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To the Editor:
I read with interest the article by Zahn et al.,1 which reviews women’s health and epilepsy. The section on contraception deserves comment.
The authors note no interaction between felbamate or tiagabine with hormonal contraception. This may be incorrect. Whereas felbamate is an overall hepatic P450 enzyme inhibitor and would not be expected to decrease hormonal efficacy, it is an inducer of the isoenzyme P4503A4. This isoenzyme is responsible for metabolism of progestins and estrogens. Felbamate may adversely affect contraceptive efficacy.2 Tiagabine is also metabolized by the isoenzyme P4503A. Information on its interaction with low dose birth control is limited. At doses of tiagabine 8 mg/day in healthy volunteers, no interaction was noted, although breakthrough bleeding did occur.3 An interaction may be expected with more typical treatment doses.
To the Editor:
Antiepileptic drugs (AED) have been known to cause bone mass loss for many years, yet anticonvulsant-induced osteoporosis remains unrecognized by the vast majority of the medical community. It is unfortunate that the recent Report of the Quality Standards Subcommittee (QSS) of the American Academy of Neurology on management issues for women with …
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