Valproate is one of the most commonly used mood stabilizers and antiepileptic drugs worldwide. It works by increasing levels of the inhibitory neurotransmitter GABA in the brain. It is metabolized primarily by the CYP2C9 enzyme system. Valproate has demonstrated efficacy in treating mania, mixed episodes, schizophrenia, depression, anxiety disorders, substance use disorders, impulsivity, aggression, migraine prevention, and epilepsy. However, it has a weak role in treating acute bipolar depression and carries risks of side effects like weight gain, menstrual irregularities, and teratogenicity. The risks of major birth defects appear to be influenced by both drug type and dose. Generic substitution of antiepileptic
Prospective Observational Study of Sodium Valproate in Seizure Control and As...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
Prospective Observational Study of Sodium Valproate in Seizure Control and As...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
New Treatment Devices and Clinical Trials jgreenberger
Dr. Kathryn Davis from Penn Epilepsy Center present on new treatment devices and clinical trials for epilepsy. From the 2014 Epilepsy Education Exchange.
Hi, I am Dr Komal Ghiya, pediatric dentist by profession, I am here to share some of my own presentations for educational purposes. I hope you a presentation on ANALGESICS IN PEDIATRIC DENTISTRY will be useful for all the dental and medical students. Comments are welcome if you like the presentations and if not please suggest some ways I could make them better for you. All the best
New Treatment Devices and Clinical Trials jgreenberger
Dr. Kathryn Davis from Penn Epilepsy Center present on new treatment devices and clinical trials for epilepsy. From the 2014 Epilepsy Education Exchange.
Hi, I am Dr Komal Ghiya, pediatric dentist by profession, I am here to share some of my own presentations for educational purposes. I hope you a presentation on ANALGESICS IN PEDIATRIC DENTISTRY will be useful for all the dental and medical students. Comments are welcome if you like the presentations and if not please suggest some ways I could make them better for you. All the best
Adjuvant therapy, also known as adjunct therapy or add-on therapy, is therapy given in addition to the primary or initial therapy to maximize its effectiveness.
Add-ons have become ubiquitous with the process of assisted reproduction (ART) which is markedly more complex than it was at its inception.
Obstetric outcomes associated with second trimester unexplained abnormal mate...Apollo Hospitals
1) To compare the adverse obstetrical outcomes in the patient population with normal blood MoMs.
2) To determine the probability of occurrence of an adverse obstetric event in relation with abnormal maternal blood
analytes.
Progesterone for luteal phase support in IVF cyclesHesham Al-Inany
Luteal phase support is essential for IVF cycles. Progesterone has many forms and modalities: which to use? this talk is an attempt to answer this question
Deleterious Effects Of Antidepressants On Semen Parameters: A Case ReportAhmed Elaghoury
Please cite as follows: Shehatto K, Abed M, Elaghoury A. Deleterious Effects Of Antidepressants On Semen Parameters: A Case Report. Poster presented at: Psychiatry of the 21st Century: Context, Controversies and Commitment. The World Psychiatric Association 17th WORLD CONGRESS OF PSYCHIATRY; 2017 Oct 8-12; Berlin, Germany.
DOI: 10.13140/RG.2.2.15518.64321
Restless Legs Syndrome/Willis-Ekbom Disease (RLS/WED) in the child psychiatry...Ahmed Elaghoury
Please, cite as follows: Elaghoury A, Abed M, Shehatto K. Restless Legs Syndrome/Willis-Ekbom Disease (RLS/WED) in the child psychiatry clinic: an occult and hidden comorbidity.
Poster presented at: Psychiatry of the 21st Century: Context, Controversies and Commitment. The World Psychiatric Association 17th WORLD CONGRESS OF PSYCHIATRY; 2017 Oct 8-12; Berlin, Germany.
DOI: 10.13140/RG.2.2.32295.85921
Sleep disorders with autism spectrum disorderAhmed Elaghoury
اضطرابات النوم لدى أطفال طيف التوحد: كلمة أمام أولياء الأمور، وبعض معلمي التربية الخاصة، وبعض العاملين في مجال الصحة النفسية للأطفال أثناء ملتقى التوحد الأول بالطايف. مستشفى الهدا العسكري
Risk of pulmonary aspiration with the outpatient electroconvulsive therapy: C...Ahmed Elaghoury
A case study presented at the 2nd International Brain Stimulation in Barcelona.
Cite as: Gad, M., & Elaghoury, A. (2017). Risk of pulmonary aspiration with the outpatient electroconvulsive therapy: Case report. Brain Stimulation: Basic, Translational, and Clinical Research in Neuromodulation, 10(2), 419.
http://dx.doi.org/10.1016/j.brs.2017.01.244
The emerging therapeutic role of the non-invasive brain stimulation in the ad...Ahmed Elaghoury
Poster 1.043 presented at the 2nd International Brain Stimulation Conference, Barcelona, Spain on 6th March 2017
Please cite as Elaghoury, A. (2017). The emerging therapeutic role of the non-invasive brain stimulation in the addiction medicine: review of the ongoing studies. Brain Stimulation: Basic, Translational, and Clinical Research in Neuromodulation, 10(2), 454-455. http://dx.doi.org/10.1016/j.brs.2017.01.333
Also, Poster #510 in the 2018 NIDA International Forum
June 8 – 11, 2018
San Diego, California
An interactive case presentation during the monthly meeting of Early-career psychiatrists in Jeddah, SA. Basically, a case managed and supervised clinically by Dr Shokry Alemam, MD
New updates in the concept and clinical usage of "mood stabilizers" based on the new report of WPA section on pharmacopsychiatry, June 2012.
http://1.usa.gov/LrRd3E
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Adv. biopharm. APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMSAkankshaAshtankar
MIP 201T & MPH 202T
ADVANCED BIOPHARMACEUTICS & PHARMACOKINETICS : UNIT 5
APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMS By - AKANKSHA ASHTANKAR
- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
- Video recording of this lecture in Arabic language: https://youtu.be/SINlygW1Mpc
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
CDSCO and Phamacovigilance {Regulatory body in India}NEHA GUPTA
The Central Drugs Standard Control Organization (CDSCO) is India's national regulatory body for pharmaceuticals and medical devices. Operating under the Directorate General of Health Services, Ministry of Health & Family Welfare, Government of India, the CDSCO is responsible for approving new drugs, conducting clinical trials, setting standards for drugs, controlling the quality of imported drugs, and coordinating the activities of State Drug Control Organizations by providing expert advice.
Pharmacovigilance, on the other hand, is the science and activities related to the detection, assessment, understanding, and prevention of adverse effects or any other drug-related problems. The primary aim of pharmacovigilance is to ensure the safety and efficacy of medicines, thereby protecting public health.
In India, pharmacovigilance activities are monitored by the Pharmacovigilance Programme of India (PvPI), which works closely with CDSCO to collect, analyze, and act upon data regarding adverse drug reactions (ADRs). Together, they play a critical role in ensuring that the benefits of drugs outweigh their risks, maintaining high standards of patient safety, and promoting the rational use of medicines.
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VALPROATE
Most common used mood-stabilizer and
antiepileptic worldwide
Valproate (VPA) is a general term used to
include all available forms of valproic
acid, such as sodium valproate, magnesium
valproate and sodium divalproex.
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VPA INCREASES GABA
Shiloh R, et al. Atlas of psychiatric pharmacotherapy. 2nd ed. 2006. Taylor & Francis group 3
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IMPORTANT KINETICS
↓ CYP 2C9
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VPA AS A PSYCHOTROPIC
BAD: Mania (euphoric, dysphoric, psychotic
or rapid cycling)
BAD: Mixed
Good prognostic signs for valproate may
include:
● Rapid cycling or dysphoric mania;
● Stable or decreasing frequency of manic
exacerbations.
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VPA AS A PSYCHOTROPIC
Augmentation to antipsychotics in
schizophrenia: a common practice with
limited evidence (Cochrane
2003), decreases aggression & impulsivity
esp if substance induced.
In Unipolar depression: (III) decreases
agitation
In anxiety ds: Panic (II), PTSD (II), social
phobia (III), OCD (IV)
In SUD: Alcohol (III)
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VPA IN IMPULSIVITY AND AGGRESSION
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WEAK ROLE OF VPA IN ACUTE BIPOLAR
DEPRESSION
Kemp D, et al. Antiepileptic Drugs in the Treatment of Rapid-Cycling Bipolar Disorder and Bipolar Depression. In: McElroy S, et al (editors). 8
Antiepileptic Drugs to Treat Psychiatric Disorders. 2008. Informa Healthcare USA, Inc.
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VPA: NEUROLOGIC USE
Epilepsy: broad spectrum AED
Migraine: prophylaxis
Neuropathic pain: weak evidence
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VPA DOSING
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SIDE EFFECTS
ESP: in children and women
Tremor, sedation, fatigue, and ataxia, behavioral
changes.
Local GI irritation that can lead to abdominal
pain, nausea, diarrhea, or constipation.
Pancreatitis
Thrombocytopenia and platelet dysfunction
Hypertransaminases, hepatotoxicity and
jaundice
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SIDE EFFECTS
Carnitine deficiency
In women, valproate is associated with
polycystic ovaries
(PCO), hyperandrogenism, and weight gain.
Combined with its teratogenic
effects, valproate use in women of
childbearing age is DONE WITH CAUTION
An increase in appetite and weight gain
occur in some patients; less often, anorexia
and weight loss occur
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VPA IN WOMEN
Weight gain
PCO
Teratogenecity: up to 5%, esp ≥ 700 mg / d
Can be used with contraception pills and
during lactation
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A RECENT MAULTVARIATE ANALYSIS FROM
EURAP
Tomson T, Battino D, Bonizzoni E, Craig J, Lindhout D, Sabers A, Perucca E, Vajda F; for the EURAP study group. Dose-
dependent risk of malformations with antiepileptic drugs: an analysis of data from the EURAP epilepsy and pregnancy registry.
Lancet Neurol. 2011 Jul;10(7):609-617. Epub 2011 Jun 5. PubMed PMID: 21652013.
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NEW LESSON FROM EURAP 2011
“The risk of major congenital
malformations is influenced not
only by TYPE of antiepileptic
drug, but also by DOSE AND
OTHER VARIABLES.” (EURAP, 2011)
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GENERIC SUBSTITUTION OF AEDS
More than 100 articles in MEDLINE
Generic prescribing for epilepsy remains
controversial worldwide
FDA and many health authorities: AGREES
AAN and many epilepsy societies :
DISAGREE
No controlled studies, but strong anecdotal
evidence, expert opinions and surveys.
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GENERIC VS BRAND
Generic drug: identical, or bioequivalent to a
brand name drug in dosage
form, safety, strength, route of
administration, quality, performance
characteristics and intended use.
Bioequivalence: demonstration that both the rate
and extent of absorption of the active
ingredient of the generic drug fall within
established parameters when compared to
that of the reference listed drug.
Office of Generic Drugs, http://www.fda.gov/cder/ogd/
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OF CONCERN AS REGARDS AEDS
Crawford P, Feely M, Guberman A, Kramer G. Are there potential problems with generic substitution of antiepileptic drugs? A
review of issues. Seizure. 2006 Apr;15(3):165-76. Review. PubMed PMID: 16504545.
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POTENTIAL DISADVANTAGES OF GENERIC
MEDICINES
Rate and extent of absorption (bioavailability) differs
between different generic versions of branded
products
Generic names are not as easy to remember, spell
or pronounce as branded names
Generic products usually differ in appearance from
the brand and from other generic versions of the
same product, leading to patient confusion and
anxiety
Excipients and colorants used in generic products
may differ from the brand, potentially causing
Crawford P, Feely M, Guberman A, Kramer G. Are there potential problems with generic substitution of antiepileptic drugs? A
problems
review of issues. Seizure. 2006 Apr;15(3):165-76. Review. PubMed PMID: 16504545.
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ISSUES FOR GENERICS SPECIFIC TO EPILEPSY
Seriousness of BREAKTHROUGH
SEIZURES.
Some AEDs have narrow therapeutic index
Defined by FDA as less than two-fold
difference between the minimum toxic
concentration and the minimum effective
concentration
Particularly true for CBZ, PHT and VPA
Individual patients may have even
narrower differences between efficacy and
Crawford P, Feely M, Guberman A, Kramer G. Are there potential problems with generic substitution of antiepileptic drugs? A
review of issues. Seizure. 2006 Apr;15(3):165-76. Review. PubMed PMID: 16504545.
toxicity 20
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WHAT ELSE?
Non linear kinetics: PHT
Titration: LMT
Continuous change of supplier: payer / price
Potential savings vs potential costs
Savings associated with a generic may be offset by
costs associated with office visits, lab
tests, emergency room visits or hospitalizations
So, problems with SWITCH: branded to generic
AED / generic to another generic.
So, you must INFORM the pt !
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CONSENSUS CLINICAL PRACTICE GUIDELINES OF THE ANDALUSIAN EPILEPSY
SOCIETY ON PRESCRIBING GENERIC ANTIEPILEPTIC DRUGS (2009)
1) Not replacing an innovative AED by its generic in a
CONTROLLED PATIENT
2) BEGINNING TREATMENT with a generic AED in monotherapy
or in association is acceptable;
3) Not exchanging generic AED from different pharmaceutical
COMPANIES
4) EXPLAINING TO THE PATIENT the rules governing the
authorization of generics and the importance of avoiding
exchanges between different generic AED
5) If there is some WORSENING of the clinical condition or side
effects appear following the introduction of a generic, the causes
must be investigated and communicated to the bodies
responsible for pharmacovigilance.
Cañadillas-Hidalgo FM, Sánchez-Alvarez JC, Serrano-Castro PJ, Mercadé-Cerdá JM; en representación de la Sociedad
Andaluza de Epilepsia. [Consensus clinical practice guidelines of the Andalusian Epilepsy Society on prescribing generic
antiepileptic drugs]. Rev Neurol. 2009 Jul 1-15;49(1):41-7. Spanish. PubMed PMID: 19557699.
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EXPERIENCE FROM FRANCE
In France: Although no formal studies
regarding cost effectiveness and the rate of
seizure recurrence is available yet, the
prevailing consensus recommends NOT TO
REPLACE an original antiepileptic drug by a
generic, due to the harmful risk of seizure
recurrence.
Maeder-Ingvar M, Foletti GB. [Generics of antiepileptic drugs]. Rev Med Suisse. 2010 May 5;6(247):907-9. PubMed PMID:
20499577.
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EXPERIENCE FROM ITALY
LICE: The working group considered that in patients who
ACHIEVED SEIZURE FREEDOM a modest change in
plasma drug levels, which may occasionally occur even
after substitution of products that meet bioequivalence
criteria, could in rare cases lead to seizure breakthrough.
Therefore, generic substitution is not recommended in
patients who achieved seizure remission.
SWITCHES between a particular generic and another
generic should also be preferably avoided.
Finally, SUSTAINED-RELEASE AED FORMULATIONS
should not be used interchangeably with immediate-
release brand or generic products.
Perucca E, Albani F, Capovilla G, Bernardina BD, Michelucci R, Zaccara G. Recommendations of the Italian League
against Epilepsy working group on generic products of antiepileptic drugs. Epilepsia. 2006;47 Suppl 5:16-20. PubMed
PMID: 17239100.
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SUGGESTED ARTICLES
Generic antiepileptic drug use was
associated with significantly greater medical
utilization and risk of epilepsy-related
medical events, compared to brand use. This
relationship was observed even in patients
characterized as STABLE.
Labiner DM, Paradis PE, Manjunath R, Duh MS, Lafeuille MH, Latrémouille-Viau D, Lefebvre P, Helmers SL. Generic
antiepileptic drugs and associated medical resource utilization in the United States. Neurology. 2010 May 18;74(20):1566-74.
PubMed PMID: 20393142.
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SUGGESTED ARTICLES
Generics do not always lead to the
anticipated MONETARY SAVINGS
Desmarais JE, Beauclair L, Margolese HC. Switching from Brand-Name to Generic Psychotropic Medications: A Literature
Review. CNS Neurosci Ther. 2010 Nov 30. PubMed PMID: 21114789.
Significantly HIGHER HEALTH CARE
COSTS were observed during generic AED
use across seizure control and AED
subgroups.
Helmers SL, Paradis PE, Manjunath R, Duh MS, Lafeuille MH, Latrémouille-Viau D, Lefebvre P, Labiner DM. Economic burden
associated with the use of generic antiepileptic drugs in the United States. Epilepsy Behav. 2010 Aug;18(4):437-44. PubMed PMID:
20580619.
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SUGGESTED ARTICLES
Current literature suggests statistically HIGHER
OVERALL HEALTHCARE COSTS during
periods of generic AED use than during periods
when branded AED are used, consistently
demonstrated across different countries
(Canada and the USA) and in both stable and
unstable epilepsy patients, with more
pronounced cost increases in patients receiving
multiple generic versions.
Brand-to-generic substitutions of AEDs do not
necessarily reduce overall healthcare costs and
may even increase them.
Duh MS, Cahill KE, Paradis PE, Cremieux PY, Greenberg PE. The economic implications of generic substitution of antiepileptic
drugs: a review of recent evidence. Expert Opin Pharmacother. 2009 Oct;10(14):2317-28. Review. PubMed PMID: 19663636.
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SUGGESTED ARTICLES
Seizure control should not be sacrificed on the basis of
costs alone. choosing AED therapy solely on the basis of
initial acquisition costs is unlikely to be cost effective in the
long-term care of patients with epilepsy.
Jobst BC, Holmes GL. Prescribing antiepileptic drugs: should patients be switched on the basis of cost? CNS Drugs.
2004;18(10):617-28. Review. PubMed PMID: 15270592.
Trinka E, Krämer G, Graf M. Requirements for generic antiepileptic medicines:
a clinical perspective. J Neurol. 2011 Jun 11. PubMed PMID: 21667222.
Sander JW, Ryvlin P, Stefan H, Booth DR, Bauer J. Generic substitution of
antiepileptic drugs. Expert Rev Neurother. 2010 Dec;10(12):1887-98. Review.
PubMed PMID: 21091318.
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GENERICS OF VPA IN EGYPT
1. CONVULEX: Gerot 8. SEIZOLOW:
Alexandria
2. DAVIKEN: Amoun
9. VALPO: Unipharma
3. DEKADEL: Delta
10. VALPOKINE: T3A
4. DEPACOM:
Chemipharm 11. VALPONEX /
5. DEPAKINE: Global VALPOEAST:
Napi Western
6. DEPAKINE: 12. VALPROEX: MUP
Sanofi-Winthrop 13. VALPROTEC:
7. DEPALEPT: ACAPI
Memphis
Ministry of Health: EDA Index, May 2011 14. XOPLICT: Medizen
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ATP SURVEY, JUNE 2011
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ATP SURVEY, JUNE 2011
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ATP SURVEY, JUNE 2011
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