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Concept
Primidone
Summary
Primidone, sold under various brand names, is a barbiturate medication that is used to treat partial and generalized seizures and essential tremors. It is taken by mouth.
Its common side effects include sleepiness, poor coordination, nausea, and loss of appetite. Severe side effects may include suicide, psychosis, and a lack of blood cells. Use during pregnancy may result in harm to the baby. Primidone is an anticonvulsant of the barbiturate class. How it works is not entirely clear.
Primidone was approved for medical use in the United States in 1954. It is available as a generic medication. In 2020, it was the 269th most commonly prescribed medication in the United States, with more than 1 million prescriptions.
It is licensed for generalized tonic-clonic and complex partial seizures in the United Kingdom. In the United States, primidone is approved for adjunctive (in combination with other drugs) and monotherapy (by itself) use in generalized tonic-clonic seizures, simple partial seizures, complex partial seizures, and myoclonic seizures. In juvenile myoclonic epilepsy, it is a second-line therapy, reserved for when the valproates or lamotrigine do not work and when the other second-line therapy, acetazolamide, does not work.
Open-label case series have suggested that primidone is effective in the treatment of epilepsy. Primidone has been compared to phenytoin, phenobarbital, mephobarbital, ethotoin, metharbital, and mephenytoin. In adult comparison trials, primidone has been found to be just as effective.
Primidone is considered to be a first-line therapy for essential tremor, along with propranolol. In tremor amplitude reduction, it is just as effective as propranolol, reducing it by 50%. Both drugs are well studied for this condition, unlike other therapies, and are recommended for initial treatment. A low-dose therapy (250 mg/day) is just as good as a high-dose therapy (750 mg/day).
Primidone is not the only anticonvulsant used for essential tremor; the others include topiramate and gabapentin.
Official source
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