, so its side effect profile is somewhat different.[[<<]]
With better technology and more competition for grant money, researchers are looking back at FGAs to see how they work.  Turns out they all don't work the same way after all.[[<<]]
FGA / standard / typical APs include:[[<<]]

to:
Like [[MedClass.AD | antidepressants (ADs)]] and [[MedClass.AED | anticonvulsants / antiepileptic drugs (AEDs),]] antipsychotics (APs) are broken up into different classes based upon things like chemical structure and how they work in your brain.  Like AEDs there is some overlapping membership, and classes that consist of a single drug.  Currently the primary classification of APs is a combination of age and how they work (pharmacodynamics). 

!!!First Generation Antipsychotic Agents
With the exception of Haldol
(haloperidol), all first generation antipsychotic agents (FGAs), also known as standard antipsychotics and typical antipsychotics, were thought to work in the exact same way - binding to D2 dopamine, M1 muscarine, H1 histamine, and maybe even a little alpha-1 noradrenergic receptors to interfere with the reception of those neurotransmitters (D2, M1, H1 and &#945;1 antagonists).  The only differences being chemical structure, potency at the various receptors, where in your brain this would happen, and each drug's [[MedInfo.PK|pharmacokinetics.]]  Haldol is different in that it doesn't do much as far as M1 and H1 are concerned, and is a lot more potent in binding to alpha-1, so its side effect profile is somewhat different.

With better technology and more competition for grant money, researchers are looking back at FGAs to see how they work.  Turns out they all don't work the same way after all.
!!!! List of First Generation / Standard / Typical Antipsychotic Agents
Changed line 16 from:
A subset of FGAs are phenothiazines[^##pheno^].  They include:[[<<]]
to:
!!!!Phenothiazines[^##pheno^], a subset of FGAs:
Changed lines 28-30 from:

Next are second generation antipsychotic agents (SGAs), more commonly known as atypical APs (AAPs), are APs that do a lot more than FGAs.  Except for Risperdal (risperidone) and Invega (paliperidone) - which is Risperdal's active metabolite (i.e. predigested for you) in pill form - no two of them work the same way.  Clozaril (clozapine), Zyprexa (olanzapine) and Saphris ( ) are fairly close in pharmacodynamics, and they bind to practically every neurotransmitter receptor you've got, while Risperdal / Invega don't do much more than Haldol.
to:
!!!Second Generation Antipsychotic Agents
Second
generation antipsychotic agents (SGAs), more commonly known as atypical APs (AAPs), are APs that do a lot more than FGAs.  Except for Risperdal (risperidone) and Invega (paliperidone) - which is Risperdal's active metabolite (i.e. predigested for you) in pill form - no two of them work the same way.  Clozaril (clozapine), Zyprexa (olanzapine) and Saphris ( ) are fairly close in pharmacodynamics, and they bind to practically every neurotransmitter receptor you've got, while Risperdal / Invega don't do much more than Haldol.

!!!! List of Second Generation / Atypical Antipsychotic Agents
Changed lines 15-27 from:
A subset of FGAs are phenothiazines.  They include:[[<<]]
Chlorpromazine Hydrochloride
Fluphenazine Decanoate
(1322)
Fluphenazine Hydrochloride (1324)
Mesoridazine Besylate (1744)
Perphenazine (1988)
Prochlorperazine (2120)
Promazine Hydrochloride (2124)
Promethazine Hydrochloride (2125)
Thiethylperazine Maleate (2337)
Thioridazine Hydrochloride (2341)
Trifluoperazine Hydrochloride (2382)

to:
A subset of FGAs are phenothiazines[^##pheno^].  They include:[[<<]]
Thorazine
(chlorpromazine HCl)
fluphenazine decanoate
Prolixin
(fluphenazine HCl)
Serentil (mesoridazine besylate)
Trilafon (perphenazine)
prochlorperazine
promazine HCl
thioridazine HCl
trifluoperazine HCl
[^## This class of meds also includes drugs with the same chemical structure that are not used as antipsychotics.  Most phenothiazines can be used to treat intense vomiting.  Phenothiazines that aren't classified as antipsychotics are popular as antiemetics in emergency rooms because they help to calm you the hell down.^]
Changed lines 12-13 from:
FGA / standard / typical APs include:
to:
FGA / standard / typical APs include:[[<<]]
Added lines 15-28:
A subset of FGAs are phenothiazines.  They include:[[<<]]
Chlorpromazine Hydrochloride
Fluphenazine Decanoate (1322)
Fluphenazine Hydrochloride (1324)
Mesoridazine Besylate (1744)
Perphenazine (1988)
Prochlorperazine (2120)
Promazine Hydrochloride (2124)
Promethazine Hydrochloride (2125)
Thiethylperazine Maleate (2337)
Thioridazine Hydrochloride (2341)
Trifluoperazine Hydrochloride (2382)

Changed lines 10-15 from:
Currently the primary classification of APs is a combination of age and how they work (pharmacodynamics).  With the exception of Haldol (haloperidol), all first generation antipsychotics (FGAs), also known as standard antipsychotics and typical antipsychotics, were thought to work in the exact same way - binding to D2 dopamine, M1 muscarine, H1 histamine, and maybe even a little alpha-1 noradrenergic receptors to interfere with the reception of those neurotransmitters.  The only differences being potency at the various receptors, where in your brain this would happen, and each drug's (or agent's) [[MedInfo.PK|pharmacokinetics.]]  Haldol is different in that it doesn't do much as far as M1 and H1 are concerned, and is a lot more potent in binding to alpha-1, so its side effect profile is somewhat different.[[<<]]
With better technology and more competition for grant money, researchers are looking back at FGAs to see how they work.  Turns out they all don't work the same way after all. 

Next are second generation antipsychotic agents (SGAs), more commonly known as atypical APs
(AAPs).  Except for Risperdal (risperidone) and Invega (paliperidone) - which is Risperdal's active metabolite (i.e. predigested for you) in pill form - no two of them work the same way.  Clozaril (clozapine), Zyprexa (olanzapine) and Saphris ( ) are fairly close in pharmacodynamics.

Third generation
to:
Currently the primary classification of APs is a combination of age and how they work (pharmacodynamics).  With the exception of Haldol (haloperidol), all first generation antipsychotic agents (FGAs), also known as standard antipsychotics and typical antipsychotics, were thought to work in the exact same way - binding to D2 dopamine, M1 muscarine, H1 histamine, and maybe even a little alpha-1 noradrenergic receptors to interfere with the reception of those neurotransmitters (D2, M1, H1 and &#945;1 antagonists).  The only differences being chemical structure, potency at the various receptors, where in your brain this would happen, and each drug's [[MedInfo.PK|pharmacokinetics.]]  Haldol is different in that it doesn't do much as far as M1 and H1 are concerned, and is a lot more potent in binding to alpha-1, so its side effect profile is somewhat different.[[<<]]
With better technology and more competition for grant money, researchers are looking back at FGAs to see how they work.  Turns out they all don't work the same way after all.[[<<]]
FGA / standard / typical APs include:
 

Next are second generation antipsychotic agents
(SGAs), more commonly known as atypical APs (AAPs), are APs that do a lot more than FGAs.  Except for Risperdal (risperidone) and Invega (paliperidone) - which is Risperdal's active metabolite (i.e. predigested for you) in pill form - no two of them work the same way.  Clozaril (clozapine), Zyprexa (olanzapine) and Saphris ( ) are fairly close in pharmacodynamics, and they bind to practically every neurotransmitter receptor you've got, while Risperdal / Invega don't do much more than Haldol.

Third generation antipsychotic agents (TGAs) are APs that are both dopamine antagonists (interfering with dopamine reception) and partial agonist (stabilizing dopamine reception).  Abilify (aripiprazole) is the first TGA on the market, several more are under development / in various clinical trial phases.

Changed lines 13-15 from:
Next are second generation antipsychotics (SGAs), more commonly known as atypical APs (AAPs).  No two of them work the same way
to:
Next are second generation antipsychotic agents (SGAs), more commonly known as atypical APs (AAPs).  Except for Risperdal (risperidone) and Invega (paliperidone) - which is Risperdal's active metabolite (i.e. predigested for you) in pill form - no two of them work the same way.  Clozaril (clozapine), Zyprexa (olanzapine) and Saphris ( ) are fairly close in pharmacodynamics.

Third generation
Changed line 5 from:
%right%<|[[MedClass.AED | AED Topic Index]]|> [[<<]]
to:
%right%<|[[MedClass.AP | AP Topic Index]]|> [[<<]]
Changed lines 8-11 from:
Like [[MedClass.AD | antidepressants]] anticonvulsants (ACs), or antiepileptic drugs (AEDs) - the terms are nearly interchangeable[^##aedac^] - are broken up into different classes based upon things like how your liver deals with them, chemical structure, and even how they work in your brain.  Unlike antidepressants there is overlapping membership, classes that consist of a single drug, or a drug and subsequent drugs derived from it, and existing anticonvulsants will be added or removed from categories as the understanding of their pharmacodynamics and/or pharmacokinetics improved.  Thus the taxonomy of AEDs is as complex and fungible as that of mushrooms.
[^##aedac Because some benzodiazepines aren't approved, and rarely, if ever prescribed off-label
to treat epilepsy, not all anticonvulsants are AEDsSimilarly not all AEDs are in the anticonvulsant class of drugs, but only because they are being prescribed off-label.  E.g. progesterone-based birth control.^]

The primary classifications of anticonvulsants are if they are [[MedClass.Benzo | benzodiazepines]] or non-benzodiazepine anticonvulsants.
While some are used as AEDs, most benzos are prescribed only for anxiety and other conditions these days, so they get their own pages.  Some, like Xanax (alprazolam), are not even approved by the FDA to treat epilepsy or any kind of seizure disorder.  Unless otherwise specified the terms "antiepileptic drug" and "anticonvulsant" will refer to non-benzodiazepine anticonvulsants.
to:
Like [[MedClass.AD | antidepressants (ADs)]] and [[MedClass.AED | anticonvulsants / antiepileptic drugs (AEDs),]] antipsychotics (APs) are broken up into different classes based upon things like chemical structure and how they work in your brain.  Like AEDs there is some overlapping membership, and classes that consist of a single drug.

Currently the primary classification of APs is
a combination of age and how they work (pharmacodynamics).  With the exception of Haldol (haloperidol), all first generation antipsychotics (FGAs), also known as standard antipsychotics and typical antipsychotics, were thought to work in the exact same way - binding to D2 dopamine, M1 muscarine, H1 histamine, and maybe even a little alpha-1 noradrenergic receptors to interfere with the reception of those neurotransmittersThe only differences being potency at the various receptors, where in your brain this would happen, and each drug's (or agent's) [[MedInfo.PK|pharmacokinetics.]]  Haldol is different in that it doesn't do much as far as M1 and H1 are concerned, and is a lot more potent in binding to alpha-1, so its side effect profile is somewhat different.[[<<]]
With better technology and more competition for grant money, researchers are looking back at FGAs to see how they work.  Turns out they all don't work the same way after all. 

Next are second generation antipsychotics (SGAs), more commonly known as atypical APs (AAPs).  No two of them work the same way

While some are used as AEDs, most benzos are prescribed only for anxiety and other conditions these days, so they get their own pages.  Some, like Xanax (alprazolam), are not even approved by the FDA to treat epilepsy or any kind of seizure disorder.  Unless otherwise specified the terms "antiepileptic drug" and "anticonvulsant" will refer to non-benzodiazepine anticonvulsants.
Changed lines 8-9 from:
Like [[MedClass.AD | antidepressants]] anticonvulsants (ACs), or antiepileptic drugs (AEDs) - the terms are nearly interchangeable'^1^' - are broken up into different classes based upon things like how your liver deals with them, chemical structure, and even how they work in your brain.  Unlike antidepressants there is overlapping membership, classes that consist of a single drug, or a drug and subsequent drugs derived from it, and existing anticonvulsants will be added or removed from categories as the understanding of their pharmacodynamics and/or pharmacokinetics improved.  Thus the taxonomy of AEDs is as complex and fungible as that of mushrooms.
to:
Like [[MedClass.AD | antidepressants]] anticonvulsants (ACs), or antiepileptic drugs (AEDs) - the terms are nearly interchangeable[^##aedac^] - are broken up into different classes based upon things like how your liver deals with them, chemical structure, and even how they work in your brain.  Unlike antidepressants there is overlapping membership, classes that consist of a single drug, or a drug and subsequent drugs derived from it, and existing anticonvulsants will be added or removed from categories as the understanding of their pharmacodynamics and/or pharmacokinetics improved.  Thus the taxonomy of AEDs is as complex and fungible as that of mushrooms.
[^##aedac Because some benzodiazepines aren't approved, and rarely, if ever prescribed off-label to treat epilepsy, not all anticonvulsants are AEDs.  Similarly not all AEDs are in the anticonvulsant class of drugs, but only because they are being prescribed off-label.  E.g. progesterone-based birth control.^]

Changed lines 33-34 from:
Lots of other medications, both crazy and non-crazy meds, induce CYP450 and UGT enzymes.  AEDs are singled out because epileptics have been given more than one med to control their seizures for over 150 years;'^2^' so neurologists as a group are more aware of drug-drug interactions and how the slightest change in dosage can affect their patients' symptoms than most other doctors.
to:
Lots of other medications, both crazy and non-crazy meds, induce CYP450 and UGT enzymes.  AEDs are singled out because epileptics have been given more than one med to control their seizures for over 150 years;[^##poly^] so neurologists as a group are more aware of drug-drug interactions and how the slightest change in dosage can affect their patients' symptoms than most other doctors.
[^##poly Most modern AEDs are approved by the FDA to be used only with other AEDs.  Topamax was the first AED in a long time to receive FDA approval to be used all by itself (monotherapy) to treat both partial and generalized seizures.[[<<]]Potassium bromide is still in use after 150 years, although it is the final straw you'd ever want to grasp at.  Phenobarbital is over 100 years old and may be in front of some newer meds to try if you're running out of options.^]

Changed line 48 from:
The next group is the aromatic anticonvulsants.  These meds don't help you smell purty.  Aromatic refers to aromatic hydroxylation, which is part of [[MedInfo.PK | the process when these drugs are metabolized.]]  With a very small percentage of people (somewhere between 1 in 1,500 or 1 in 10,000) the metabolism isn't done correctly and a toxic substance (arene oxides) is left over instead of getting cleaned up.  The leftover  triggers [[http://www.medscape.com/viewarticle/564608 | anticonvulsant hypersensitivity syndrome]], and that sucks donkey dong.  Anticonvulsants with a particular chemical structure (similar to [[MedClass.TCA | TCAs]], and [[http://www.ncbi.nlm.nih.gov/pubmed/17165282 | TCAs may trigger a similar reaction]]) are going to be converted into the problem toxin, but there's no way (yet) of telling if someone won't be able to properly metabolize the toxin once it is created.  While the odds are a bad reaction of one of these drugs means a bad reaction to one or more, if not all of the others, someone may have a problem with just one of them.'^3^'  Or there may be one of them they can take.
to:
The next group is the aromatic anticonvulsants.  These meds don't help you smell purty.  Aromatic refers to aromatic hydroxylation, which is part of [[MedInfo.PK | the process when these drugs are metabolized.]]  With a very small percentage of people (somewhere between 1 in 1,500 or 1 in 10,000) the metabolism isn't done correctly and a toxic substance (arene oxides) is left over instead of getting cleaned up.  The leftover  triggers [[http://www.medscape.com/viewarticle/564608 | anticonvulsant hypersensitivity syndrome]], and that sucks donkey dong.  Anticonvulsants with a particular chemical structure (similar to [[MedClass.TCA | TCAs]], and [[http://www.ncbi.nlm.nih.gov/pubmed/17165282 | TCAs may trigger a similar reaction]]) are going to be converted into the problem toxin, but there's no way (yet) of telling if someone won't be able to properly metabolize the toxin once it is created.  While the odds are a bad reaction of one of these drugs means a bad reaction to one or more, if not all of the others, someone may have a problem with just one of them.[^##SJS^]  Or there may be one of them they can take.
Changed lines 57-59 from:
to:
[^##SJS Cross-sensitivity, or in English, having the same sort of bad reaction to a similar substance, runs in the neighborhood of 40 to 80% when it comes to people who took one aromatic AC and had the same bad reaction to another one.^]

Changed lines 151-158 from:
>>font-family:arial font-size:3<<
 
'
^1^' Because some benzodiazepines aren't approved, and rarely, if ever prescribed off-label to treat epilepsy, not all anticonvulsants are AEDs.  Similarly not all AEDs are in the anticonvulsant class of drugs, but only because they are being prescribed off-label.  E.g. progesterone-based birth control.
 
'^2^' Most modern AEDs are approved by the FDA to be used only with other AEDs.  Topamax was the first AED in a long time to receive FDA approval to be used all by itself (monotherapy) to treat both partial and generalized seizures.[[<<
]]
Potassium bromide is still in use after 150 years, although it is the final straw you'd ever want to grasp at.  Phenobarbital is over 100 years old and may be in front of some newer meds to try if you're running out of options.

'^3^' Cross-sensitivity, or in English, having the same sort of bad reaction to a similar substance, runs in the neighborhood of 40 to 80% when it comes to people who took one aromatic AC and had the same bad reaction to another one.
to:
[^#^]
Changed line 75 from:
Dibenzapine derivities
to:
Dibenzapine derivities (carboxamides)
Changed line 129 from:
* sultiame
to:
* sulthiame
Changed line 129 from:
* sultiame
to:
* sulthiame
November 25, 2010, at 12:19 PM by Jerod Poore - Clarification of some terminology.
Changed lines 8-11 from:
Like [[MedClass.AD | antidepressants]] anticonvulsants (ACs), or antiepileptic drugs (AEDs) - the terms are interchangeable - are broken up into different classes based upon things like how your liver deals with them, chemical structure, and even how they work in your brain.  Unlike antidepressants there is overlapping membership, classes that consist of a single drug, or a drug and subsequent drugs derived from it, and existing anticonvulsants will be added or removed from categories as the understanding of their pharmacodynamics and/or pharmacokinetics improved.  Thus the taxonomy of AEDs is as complex and fungible as that of mushrooms.

The primary classifications of anticonvulsants are [[MedClass.Benzo | benzodiazepine]] and non-benzodiazepine.  While still used as AEDs, benzos are more often prescribed for anxiety and other conditions these days, so they get their own pages.  These pages, and the terms "antiepileptic drug" and "anticonvulsant" are for non-benzodiazepine AEDs / anticonvulsants.
to:
Like [[MedClass.AD | antidepressants]] anticonvulsants (ACs), or antiepileptic drugs (AEDs) - the terms are nearly interchangeable'^1^' - are broken up into different classes based upon things like how your liver deals with them, chemical structure, and even how they work in your brain.  Unlike antidepressants there is overlapping membership, classes that consist of a single drug, or a drug and subsequent drugs derived from it, and existing anticonvulsants will be added or removed from categories as the understanding of their pharmacodynamics and/or pharmacokinetics improved.  Thus the taxonomy of AEDs is as complex and fungible as that of mushrooms.

The primary classifications of anticonvulsants are if they are [[MedClass.Benzo | benzodiazepines]] or non-benzodiazepine anticonvulsants.  While some are used as AEDs, most benzos are prescribed only for anxiety and other conditions these days, so they get their own pages.  Some, like Xanax (alprazolam), are not even approved by the FDA to treat epilepsy or any kind of seizure disorder.  Unless otherwise specified the terms "antiepileptic drug" and "anticonvulsant" will refer to non-benzodiazepine anticonvulsants.
Changed lines 32-33 from:
Lots of other medications, both crazy and non-crazy meds, induce CYP450 and UGT enzymes.  AEDs are singled out because epileptics have been given more than one med to control their seizures for over 150 years;'^1^' so neurologists as a group are more aware of drug-drug interactions and how the slightest change in dosage can affect their patients' symptoms than most other doctors.
to:
Lots of other medications, both crazy and non-crazy meds, induce CYP450 and UGT enzymes.  AEDs are singled out because epileptics have been given more than one med to control their seizures for over 150 years;'^2^' so neurologists as a group are more aware of drug-drug interactions and how the slightest change in dosage can affect their patients' symptoms than most other doctors.
Changed line 46 from:
The next group is the aromatic anticonvulsants.  These meds don't help you smell purty.  Aromatic refers to aromatic hydroxylation, which is part of [[MedInfo.PK | the process when these drugs are metabolized.]]  With a very small percentage of people (somewhere between 1 in 1,500 or 1 in 10,000) the metabolism isn't done correctly and a toxic substance (arene oxides) is left over instead of getting cleaned up.  The leftover  triggers [[http://www.medscape.com/viewarticle/564608 | anticonvulsant hypersensitivity syndrome]], and that sucks donkey dong.  Anticonvulsants with a particular chemical structure (similar to [[MedClass.TCA | TCAs]], and [[http://www.ncbi.nlm.nih.gov/pubmed/17165282 | TCAs may trigger a similar reaction]]) are going to be converted into the problem toxin, but there's no way (yet) of telling if someone won't be able to properly metabolize the toxin once it is created.  While the odds are a bad reaction of one of these drugs means a bad reaction to one or more, if not all of the others, someone may have a problem with just one of them.'^2^'  Or there may be one of them they can take.
to:
The next group is the aromatic anticonvulsants.  These meds don't help you smell purty.  Aromatic refers to aromatic hydroxylation, which is part of [[MedInfo.PK | the process when these drugs are metabolized.]]  With a very small percentage of people (somewhere between 1 in 1,500 or 1 in 10,000) the metabolism isn't done correctly and a toxic substance (arene oxides) is left over instead of getting cleaned up.  The leftover  triggers [[http://www.medscape.com/viewarticle/564608 | anticonvulsant hypersensitivity syndrome]], and that sucks donkey dong.  Anticonvulsants with a particular chemical structure (similar to [[MedClass.TCA | TCAs]], and [[http://www.ncbi.nlm.nih.gov/pubmed/17165282 | TCAs may trigger a similar reaction]]) are going to be converted into the problem toxin, but there's no way (yet) of telling if someone won't be able to properly metabolize the toxin once it is created.  While the odds are a bad reaction of one of these drugs means a bad reaction to one or more, if not all of the others, someone may have a problem with just one of them.'^3^'  Or there may be one of them they can take.
Changed lines 54-55 from:
to:
[[http://emedicine.medscape.com/article/756523-overview | Stevens-Johnson Syndrome (SJS)]], a.k.a. The Lamictal Rash, is thought to be a component of anticonvulsant hypersensitivity syndrome.  So if you got SJS, or any rash scary enough that you and/or your doctor thought it best to discontinue one or more of the above meds, the odds are you'll get a rash from one or more of the others.
Changed line 62 from:
* pentobarbital
to:
* Nembutal (pentobarbital sodium)
Changed lines 149-151 from:
'^1^' Most modern AEDs are approved by the FDA to be used only with other AEDs.  Topamax was the first AED in a long time to receive FDA approval to be used all by itself (monotherapy) to treat both partial and generalized seizures.[[<<]]
to:
'^1^' Because some benzodiazepines aren't approved, and rarely, if ever prescribed off-label to treat epilepsy, not all anticonvulsants are AEDs.  Similarly not all AEDs are in the anticonvulsant class of drugs, but only because they are being prescribed off-label.  E.g. progesterone-based birth control.
 
'^2
^' Most modern AEDs are approved by the FDA to be used only with other AEDs.  Topamax was the first AED in a long time to receive FDA approval to be used all by itself (monotherapy) to treat both partial and generalized seizures.[[<<]]
Changed line 154 from:
'^2^' Cross-sensitivity, or in English, having the same sort of bad reaction to a similar substance, runs in the neighborhood of 40 to 80% when it comes to people who took one aromatic AC and had the same bad reaction to another one.
to:
'^3^' Cross-sensitivity, or in English, having the same sort of bad reaction to a similar substance, runs in the neighborhood of 40 to 80% when it comes to people who took one aromatic AC and had the same bad reaction to another one.
November 25, 2010, at 11:57 AM by Jerod Poore - Clarification of some terminology.
Changed lines 8-11 from:
Like [[MedClass.AD | antidepressants]] anticonvulsants (ACs), or antiepileptic drugs (AEDs) - the terms are interchangeable - are broken up into different classes based upon things like how your liver deals with them, chemical structure, and even how they work in your brain.  Unlike antidepressants there is overlapping membership, classes that consist of a single drug, or a drug and subsequent drugs derived from it, and existing anticonvulsants will be added or removed from categories as the understanding of their pharmacodynamics and/or pharmacokinetics improved.  Thus the taxonomy of AEDs is as complex and fungible as that of mushrooms.

The primary classifications of anticonvulsants are [[MedClass.Benzo | benzodiazepine]] and non-benzodiazepine.  While still used as AEDs, benzos are more often prescribed for anxiety and other conditions these days, so they get their own pages.  These pages, and the terms "antiepileptic drug" and "anticonvulsant" are for non-benzodiazepine AEDs / anticonvulsants.
to:
Like [[MedClass.AD | antidepressants]] anticonvulsants (ACs), or antiepileptic drugs (AEDs) - the terms are nearly interchangeable'^1^' - are broken up into different classes based upon things like how your liver deals with them, chemical structure, and even how they work in your brain.  Unlike antidepressants there is overlapping membership, classes that consist of a single drug, or a drug and subsequent drugs derived from it, and existing anticonvulsants will be added or removed from categories as the understanding of their pharmacodynamics and/or pharmacokinetics improved.  Thus the taxonomy of AEDs is as complex and fungible as that of mushrooms.

The primary classifications of anticonvulsants are if they are [[MedClass.Benzo | benzodiazepines]] or non-benzodiazepine anticonvulsants.  While some are used as AEDs, most benzos are prescribed only for anxiety and other conditions these days, so they get their own pages.  Some, like Xanax (alprazolam), are not even approved by the FDA to treat epilepsy or any kind of seizure disorder.  Unless otherwise specified the terms "antiepileptic drug" and "anticonvulsant" will refer to non-benzodiazepine anticonvulsants.
Changed lines 148-150 from:
'^1^' Most modern AEDs are approved by the FDA to be used only with other AEDs.  Topamax was the first AED in a long time to receive FDA approval to be used all by itself (monotherapy) to treat both partial and generalized seizures.[[<<]]
to:
'^1^' Because some benzodiazepines aren't approved, and rarely, if ever prescribed off-label to treat epilepsy, not all anticonvulsants are AEDs.  Similarly not all AEDs are in the anticonvulsant class of drugs, but only because they are being prescribed off-label.  E.g. progesterone-based birth control.
 
'^2
^' Most modern AEDs are approved by the FDA to be used only with other AEDs.  Topamax was the first AED in a long time to receive FDA approval to be used all by itself (monotherapy) to treat both partial and generalized seizures.[[<<]]
Changed line 153 from:
'^2^' Cross-sensitivity, or in English, having the same sort of bad reaction to a similar substance, runs in the neighborhood of 40 to 80% when it comes to people who took one aromatic AC and had the same bad reaction to another one.
to:
'^3^' Cross-sensitivity, or in English, having the same sort of bad reaction to a similar substance, runs in the neighborhood of 40 to 80% when it comes to people who took one aromatic AC and had the same bad reaction to another one.
Changed lines 1-2 from:
(:Title Classifications of Antiepileptic Drugs (AEDs) / Anticonvulsants :)
(:Description An overview of the different classifications of AEDs / anticonvulsants. :)
to:
(:Title Classifications of Antiepileptic Drugs / Anticonvulsants :)
(:Description An overview of the different classifications of Antiepileptic Drugs / Anticonvulsants. :)
November 23, 2010, at 01:27 PM by Jerod Poore - Added table of contents, some formatting
Changed lines 5-8 from:
%right%<|[[MedClass.AED | AED Topic Index]]|>

Like
[[MedClass.AD | antidepressants]] anticonvulsants are broken up into different classes based upon things like chemical structure, how they work in your brain or how your liver deals with them.  Unlike antidepressants there is overlapping membership, classes that consist of a single drug or a drug and drugs derived from it, and existing anticonvulsants will be added or removed from categories as the understanding of their pharmacodynamics and/or pharmacokinetics improved.  Thus the taxonomy of antiepileptic drugs (AEDs) is as complex and fungible as that of mushrooms.
to:
%right%<|[[MedClass.AED | AED Topic Index]]|> [[<<]]
(:toc-float:)

Like [[MedClass.AD | antidepressants]] anticonvulsants (ACs), or antiepileptic drugs (AEDs) - the terms are interchangeable - are broken up into different classes based upon things like how your liver deals with them, chemical structure
, and even how they work in your brain.  Unlike antidepressants there is overlapping membership, classes that consist of a single drug, or a drug and subsequent drugs derived from it, and existing anticonvulsants will be added or removed from categories as the understanding of their pharmacodynamics and/or pharmacokinetics improved.  Thus the taxonomy of AEDs is as complex and fungible as that of mushrooms.
Changed lines 12-14 from:
The next classifications are based on [[MedInfo.PK | pharmacokinetics]].[[<<]]
to:
The next classifications are based on [[MedInfo.PK | pharmacokinetics]].

!!!!Enzyme-inducing AEDs
Changed lines 34-35 from:
Some doctors, researchers, et al. lump remaining AEDs into a category called non-EIAED, but the true flipside of enzyme induction is [[MedInfo.PK | enzyme inhibition or suppression]].  Currently there is only one group of AEDs that inhibits UGT (or any) enzymes involved in the metabolism of any medications, and that's [[Meds.valproates | the valproates]]:
to:
!!!!Enzyme-inhibiting AEDs
Some
doctors, researchers, et al. lump remaining AEDs into a category called non-EIAED, but the true flipside of enzyme induction is [[MedInfo.PK | enzyme inhibition or suppression]].  There is only one group of commonly-prescribed AEDs that inhibits UGT (or any) enzymes involved in the metabolism of any medications to any meaningful extent, and that's [[Meds.valproates | the valproates]]:
Added line 45:
!!!!Aromatic Anticonvulsants
Changed lines 55-56 from:
Finally we come to classifications of drugs that are chemically related and/or work in similar ways.  There may be only one drug per class because it is unique, or it is the only still on the market, or that ever made it to the market in the first place.
to:
!!!!All other AED classes
Finally we come to classifications of AEDs that are chemically related and/or work in similar ways.  There may be only one drug per class because
it is unique, or it is the only still on the market, or that ever made it to the market in the first place.[[<<]]
The classes Carbonic Anhydrase Inhibitors (CAI) and GABA Reuptake Inhibitors contain drugs that do ''only'' that, otherwise most AEDs would be classified as a GABA reuptake inhibitor, and Topamax and Zonegran would also be CAIs.

Changed line 70 from:
Carbonic Anhydrase Inhibitors (CAIs) (and nothing else)
to:
Carbonic Anhydrase Inhibitors (CAIs)
Changed line 94 from:
GABA reuptake inhibitors (and nothing else)
to:
GABA reuptake inhibitors
Changed lines 97-98 from:
* Lyrica (pregablain) - although not everyone agrees on just how Neurontin and Lyrica work
to:
* Lyrica (pregablain) - although not everyone agrees on just how Neurontin and Lyrica work...

alpha 2 delta ligands
* Neurontin (gabapentin) - because they're also categorized as this
* Lyrica (pregablain)

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!!!!AED equivalences
Added lines 143-146:
>><<
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>><<
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November 23, 2010, at 01:00 PM by Jerod Poore - Creation of pages on AC/AED classes
Added lines 1-149:
(:Title Classifications of Antiepileptic Drugs (AEDs) / Anticonvulsants :)
(:Description An overview of the different classifications of AEDs / anticonvulsants. :)
%comment%(:if expr ( auth admin || {$Author} {$$author} ):) {[foxedit form=Meds.NewArticle]} (:if:)%
>>font-family:arial font-size:4<<
%right%<|[[MedClass.AED | AED Topic Index]]|>

Like [[MedClass.AD | antidepressants]] anticonvulsants are broken up into different classes based upon things like chemical structure, how they work in your brain or how your liver deals with them.  Unlike antidepressants there is overlapping membership, classes that consist of a single drug or a drug and drugs derived from it, and existing anticonvulsants will be added or removed from categories as the understanding of their pharmacodynamics and/or pharmacokinetics improved.  Thus the taxonomy of antiepileptic drugs (AEDs) is as complex and fungible as that of mushrooms.

The primary classifications of anticonvulsants are [[MedClass.Benzo | benzodiazepine]] and non-benzodiazepine.  While still used as AEDs, benzos are more often prescribed for anxiety and other conditions these days, so they get their own pages.  These pages, and the terms "antiepileptic drug" and "anticonvulsant" are for non-benzodiazepine AEDs / anticonvulsants.

The next classifications are based on [[MedInfo.PK | pharmacokinetics]].[[<<]]
The first is which AEDs induce CYP450 and/or UGT enzymes.  Enzyme-inducing AEDs (EIAEDs) can have numerous drug-drug interactions, as well as deplete your body of vitamin D'_3_'.  EIAEDs include:   
* Tegretol (carbamazapine)
* Dilantin (phenytoin)
* phenobarbital
* primidone
* Trileptal (oxacarbazepine)
* Topamax (topiramate)
* Sabril (vigabatrin)

Most of the time EIAEDs refers only to Tegretol, Dilantin, and phenobarbital, because:
* primidone is converted to phenobarbital.
* Trileptal's induction of UGT enzymes is only moderate and it doesn't do much in the way of CYP3A4/5 induction like Tegretol does.
* Topamax induces some enzymes, but only at higher dosages.
* Lamictal barely induces UGT enzymes, so it rarely makes a difference.
* Why Sabril speeds up the clearance of some meds hasn't been identified.  Enzyme induction is assumed.
* Anything else that may induce CYP or UGT enzymes is so rarely prescribed these days that any doctor who prescribes it had better know everything there is about that med.

Lots of other medications, both crazy and non-crazy meds, induce CYP450 and UGT enzymes.  AEDs are singled out because epileptics have been given more than one med to control their seizures for over 150 years;'^1^' so neurologists as a group are more aware of drug-drug interactions and how the slightest change in dosage can affect their patients' symptoms than most other doctors.

Some doctors, researchers, et al. lump remaining AEDs into a category called non-EIAED, but the true flipside of enzyme induction is [[MedInfo.PK | enzyme inhibition or suppression]].  Currently there is only one group of AEDs that inhibits UGT (or any) enzymes involved in the metabolism of any medications, and that's [[Meds.valproates | the valproates]]:

* [[Meds.Depakote | Depakote (divalproex sodium)]]
* [[Meds.Depakene | Depakene (valproic acid)]]
* [[Meds.Depacon  | Depacon (valproate sodium or sodium valproate)]]

----
(:GoogleAEDs:)
----

The next group is the aromatic anticonvulsants.  These meds don't help you smell purty.  Aromatic refers to aromatic hydroxylation, which is part of [[MedInfo.PK | the process when these drugs are metabolized.]]  With a very small percentage of people (somewhere between 1 in 1,500 or 1 in 10,000) the metabolism isn't done correctly and a toxic substance (arene oxides) is left over instead of getting cleaned up.  The leftover  triggers [[http://www.medscape.com/viewarticle/564608 | anticonvulsant hypersensitivity syndrome]], and that sucks donkey dong.  Anticonvulsants with a particular chemical structure (similar to [[MedClass.TCA | TCAs]], and [[http://www.ncbi.nlm.nih.gov/pubmed/17165282 | TCAs may trigger a similar reaction]]) are going to be converted into the problem toxin, but there's no way (yet) of telling if someone won't be able to properly metabolize the toxin once it is created.  While the odds are a bad reaction of one of these drugs means a bad reaction to one or more, if not all of the others, someone may have a problem with just one of them.'^2^'  Or there may be one of them they can take.
* Lamictal (lamotrigine)
* Trileptal (oxcarbazepine)
* Zonegran (zonisamide)
* Tegretol (carbamazepine)
* Dilantin (phenytoin)
* phenobarbital (the data are mixed regarding primidone)
* Felbatol (felbamate)

Finally we come to classifications of drugs that are chemically related and/or work in similar ways.  There may be only one drug per class because it is unique, or it is the only still on the market, or that ever made it to the market in the first place.

Barbiturates
* mephobarbital
* pentobarbital
* phenobarbital

Bromides
* potassium bromide

Carbamates
* Felbatol (felbamate)

Carbonic Anhydrase Inhibitors (CAIs) (and nothing else)
* Diamox (acetazolamide)
* sultiame

Dibenzapine derivities
* Tegretol (carbamazapine)
* Trileptal (oxacarbazepine)
* Banzel (rufinamide)
* eslicarbazepine

Fatty acid derivities
* valproates:
** [[Meds.Depakote | Depakote (divalproex sodium)]]
** [[Meds.Depakene | Depakene (valproic acid)]]
** [[Meds.Depacon  | Depacon (valproate sodium or sodium valproate)]]
* Gabatril (tiagabine)
* Gabrene (progabide)
* Sabril (vigabatrin)

GABA analogues
* Gabrene (progabide)
* Sabril (vigabatrin)
* Neurontin (gabapentin) and Lyrica (pregablain) were once considered GABA analogues.

GABA reuptake inhibitors (and nothing else)
* Gabatril (tiagabine)
* Neurontin (gabapentin)
* Lyrica (pregablain) - although not everyone agrees on just how Neurontin and Lyrica work

Hydantoins
* Peganone (ethotoin)
* Mesantoin (fosphentyoin)
* Dilantin (phenytoin)

Oxazolidinediones
* trimethadione

Phenyltriazines / Triazines
* Lamictal (lamotrigine)

Pyrrolidines
* Keppra (levetiracetam)
* Keppra derivatives (e.g. brivaracetam) that UCB is working on.

Succinimides
* ethosuximide
* methsuximide
* phensuximide

Sulfamate-substituted monosaccharides / Fructose derivatives
* Topamax (topiramate)

Sulfonamides
* Diamox (acetazolamide)
* sultiame
* Zonegran (zonisamide)

----
(:GoogleAEDs:)
----

Given how there are so few AEDs in each class it's little wonder few of them work the same way.  Many people ask about AEDs/ACs that are equivalent, the way SSRIs are.  Very few AEDs are: 
* The valproates are essentially interchangeable, there are some dosage adjustments required, as well as getting used to different side effects.  More information on [[valproates | the valproates page]].
* Trileptal is a derivative of Tegretol.  They aren't exactly alike, but they are close enough that switching from one to the other can be done without titration if absolutely necessary.  300mg of Trileptal (oxcarbazepine) = 200mg of Tegretol (carbamazepine USP).  The US PI sheets ([[http://crazymeds.us/TrileptalPI.pdf | Trileptal's prescribing information]] [[http://crazymeds.us/TegretolPI.pdf | Tegretol's prescribing information]]) are full of information about switching between the two.
* Lyrica isn't derived from Neurontin, but they probably have the same mechanism of action.
* Diamox and sultiame
* Zonegran and Topamax have a vaguely similar chemical structure and a very similar mechanism of action.

 
'^1^' Most modern AEDs are approved by the FDA to be used only with other AEDs.  Topamax was the first AED in a long time to receive FDA approval to be used all by itself (monotherapy) to treat both partial and generalized seizures.[[<<]]
Potassium bromide is still in use after 150 years, although it is the final straw you'd ever want to grasp at.  Phenobarbital is over 100 years old and may be in front of some newer meds to try if you're running out of options.

'^2^' Cross-sensitivity, or in English, having the same sort of bad reaction to a similar substance, runs in the neighborhood of 40 to 80% when it comes to people who took one aromatic AC and had the same bad reaction to another one.

>><<
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Page created by: Jerod Poore.  Date created: 21 November 2010  Last edited by: {$Author}
>><<
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(:include Sources.Copyright:)
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(:include Sources.Disclaimer:)
>><<
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November 23, 2010, at 12:38 PM by Jerod Poore - Creation of pages on AC/AED classes
Changed lines 5-6 from:
%comment%%right%<|[[MedClass.{{$$articlename}}Index|{{$$articletitle}} Index]]|>%
to:
%right%<|[[MedClass.AED | AED Topic Index]]|>
Changed lines 9-10 from:
The primary classification of anticonvulsants is [[MedClass.Benzo | benzodiazepine]] and non-benzodiazepine.  While still used as AEDs, benzos are more often prescribed for anxiety and other conditions these days, so they get their own pages.  These pages, and the terms "antiepileptic drug" and "anticonvulsant" are for non-benzodiazepine AEDs / anticonvulsants.
to:
The primary classifications of anticonvulsants are [[MedClass.Benzo | benzodiazepine]] and non-benzodiazepine.  While still used as AEDs, benzos are more often prescribed for anxiety and other conditions these days, so they get their own pages.  These pages, and the terms "antiepileptic drug" and "anticonvulsant" are for non-benzodiazepine AEDs / anticonvulsants.
Changed lines 29-30 from:
Some doctors, researchers, et al. lump the rest into the category of non-EIAED, but the true flipside of enzyme induction is [[MedInfo.PK | enzyme inhibition or suppression]].  Currently there is only one group of AEDs that inhibits UGT (or any) enzymes involved in the metabolism of any medications, and that's [[Meds.valproates | the valproates]]:
to:
Some doctors, researchers, et al. lump remaining AEDs into a category called non-EIAED, but the true flipside of enzyme induction is [[MedInfo.PK | enzyme inhibition or suppression]].  Currently there is only one group of AEDs that inhibits UGT (or any) enzymes involved in the metabolism of any medications, and that's [[Meds.valproates | the valproates]]:
Changed line 39 from:
The next group is the aromatic anticonvulsants.  These meds don't help you smell purty.  Aromatic refers to aromatic hydroxylation, which is part of [[MedInfo.PK | the process when these drugs are metabolized by CYP450 enzymes.]]  With a very small percentage of people (somewhere between 1 in 1,500 or 1 in 10,000) the metabolism isn't done correctly and a toxic substance is left over instead of cleaned up.  That triggers [[http://www.medscape.com/viewarticle/564608 | anticonvulsant hypersensitivity syndrome]], and that sucks donkey dong.  Anticonvulsants with a particular chemical structure (similar to [[MedClass.TCA | TCAs]], and [[http://www.ncbi.nlm.nih.gov/pubmed/17165282 | TCAs may trigger a similar reaction]]) are going to be converted into the problem toxin, but there's no way (yet) of telling if someone won't be able to properly metabolize the toxin once it is created.  While the odds are a bad reaction of one of these drugs means a bad reaction to one or more, if not all of the others, someone may have a problem with just one of them.  Or there may be one of them they can take.
to:
The next group is the aromatic anticonvulsants.  These meds don't help you smell purty.  Aromatic refers to aromatic hydroxylation, which is part of [[MedInfo.PK | the process when these drugs are metabolized.]]  With a very small percentage of people (somewhere between 1 in 1,500 or 1 in 10,000) the metabolism isn't done correctly and a toxic substance is left over instead of getting cleaned up.  The leftover  triggers [[http://www.medscape.com/viewarticle/564608 | anticonvulsant hypersensitivity syndrome]], and that sucks donkey dong.  Anticonvulsants with a particular chemical structure (similar to [[MedClass.TCA | TCAs]], and [[http://www.ncbi.nlm.nih.gov/pubmed/17165282 | TCAs may trigger a similar reaction]]) are going to be converted into the problem toxin, but there's no way (yet) of telling if someone won't be able to properly metabolize the toxin once it is created.  While the odds are a bad reaction of one of these drugs means a bad reaction to one or more, if not all of the others, someone may have a problem with just one of them.'^2^'  Or there may be one of them they can take.
Added lines 132-134:

'^2^' Cross-sensitivity, or in English, having the same sort of bad reaction to a similar substance, runs in the neighborhood of 40 to 80% when it comes to people who took one aromatic AC and had the same bad reaction to another one.

November 22, 2010, at 05:00 PM by Jerod Poore - Creation of pages on AC/AED classes
Added lines 125-127:
* Lyrica isn't derived from Neurontin, but they probably have the same mechanism of action.
* Diamox and sultiame
* Zonegran and Topamax have a vaguely similar chemical structure and a very similar mechanism of action.
November 22, 2010, at 04:48 PM by Jerod Poore - Creation of pages on AC/AED classes
Changed lines 123-124 from:
* The valproates are essentially interchangeable, there are some dosage adjustments required, as well as getting used to different side effects.
* Trileptal is a derivative of Tegretol.  They aren't exactly alike, but they are close enough that switching from one to the other can be done without titration if absolutely necessary.  300mg of Trileptal (oxcarbazepine) = 200mg of Tegretol (carbamazepine USP).  The PI sheets are full of information about switching between the two.
to:
* The valproates are essentially interchangeable, there are some dosage adjustments required, as well as getting used to different side effects.  More information on [[valproates | the valproates page]].
* Trileptal is a derivative of Tegretol.  They aren't exactly alike, but they are close enough that switching from one to the other can be done without titration if absolutely necessary.
  300mg of Trileptal (oxcarbazepine) = 200mg of Tegretol (carbamazepine USP).  The US PI sheets ([[http://crazymeds.us/TrileptalPI.pdf | Trileptal's prescribing information]] [[http://crazymeds.us/TegretolPI.pdf | Tegretol's prescribing information]]) are full of information about switching between the two.

 
November 22, 2010, at 04:44 PM by Jerod Poore - Creation of pages on AC/AED classes
Added lines 35-38:
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Changed lines 86-87 from:
* Gabatril (tiagabine)
to:
* Gabatril (tiagabine)
* Neurontin (gabapentin)
* Lyrica (pregablain) - although not everyone agrees on just how Neurontin and Lyrica work

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(:GoogleAEDs:)
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Given how there are so few AEDs in each class it's little wonder than few of them work the same.  So many people ask about AEDs/ACs that are equivalent, the way SSRIs are.  Very few AEDs are: 
* The valproates are essentially interchangeable, there are some dosage adjustments required, as well as getting used to different side effects.
* Trileptal is a derivative of Tegretol.  They aren't exactly alike, but they are close enough that switching from one to the other can be done without titration if absolutely necessary.  300mg of Trileptal (oxcarbazepine
) = 200mg of Tegretol (carbamazepine USP).  The PI sheets are full of information about switching between the two.
November 22, 2010, at 04:29 PM by Jerod Poore - Creation of pages on AC/AED classes
Added lines 57-60:
Carbonic Anhydrase Inhibitors (CAIs) (and nothing else)
* Diamox (acetazolamide)
* sultiame

Changed lines 104-106 from:
Can you guess how these last groups are related:

Sulfamate-substituted monosaccharides
to:
Sulfamate-substituted monosaccharides / Fructose derivatives
Deleted lines 111-115:
Carbonic Anhydrase Inhibitors (CAIs) (and nothing else)
* Diamox (acetazolamide)
* sultiame

That's right, they are all CAIs, although Topamax and Zonegran do a lot more.  Topamax and Zonegran have similar mechanisms of action, and are two of extremely few AEDs that work in similar ways where one isn't derived from the other.
November 22, 2010, at 04:05 PM by Jerod Poore - Creation of pages on AC/AED classes
Added lines 1-138:
(:Title Classifications of Antiepileptic Drugs (AEDs) / Anticonvulsants :)
(:Description An overview of the different classifications of AEDs / anticonvulsants. :)
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%comment%%right%<|[[MedClass.{{$$articlename}}Index|{{$$articletitle}} Index]]|>%

Like [[MedClass.AD | antidepressants]] anticonvulsants are broken up into different classes based upon things like chemical structure, how they work in your brain or how your liver deals with them.  Unlike antidepressants there is overlapping membership, classes that consist of a single drug or a drug and drugs derived from it, and existing anticonvulsants will be added or removed from categories as the understanding of their pharmacodynamics and/or pharmacokinetics improved.  Thus the taxonomy of antiepileptic drugs (AEDs) is as complex and fungible as that of mushrooms.

The primary classification of anticonvulsants is [[MedClass.Benzo | benzodiazepine]] and non-benzodiazepine.  While still used as AEDs, benzos are more often prescribed for anxiety and other conditions these days, so they get their own pages.  These pages, and the terms "antiepileptic drug" and "anticonvulsant" are for non-benzodiazepine AEDs / anticonvulsants.

The next classifications are based on [[MedInfo.PK | pharmacokinetics,]] specifically those AEDs that induce CYP450 and/or UGT enzymes.  Enzyme-inducing AEDs (EIAEDs) can have numerous drug-drug interactions, as well as deplete your body of vitamin D'_3_'.  EIAEDs include:   
* Tegretol (carbamazapine)
* Dilantin (phenytoin)
* phenobarbital
* primidone
* Trileptal (oxacarbazepine)
* Topamax (topiramate)
* Sabril (vigabatrin)

Most of the time EIAEDs refers only to Tegretol, Dilantin, and phenobarbital, because:
* primidone is converted to phenobarbital.
* Trileptal's induction of UGT enzymes is only moderate and it doesn't do much in the way of CYP3A4/5 induction like Tegretol does.
* Topamax induces some enzymes, but only at higher dosages.
* Lamictal barely induces UGT enzymes, so it rarely makes a difference.
* Why Sabril speeds up the clearance of some meds hasn't been identified.  Enzyme induction is assumed.

Lots of other medications, both crazy and non-crazy meds, induce CYP450 and UGT enzymes.  AEDs are singled out because epileptics have been given more than one med to control their seizures for over 150 years;'^1^' so neurologists as a group are more aware of drug-drug interactions and how the slightest change in dosage can affect their patients' symptoms than most other doctors.

Some doctors, researchers, et al. lump the rest into the category of non-EIAED, but the true flipside of enzyme induction is [[MedInfo.PK | enzyme inhibition or suppression]].  Currently there is only one group of AEDs that inhibits UGT (or any) enzymes involved in the metabolism of any medications, and that's [[Meds.valproates | the valproates]]:

* [[Meds.Depakote | Depakote (divalproex sodium)]]
* [[Meds.Depakene | Depakene (valproic acid)]]
* [[Meds.Depacon  | Depacon (valproate sodium or sodium valproate)]]

The next group is the aromatic anticonvulsants.  These meds don't help you smell purty.  Aromatic refers to aromatic hydroxylation, which is part of [[MedInfo.PK | the process when these drugs are metabolized by CYP450 enzymes.]]  With a very small percentage of people (somewhere between 1 in 1,500 or 1 in 10,000) the metabolism isn't done correctly and a toxic substance is left over instead of cleaned up.  That triggers [[http://www.medscape.com/viewarticle/564608 | anticonvulsant hypersensitivity syndrome]], and that sucks donkey dong.  Anticonvulsants with a particular chemical structure (similar to [[MedClass.TCA | TCAs]], and [[http://www.ncbi.nlm.nih.gov/pubmed/17165282 | TCAs may trigger a similar reaction]]) are going to be converted into the problem toxin, but there's no way (yet) of telling if someone won't be able to properly metabolize the toxin once it is created.  While the odds are a bad reaction of one of these drugs means a bad reaction to one or more, if not all of the others, someone may have a problem with just one of them.  Or there may be one of them they can take.
* Dilantin (phenytoin)
* Tegretol (carbamazepine)
* phenobarbital (the data are mixed regarding primidone)
* Lamictal (lamotrigine)
* Felbatol (felbamate)
* Trileptal (oxcarbazepine)
* Zonegran (zonisamide)

Finally we come to classifications of drugs that are chemically related and/or work in similar ways.  There may be only one drug per class because it is unique, or it is the only still on the market, or that ever made it to the market in the first place.

Barbiturates
* mephobarbital
* pentobarbital
* phenobarbital

Bromides
* potassium bromide

Carbamates
* Felbatol (felbamate)

Dibenzapine derivities
* Tegretol (carbamazapine)
* Trileptal (oxacarbazepine)
* Banzel (rufinamide)
* eslicarbazepine

Fatty acid derivities
* valproates:
** [[Meds.Depakote | Depakote (divalproex sodium)]]
** [[Meds.Depakene | Depakene (valproic acid)]]
** [[Meds.Depacon  | Depacon (valproate sodium or sodium valproate)]]
* Gabatril (tiagabine)
* Gabrene (progabide)
* Sabril (vigabatrin)

GABA analogues
* Gabrene (progabide)
* Sabril (vigabatrin)
* Neurontin (gabapentin) and Lyrica (pregablain) were once considered GABA analogues.

GABA reuptake inhibitors (and nothing else)
* Gabatril (tiagabine)

Hydantoins
* Peganone (ethotoin)
* Mesantoin (fosphentyoin)
* Dilantin (phenytoin)

Oxazolidinediones
* trimethadione

Phenyltriazines / Triazines
* Lamictal (lamotrigine)

Pyrrolidines
* Keppra (levetiracetam)
* Keppra derivatives (e.g. brivaracetam) that UCB is working on.

Succinimides
* ethosuximide
* methsuximide
* phensuximide

Can you guess how these last groups are related:

Sulfamate-substituted monosaccharides
* Topamax (topiramate)

Sulfonamides
* Diamox (acetazolamide)
* sultiame
* Zonegran (zonisamide)

Carbonic Anhydrase Inhibitors (CAIs) (and nothing else)
* Diamox (acetazolamide)
* sultiame

That's right, they are all CAIs, although Topamax and Zonegran do a lot more.  Topamax and Zonegran have similar mechanisms of action, and are two of extremely few AEDs that work in similar ways where one isn't derived from the other.

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'^1^' Most modern AEDs are approved by the FDA to be used only with other AEDs.  Topamax was the first AED in a long time to receive FDA approval to be used all by itself (monotherapy) to treat both partial and generalized seizures.[[<<]]
Potassium bromide is still in use after 150 years, although it is the final straw you'd ever want to grasp at.  Phenobarbital is over 100 years old and may be in front of some newer meds to try if you're running out of options.
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Page created by: Jerod Poore.  Date created: 21 November 2010  Last edited by: {$Author}
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