Side Effects of primidone: A Synthesis of Findings from 26 Studies

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Original Abstract of the Article

Major Research Findings

Primidone is a medication used for essential tremor, but it has side effects. 25 points out that a considerable proportion of patients with essential tremor are resistant to various pharmaceuticals currently used for treatment. 18 reports that in an elderly patient with essential tremor, primidone had to be discontinued due to severe side effects. The study also observed a decline in the patient’s cognitive abilities after 28 months of topiramate treatment, highlighting the importance of careful consideration when prescribing topiramate to elderly patients. 23 shows that while tapering primidone in patients with epilepsy and intellectual disability, some patients experienced cognitive improvements, but others had seizure worsening and other side effects.

Reasons for Side Effects

Primidone’s side effects are possibly attributed to the effects of phenobarbital, an active metabolite produced during the body’s metabolism of the drug. 14 mentions that primidone is converted into phenobarbital, with its active metabolites contributing to the drug’s action. Additionally, the side effects of primidone might be dose-dependent. 14 suggests that the side effects of phenobarbital are dose-dependent. Furthermore, primidone is known to be a potent inducer of CYP3A4. 14

Common Side Effects

Drowsiness

Drowsiness is a frequent side effect associated with primidone. 14 mentions drowsiness as a side effect of phenobarbital. 21 mentions that primidone is used for treating drug-induced postural tremor, but also lists drowsiness as a side effect.

Dizziness

Dizziness is another side effect linked to primidone. 21 reports that primidone is used for treating drug-induced postural tremor, but also lists dizziness as a side effect.

Cognitive Impairment

Primidone has the potential to cause cognitive impairment. 18 reports that cognitive decline is observed in elderly patients with essential tremor after administering primidone. 23 reports that while tapering primidone in patients with epilepsy and intellectual disability, some patients experienced cognitive improvements, but others had seizure worsening and other side effects.

Liver Dysfunction

Primidone might cause liver dysfunction. 9 mentions that antiepileptic drugs like primidone can potentially lead to liver dysfunction in children.

Skin Reactions

Primidone can trigger skin reactions. 10 states that aromatic antiepileptic drugs, including primidone, can induce severe skin reactions like Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN). highlights that aromatic antiepileptic drugs, including primidone, can cause drug hypersensitivity syndrome (DHS).

Hormonal Imbalance

Primidone can disrupt hormonal balance. 24 suggests that some antiepileptic drugs, including primidone, inhibit aromatase, which could lead to hormonal imbalances.

Measures for Side Effects

Drowsiness

To manage drowsiness, consider taking primidone at bedtime or reducing daytime activity levels. Consulting your doctor about switching to a different medication is also an option.

Dizziness

To manage dizziness, try getting up slowly after taking primidone and resting in a sitting or lying position. Consulting your doctor about switching to a different medication is also an option.

Cognitive Impairment

To manage cognitive impairment, consider reducing the dosage of primidone or switching to another medication. Regular cognitive function tests are crucial.

Liver Dysfunction

To manage liver dysfunction, regular liver function tests are essential. Consulting your doctor about switching to a different medication is also an option.

Skin Reactions

If you experience skin reactions, consult with your doctor immediately. Severe cases may require hospitalization.

Hormonal Imbalance

To manage hormonal imbalances, consult with your doctor about switching to another medication or pursuing hormone replacement therapy.

Comparison of Studies

Commonalities

Many studies have shown that primidone is effective in treating essential tremor. However, many studies consistently report that primidone has a high potential for side effects.

Differences

Studies have reported varying incidences and types of primidone side effects. This is likely due to various factors, including the age and gender of study participants, the dosage of primidone, and any concomitant medications. Additionally, individual constitution can influence primidone side effects.

Precautions for Applying the Research to Real Life

While primidone is an effective medication for treating essential tremor, it’s crucial to be aware of its potential side effects. When taking primidone, consult with your doctor to fully understand the risks and benefits before starting treatment. If you experience any changes in your health while taking primidone, consult with your doctor immediately.

Limitations of Current Research

Research on the side effects of primidone is still insufficient. Further research is needed, especially regarding the relationship between primidone side effects and individual differences. Additionally, further research is required on precautions to take when taking primidone and methods to reduce side effects.

Future Directions for Research

Future research should focus on elucidating the mechanisms underlying the occurrence of primidone side effects and developing new treatments to reduce them. It is also crucial to clarify the relationship between primidone side effects and individual differences to develop individualized treatment approaches for each patient.

Conclusion

Primidone is an effective medication for treating essential tremor, but it’s crucial to be aware of its potential side effects. When taking primidone, consult with your doctor to fully understand the risks and benefits before starting treatment. If you experience any changes in your health while taking primidone, consult with your doctor immediately.

Literature analysis of 26 papers
Positive Content
16
Neutral Content
4
Negative Content
6
Article Type
0
1
2
11
25
1.

Development of tolerance to the side effects of primidone.

Author: LeppikI E, CloydJ C, MillerK

Tolerance to the side effects of primidone developed rapidly, and previous exposure to other antiepileptic drugs did not alter this tolerance.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Research Support, U.S. Gov't, P.H.S.Research funding provided by the Public Health Service (PHS).

Language : English

2.

Primidone Intolerance in Essential tremor: Is it More than Just Age?

Author: LenkaAbhishek, LouisElan D

Primidone ADRs

Primidone, a medication for essential tremor, is associated with significant adverse drug reactions (ADRs). This study investigates the reasons for variability in ADRs among primidone-treated patients with essential tremor compared to those with epilepsy.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Research Support, N.I.H., ExtramuralResearch funding provided by the NIH to external research institutions and researchers.
ReviewAn article that critically examines existing research on a particular topic and summarizes the current state of knowledge in the field.

Language : English

4.

Botulinum toxin type A for hand tremor: a meta-analysis of randomised controlled trials.

Author: ZhengXiaoyan, WeiWenjing, LiuPeidong, WuChunxiao, LuLiming, TangChunzhi

BoNT-A for tremor
Uncertain efficacy
Uncertain safety

Tremor is a common movement disorder that doesn't always respond well to standard medications because of side effects and dosage limits. While botulinum toxin type A (BoNT-A) has been used to treat tremor, its effectiveness and safety are still being studied.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Meta-AnalysisA statistical technique that integrates the results of multiple studies to draw more general conclusions about a particular issue.
Systematic ReviewA review that systematically collects, evaluates, and integrates relevant research to answer a specific research question.

Language : English

5.

Risks and management of antiepileptic drug induced skin reactions in the adult out-patient setting.

Author: FowlerThomas, BansalAmolak S, LozsádiDora

AED management
Drug allergy
Severe rash

This study provides a management pathway for patients suffering from suspected drug-induced rash caused by antiepileptic drugs (AEDs). It includes pretreatment screening guidelines, clinical assessment, and information on alternative medications.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
ReviewAn article that critically examines existing research on a particular topic and summarizes the current state of knowledge in the field.

Language : English

6.

Treatment of essential tremor: current status.

Author: SharmaSoumya, PandeySanjay

Tremor severity reduction
Functional disability
Side effects

This review covers the current management of essential tremor, focusing on different anatomical locations and treatment modalities, including pharmacotherapy, botulinum toxin injections, and surgical interventions. It also addresses a new subgroup, 'Essential tremor plus', which requires a tailored treatment approach.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
ReviewAn article that critically examines existing research on a particular topic and summarizes the current state of knowledge in the field.

Language : English

7.

High-dose thiamine and essential tremor.

Author: CostantiniAntonio

Essential tremor treatment

High doses of intramuscular thiamine may be a highly effective and long-lasting medical treatment for essential tremor, showing no relevant side effects.

Case ReportsIn the medical field, a report that describes in detail a unique case, an unusual medical condition, or the effect of a treatment. Provides new insights and possibilities for treatment through individual patient cases.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.

Language : English

8.

Update on Pharmacological Treatment of Progressive Myoclonus Epilepsies.

Author: FerlazzoEdoardo, TreniteDorothee Kasteleijn-Nolst, HaanGerrit-Jan de, Felix NitschkeFelix, AhonenSaija, GaspariniSara, MinassianBerge A

Progressive myoclonus epilepsies (PMEs) are a group of rare inherited conditions. This review discusses the current pharmacological treatments for PMEs.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Research Support, N.I.H., ExtramuralResearch funding provided by the NIH to external research institutions and researchers.
Research Support, Non-U.S. Gov'tResearch funding provided by government agencies outside the United States.
ReviewAn article that critically examines existing research on a particular topic and summarizes the current state of knowledge in the field.

Language : English

9.

Ursodeoxycholic Acid Can Improve Liver Transaminase Quantities in Children with Anticonvulsant Drugs Hepatotoxicity: a Pilot Study.

Author: AsgarshiraziMasoumeh, ShariatMamak, DaliliHosein, KeihanidoostZarrin

Drug-induced hepatitis treatment

Ursodeoxycholic acid (UDCA) was found to be effective and safe in reducing elevated liver enzymes in children who were taking anticonvulsant medications.

Clinical StudyResearch involving human participants to assess the safety, efficacy, and effects of an intervention/treatment.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.

Language : English

10.

Antiepileptic drugs and adverse skin reactions: An update.

Author: BłaszczykBarbara, LasońWładysław, CzuczwarStanisław Jerzy

Skin reactions

This paper summarizes current views on clinical manifestation, pathogenesis, prognosis, and management of antiepileptic drug (AED)-induced adverse skin reactions. Aromatic AEDs are more frequently associated with cutaneous eruption and other signs or symptoms of drug hypersensitivity.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Research Support, Non-U.S. Gov'tResearch funding provided by government agencies outside the United States.
ReviewAn article that critically examines existing research on a particular topic and summarizes the current state of knowledge in the field.

Language : English

11.

Bone mineral density in ambulatory children with epilepsy.

Author: YaghiniOmid, TonekaboniSeyed Hasan, Amir ShahkaramiSeyed Mohammad, Ahmad AbadiFarzad, ShariatFakhredin, Abdollah GorjiFatemeh

Affected alkaline phosphatase
Decreased bone mineral density

Both enzyme-inducing AEDs and non enzyme-inducing AEDs decrease bone mineral density (BMD) and affect alkaline phosphatase (ALP) in ambulatory epileptic children. Valproic acid (a non-enzyme-inducing agent) does not have these side effects.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Research Support, Non-U.S. Gov'tResearch funding provided by government agencies outside the United States.

Language : English

12.

Impact of mood stabilizers and antiepileptic drugs on cytokine production in-vitro.

Author: HimmerichHubertus, BartschStefanie, HamerHajo, MerglRoland, SchönherrJeremias, PeterseinCharlotte, MunzerAlexander, KirkbyKenneth Clifford, BauerKatrin, SackUlrich

Mood stabilizers and antiepileptic drugs (AEDs) were found to modulate cytokine production in healthy female subjects. These findings suggest that their mechanisms of action and side effects may involve interactions with IL-1β, IL-2, IL-22, and TNF-α signaling pathways.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Research Support, Non-U.S. Gov'tResearch funding provided by government agencies outside the United States.

Language : English

13.

Update on treatment of essential tremor.

Author: ZesiewiczTheresa A, ShawJessica D, AllisonKevin G, StaffettiJoseph S, OkunMichael S, SullivanKelly L

Essential tremor treatment
Medication side effects

Propranolol is the only FDA-approved medication for essential tremor (ET), but other medications, such as primidone, topiramate, and atenolol, may also be effective. Deep brain stimulation (DBS) is an alternative treatment for patients who don't respond well to medications.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.

Language : English

15.

Treatment of essential tremor: a systematic review of evidence and recommendations from the Italian Movement Disorders Association.

Author: ZappiaMario, AlbaneseAlberto, BrunoElisa, ColosimoCarlo, FilippiniGraziella, MartinelliPaolo, NicolettiAlessandra, QuattrocchiGraziella, AbbruzzeseGiovanni, BerardelliAlfredo, AllegraRoberta, AnielloMaria Stella, EliaAntonio E, MartinoDavide, MurgiaDaniela, PicilloMarina, SquintaniGiovanna

First-line therapy
Refractory ET treatment
Second-line treatment
Side effects

This review assesses the current state of knowledge regarding essential tremor (ET) therapy. Propranolol, primidone, and topiramate are recommended as first-line treatment options, while botulinum toxin type A and thalamic deep-brain stimulation are reserved for refractory ET.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
ReviewAn article that critically examines existing research on a particular topic and summarizes the current state of knowledge in the field.
Systematic ReviewA review that systematically collects, evaluates, and integrates relevant research to answer a specific research question.

Language : English

16.

Treatment of patients with essential tremor.

Author: DeuschlGünther, RaethjenJan, HellriegelHelge, ElbleRodger

Essential tremor treatment
Side effects

Essential tremor is a common movement disorder with varying severity and handicap. Many patients are never diagnosed or treated. Drugs such as propranolol and primidone reduce tremor by about 50%, while deep brain stimulation (DBS) in the thalamic nucleus ventrointermedius or neighboring subthalamic structures can reduce tremor by about 90%. However, further controlled trials are needed to determine the safety and efficacy of DBS.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Research Support, Non-U.S. Gov'tResearch funding provided by government agencies outside the United States.
ReviewAn article that critically examines existing research on a particular topic and summarizes the current state of knowledge in the field.

Language : English

17.

Drug hypersensitivity syndrome.

Author: KumariRashmi, TimshinaDependra K, ThappaDevinder Mohan

Drug hypersensitivity

Drug hypersensitivity syndrome (DHS) is a serious adverse drug reaction that is often associated with aromatic antiepileptic drugs. It is characterized by fever, rash, lymphadenopathy, and internal organ involvement. The syndrome is managed by immediate withdrawal of the culprit drug, symptomatic treatment, and systemic steroids or immunoglobulins.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
ReviewAn article that critically examines existing research on a particular topic and summarizes the current state of knowledge in the field.

Language : English

18.

Topiramate Treatment of Essential Tremor in a Patient with Cognitive Deficits.

Author: LeblhuberF, SteinerK

Tremor reduction
Cognitive decline

A 79-year-old patient with essential tremor showed a satisfying response to topiramate after experiencing severe side effects from other treatments. However, the patient experienced a decline in cognitive function after 28 months of topiramate treatment, emphasizing the importance of careful monitoring in elderly patients.

Case ReportsIn the medical field, a report that describes in detail a unique case, an unusual medical condition, or the effect of a treatment. Provides new insights and possibilities for treatment through individual patient cases.

Language : English

19.

How are we doing with the treatment of essential tremor (ET)?: Persistence of patients with ET on medication: data from 528 patients in three settings.

Author: LouisE D, RiosE, HenchcliffeC

Inadequate treatment
Side effects

Nearly one-third of patients with essential tremor (ET) who were prescribed medication for tremor had discontinued pharmacotherapy. This highlights the inadequacy of current pharmacotherapeutic options for this common neurological disease.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Research Support, N.I.H., ExtramuralResearch funding provided by the NIH to external research institutions and researchers.

Language : English

21.

Postural induced-tremor in psychiatry.

Author: ArbaizarBeatriz, Gómez-AceboInés, LlorcaJavier

Postural tremor

Postural tremor is a common movement disorder in psychiatry. Drugs like lithium, valproic acid, lamotrigine, antidepressants, and neuroleptics can cause drug-induced postural tremor. Beta-blockers, primidone, gabapentin, topiramate, and benzodiazepines may be used for treatment.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
ReviewAn article that critically examines existing research on a particular topic and summarizes the current state of knowledge in the field.

Language : English

22.

Antiepileptic drug therapy in pregnancy II: fetal and neonatal exposure.

Author: HovingaCollin A, PennellPage B

Antiepileptic drug safety
Lactation safety
AED breast milk concentration

This review discusses the transfer of antiepileptic drugs (AEDs) across the placenta and into breast milk. While most AEDs are safe for breastfeeding with some cautions, phenobarbital and primidone should be avoided.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
ReviewAn article that critically examines existing research on a particular topic and summarizes the current state of knowledge in the field.

Language : English

23.

Ambiguous results of an attempt to withdraw barbiturates in epilepsy patients with intellectual disability.

Author: HuberBernd, BocchicchioM, HauserI, HorstmannV, JokeitG, MayT, MeinertT, RobertsonE, SchorlemmerH, SchulzL, WagnerW, SeidelM

Cognitive improvement
Reduced barbiturate use
Reduced polypharmacy
Seizure exacerbation

Phenobarbital and primidone were tapered in patients with epilepsy and intellectual disability. The study aimed to improve cognitive and psychological state and reduce seizure frequency.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.

Language : English

25.

[Effectiveness and safety of levetiracetam in patients with essential tremor: data from an open 11-week follow-up trial].

Author: Sanz-CartagenaP, FossasP, Floriach-RobertM, Serra-PratM, CanoA, PalomerasE

Levetiracetam (LEV) did not demonstrate significant improvement in tremor severity in patients with essential tremor who were resistant to or had contraindications for beta blockers or primidone. The study involved 14 patients and concluded after 11 weeks. Six patients discontinued the study due to lack of effectiveness or side effects.

Clinical TrialA clinical trial is a planned study conducted on humans to evaluate the efficacy and safety of pharmaceuticals, medical devices, and treatment methods. It aims to explore the possibilities of new treatments and improve the health of patients.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.

Language : Spanish

26.

[Deep brain stimulation of the ventral intermediate thalamic nucleus in the treatment of essential tremor].

Author: SobstylMichał, ZabekMirosław

Essential tremor treatment
Tremor control

This study discusses the treatment of essential tremor (ET), the most common movement disorder. The study reviews pharmacological and surgical treatment options for ET, including propranolol, primidone, gabapentin, botulinum toxin injections, thalamotomy, and deep brain stimulation (DBS). The study concludes that thalamic DBS is a highly efficacious and safe procedure for treating ET.

English AbstractA summary of a research paper/publication written in English for a wider audience.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
ReviewAn article that critically examines existing research on a particular topic and summarizes the current state of knowledge in the field.

Language : Polish

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