Carbamazepine [KLH]

Approximately one-third of people living with epilepsy are unable to obtain seizure control with the currently marketed antiseizure medications (ASMs), creating a need for novel therapeutics with new mechanisms of action. Cenobamate (CBM) is a tetrazole alkyl carbamate derivative that received US Food and Drug Administration approval in 2019 for the treatment of adult partial onset (focal) seizures. Although CBM displayed impressive seizure reduction in clinical trials across all seizure types, including focal aware motor, focal impaired awareness, and focal to bilateral tonic-clonic seizures, the precise mechanism(s) through which CBM exerts its broad-spectrum antiseizure effects is not known. Experimental evidence suggests that CBM differentiates itself from other ASMs in that it appears to possess dual modes of action (MOAs); that is, it predominately blocks persistent sodium currents and increases both phasic and tonic gamma-aminobutyric acid (GABA) inhibition. In this review, we analyze the preclinical efficacy of CBM alongside ASMs with similar MOAs to better understand the mechanism(s) through which CBM achieves such broad-spectrum seizure protection. CBM's preclinical performance in tests, including the mouse 6-Hz model of treatment-resistant seizures, the chemoconvulsant seizure models of generalized epilepsy, and the rat hippocampal kindling model of focal epilepsy, was distinct from other voltage-gated sodium channel blockers and GABA(A)modulators. This distinction, in light of its proposed mechanism(s) of action, provides insight into the impressive clinical efficacy of CBM in the adult patient with focal onset epilepsy. The results of this comparative reverse translational analysis suggest that CBM is a mechanistically distinct ASM that offers an important advancement in drug development for treatment of therapy-resistant epilepsy.

Pharmaceuticals have been found extensively within an aquatic environment. Carbamazepine was one of them that was found at the highest frequency and amounts. The persistence of these micropollutants in the environment is of concern because of a combination of characteristics, which includes the toxicity of humans and animal health. In this study, acute toxicity from carbamazepine, which is regularly used in anti-epileptic pharmaceuticals, was investigated using Lepidium sativum (L. sativum), Daphnia magna (D. magna), and Vibrio fischeri (V. fischeri) toxicity test methods. These different toxicity test methods were used and their sensitivities were compared. The results obtained from all experiments were evaluated according to the applied method. Accordingly, electrical conductivity (EC50) (the 50% effect concentration) values ranged from 9.53 to 94.39 mg/L. The test results were expressed as "toxic unit" (TU) which were calculated as 1.05 for L. sativum, 10.49 for D. magna, and 2.7 for V. fischeri. According to the TU values, sensitivities were D. magna > V. fischeri > L. sativum, respectively. The most sensitive values were obtained from D. magna toxicity test method.