Pharmacology/gabitril

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QUESTION: dr cappuccilli.I am a 80 year old and have  been taking for insomnia Xanax and lunesta.my doctor said get off Xanax and try gabitril a epilectic medication.it is off label but she has 50 non-epilectics taking gabitril for sleep.she said chances of non-epilectic getting seizurers are only about 1%doctor said it works on gaba like most hyptonics.however shs said gabitril has less side effects then ambien or lunesta.sounds good should I be concerned about seizurers with gabitril since im non-epilectic

ANSWER: There is always a possibility of adverse reactions with ANYTHING we take - all the way to drinking water and breathing oxygen - everything has risks.  What you should be concerned with is the risk benefit profile.

Xanax does not bind with the GABA receptor.
They (benzodiazepines including XANAX and Valium) do not bind to the GABA recognition site, the Benzodiazepines do not work as directly as GABA in allowing the free passage of chloride ions through the pore of the receptor. Instead, when a drug like Valium of Xanax binds to its specific recognition site, the 3-dimensional shape of the GABAa receptor changes in such a way as to allow GABA to bind more easily to its own binding site.

Tiagabine actually binds to the GABA reuptake receptors - this slows the reuptake of the molecule which subsequently provides higher levels of the neurotransmitter in the synapse - increasing and prolonging activity.

The fact that they do not work the same means that the Tiagabine may or may not work on you in the same way.  In the risk benefit balance however - the Tiagabine has a much LOWER side effect profile and in my judgment is a better option for you.  Long term use of medications like Xanax is never a good idea.  We become tolerant and physically dependent and ultimately addicted to drugs like this. If you can get off Xanax you should.

I agree with the doctor's opinion that the Gabitril is a better option for you.

Hope that helps.

Joshua Cappuccilli, PharmD, Rph



---------- FOLLOW-UP ----------

QUESTION: appreciate e-mail you sent me which was nicely written and informative.i agree with  you that gabitril is the way to go.as a non-epilectic should I be  concerned about seizurers

Answer
Frank,

I can see how you would still be unclear because I didn't specifically say that they would or would not be a challenge.  What I meant when I said that Gabitril has a lower side effect profile I meant that I do not believe there are likely side effects that would outweigh the benefits.

If I felt that there was a likely risk of seizures I would have made note of that.

Hope that clears it up for you.

Joshua

Pharmacology

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Dr. Joshua Cappuccilli

Expertise

I can answer most questions involving medication use, side effects, adverse effects, interactions and how drugs relate to specific disease states. No one can answer all questions; I will respond as such if I cannot provide an answer. I will provide resources / references for the information that I use to formulate the answer given.

Experience

I am a Doctor of Pharmacy currently practicing in Florida in a retail pharmacy.

Organizations
California Phamacist Association American Pharmacy Assocaition

Education/Credentials
BA University of South Florida PharmD University of Florida APhA Medication Therapy Management certification

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