Background

Anticonvulsants are used primarily to treat seizure disorders. But they are also widely prescribed to treat people with bipolar disorder, certain types of pain caused by nerve damage or trauma, and fibromyalgia.

To help you and your doctor choose an anticonvulsant medicine if you need one, Consumer Reports Best Buy Drugs has evaluated the drugs in this category based on their effectiveness, safety, and cost. This brief is a summary of a 22-page report you can access on the Internet at CRBestBuyDrugs.org. You can also learn about other drugs we’ve analyzed on this free Web site.

Our independent evaluations are based on scientific reviews conducted by the Oregon Health and Science University-based Drug Effectiveness Review Project. Grants from the Engelberg Foundation and the National Library of Medicine help fund Consumer Reports Best Buy Drugs. These materials were made possible by a grant from the state Attorney General Consumer and Prescriber Education Grant Program, which is funded by the multi-state settlement of consumer fraud claims regarding the marketing of the prescription drug Neurontin (gabapentin).

Do You Need an Anticonvulsant?

If you are diagnosed with bipolar disorder, nerve pain, or fibromyalgia, your need for an anticonvulsant may not be all that clear. Other treatments and drugs exist for all three conditions that may be better initial choices, particularly for people with bipolar disorder. The anticonvulsants are better accepted in treating specific types of nerve pain. If you have one of these three conditions and you get no benefit from other drugs, your doctor may consider an anticonvulsant.

Effectiveness

Drug

Bipolar Disorder*

Nerve Pain*

Carbamazepine

Mood stabilization in 40 to 70% of people in studies (manic phase only)

75% with trigeminal neuralgia (facial pain) get some relief, and about one in three get almost complete pain relief

Valproic Acid

Mood stabilization in 40 to 60% of people in studies (manic phase only)

60% with shingles pain get some or complete relief

Gabapentin

Not found to be effective in limited studies

Good results in treating shingles pain and diabetic nerve pain; possible effectiveness in treating spinal cord injury pain and nerve pain related to cancer

Pregabalin (Lyrica)

No evidence

28 to 58% with shingles pain and 40 to 48% with diabetic nerve pain get relief

Lamotrigine (Lamictal)

Relief from depressive phase of bipolar disorder, lasting at least 7 months in one key study

Possible effectiveness treating nerve pain that follows a stroke and pain associated with trigeminal neuralgia

Topiramate (Topamax)

Not found to be effective in limited studies

Some evidence for effectiveness in treating diabetic nerve pain, with 36% of patients experiencing relief

* Results are from a range of studies.

Our Recommendations

Some anticonvulsants have been linked to clear clinical benefits and are approved by the Food and Drug Administration (FDA) for use in treating bipolar disorder, nerve pain, or fibromyalgia.

Anticonvulsants can cause serious side effects, including an increased risk of suicide and life-threatening skin rashes. Newer anticonvulsants marketed since the late 1990s have sometimes been touted as safer than older ones. No large, good-quality studies have tested this directly, but small, short-term studies that compared the drugs don’t support such a conclusion.

Taking cost, dosing convenience, and the evidence for effectiveness, safety, and adverse effects into consideration, we have chosen the following as Consumer Reports Best Buy Drugs if your doctor and you have decided to try an anticonvulsant:

• Generic carbamazepine—for treating the manic phase of bipolar disorder or trigeminal neuralgia, a type of nerve pain that affects a facial nerve

• Generic valproic acid or generic divalproex—for treating the manic phase of bipolar disorder

• Generic Lamotrigine—for treating the depressive phase of bipolar disorder

• Generic gabapentin—for treating the nerve pain associated with diabetes or herpes zoster infection (shingles), and for treating fibromyalgia

This report was published in July 2011.

Cost Comparison

The older drugs are in italics under “Generic Name and Dose.” The newer ones are in regular text.

Generic Name and Dose1

Brand Name2

Number of Pills per Day3

Total Daily Dose

Average Monthly Cost4

Carbamazepine 100 mg chewable tablet

Generic

Three

300 mg

$21*

Carbamazepine 200 mg tablet

Tegretol

Three

600 mg

$115

Carbamazepine 200 mg tablet

Generic

Three

600 mg

$19*

Carbamazepine 200 mg SR tablet5

Carbatrol

Two

400 mg

$133

Carbamazepine 200 mg SR tablet

Tegretol XR6

Two

400 mg

$79

Carbamazepine 200 mg SR tablet

Generic

Two

400 mg

$58

Divalproex 250 mg tablet

Depakote

Three

750 mg

$242

Divalproex 250 mg tablet

Generic

Three

750 mg

$108

Divalproex 250 mg SR tablet

Depakote ER

One

250 mg

$79

Divalproex 250 mg SR tablet

Generic

One

250 mg

$42

Gabapentin 100 mg capsule

Neurontin

Three

300 mg

$99

Gabapentin 100 mg tablet

Generic

Three

300 mg

$33*

Lamotrigine 100 mg tablet

Lamictal

One

100 mg

$212

Lamotrigine 100 mg tablet

Generic

One

100 mg

$106

Lamotrigine 200 mg tablet

Lamictal

One

200 mg

$255

Lamotrigine 200 mg tablet

Generic

One

200 mg

$122

Lamotrigine 25 mg dissolvable tablet

Lamictal ODT

One

25 mg

$186

Lamotrigine 50 mg dissolvable tablet

Lamictal ODT

One

50 mg

$200

Levetiracetam 250 mg tablet

Keppra

Two

500 mg

$327

Levetiracetam 250 mg tablet

Generic

Two

500 mg

$109

Oxcarbazepine 300 mg tablet

Trileptal

Two

600 mg

$287

Oxcarbazepine 300 mg tablet

Generic

Two

600 mg

$125

Pregabalin 100 mg capsule

Lyrica

Three

300 mg

$307

Phenytoin 100 mg ER capsule

Dilantin

Three

300 mg

$56

Phenytoin 100 mg ER capsule

Generic

Three

300 mg

$27

Tiagabine 4 mg tablet

Gabitril

Three

12 mg

$513

Topiramate 100 mg tablet

Topamax

Two

200 mg

$625

Topiramate 100 mg tablet

Generic

Two

200 mg

$303

Topiramate 25 mg capsule

Topamax

Two

50 mg

$315

Topiramate 25 mg capsule

Generic

Two

50 mg

$158

Valproic Acid 250 mg capsule

Generic

Three

750 mg

$41

Valproic Acid 250 mg delayed release capsule

Stavzor

Three

750 mg

$233

Zonisamide 25 mg capsule

Zonegran

One

25 mg

$37

Zonisamide 25 mg capsule

Generic

One

25 mg

$14*

*Indicates the dose of that drug imay be available for a low monthly cost through programs offered by chain stores. For example, Kroger, Sam’s Club, Target, and Walmart offer a month’s supply of selected generic drugs for $4 or a three-month supply for $10. Other stores, such as Costco, CVS, Kmart, and Walgreens, offer similar programs. Some programs have restrictions or membership fees, so check the details carefully for restrictions and to make sure your drug is covered.

1. Selected doses. For the complete table, see our full anticonvulsant report at CRBestBuyDrugs.org.

2. “Generic” indicates that this is the generic version of a brand name drug at the dose given.

3. The dose at which anticonvulsants work can vary widely.

4. Prices reflect nationwide retail averages for April 2011. They are rounded to the nearest dollar. Information derived by Consumer Reports Best Buy Drugs from data provided by Symphony Health Solutions, which is not involved in our analysis or recommendations.

5. SR=Sustained release

6. XR/ER=Extended release

Note: The information contained in the Consumer Reports Best Buy Drugs™ reports is for general informational purposes and is not intended to replace consultation with a physician or other health-care professional. Consumers Union is not liable for any loss or injury related to your use of the reports. The reports are intended solely for individual, noncommercial use and may not be used in advertising, promotion or for any other commercial purpose.


Copyright 2010, Consumers Union of United States, Inc

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