Gabitril (Tiagabine) - Oral

What Is Gabitril?

Gabitril (tiagabine) is an anti-seizure medication known as an anticonvulsant or antiepileptic drug (AED) approved for use in adults and adolescents 12 and older. Gabitril is typically used as an adjunctive therapy (used alongside other AEDs) to treat focal (partial) seizures.

It is not known precisely how Gabitril works, but it is thought to work by increasing y-aminobutyric acid (GABA) activity in our brains to prevent seizure activity.

GABA is a naturally occurring chemical in the central nervous system (CNS; brain and spinal cord).

Gabitril is a brand-name medication and contains the active ingredient tiagabine. Tiagabine is available as a generic product that is administered in the form of oral (taken by mouth) tablets.

This article will highlight the brand-name drug Gabitril, administered in the form of oral tablets.

What Is Gabitril Used For?

The Food and Drug Administration (FDA) has approved Gabitril (often given as an adjunctive therapy) that is used to treat seizures—specifically focal (partial) seizures—in adults and adolescents 12 and older.

People with this medical condition have seizures that start on one side of the brain. It's the most common seizure type in adults with epilepsy.

In 2015, the Centers for Disease Control and Prevention (CDC) estimated that three million adults and nearly 500,000 children had epilepsy in the United States.

People with epilepsy have a history of at least two seizures.

How to Take Gabitril

Take Gabitril by mouth one to four times daily with food.

However, for the first week of treatment, you will only take Gabitril once daily. Your healthcare provider will periodically increase your dose until you reach the amount of Gabitril you should take regularly.

Finally, take Gabitril around the same time(s) every day to establish a routine.

Storage

When you receive Gabitril from the pharmacy, keep the medication at room temperature (68 F to 77 F).

Protect Gabitril from light and moisture. Keep your medications tightly closed and out of the reach of children and pets, ideally locked in a cabinet or closet.

Avoid pouring unused and expired drugs down the drain or in the toilet. Visit the FDA's website to learn where and how to discard all unused and expired drugs.

You can also find disposal boxes in your area. Ask your healthcare provider if you have any questions about the best ways to dispose of your medications.

If you plan to travel with tiagabine, get familiar with your final destination's regulations. Checking with the U.S. embassy or consulate might be a helpful resource. In general, however, make a copy of your tiagabine prescription.

It's also a good idea to keep your medication in its original container from your pharmacy with your name on the label.

Ask your healthcare provider if you have any questions about traveling with your medicine.

Off-Label Uses

Healthcare providers may prescribe Gabitril for the following off-label uses (for conditions other than what the FDA specifically approved it for):

• Mental health conditions, such as depression and anxiety
• Migraines
• Other seizures, such as infantile spasms (a type of serious seizure in young children)
• Muscle spasticity (muscles spasms from brain injury or nerve damage)
  

What Are the Side Effects of Gabitril?

This is not a complete list of side effects, and others may occur. A healthcare provider can advise you on side effects. If you experience other effects, contact your pharmacist or a healthcare provider. You may report side effects to the FDA at fda.gov/medwatch or 800-FDA-1088.

Common Side Effects

Common side effects associated with the use of Gabitril may include:

• Abnormal thinking
• Dizziness or lightheadedness
• Lethargy
• Irritability
• Nausea
• Problems with concentration (focus) or attention
• Stomach pain
• Tremors
  

Severe Side Effects

Notify your healthcare provider right away if you have serious side effects. Call 911 if your symptoms feel life-threatening or if you think you have a medical emergency.

Serious side effects and their symptoms can include the following:

• Severe allergic reaction: If you have a severe allergic reaction to Gabitril, symptoms may include itchiness, swelling, and breathing difficulties.
• Withdrawal seizures: Suddenly stopping Gabitril might result in withdrawal (discontinuation) side effects, such as more seizures. If you and your healthcare provider decide to stop this medication, it will need to be slowly tapered over time.
• Suicidal thoughts or behaviors: AEDs—like Gabitril—are generally linked to a higher risk of suicidal thoughts or behaviors. Loved ones might notice abnormal changes in behavior, such as being withdrawn. You may also experience depression or worsening depression.
• Status epilepticus: There are reports of status epilepticus with Gabitril—with a prior history of status epilepticus being a risk factor. Status epilepticus is an emergency situation. It's a medical condition of a long-lasting seizure or a cluster of multiple seizures.
• Other brain-related side effects: Gabitril is connected to confusion and problems with concentration (focus), speech, or language. Other side effects may also include excessive drowsiness, sleepiness, and tiredness. These side effects tend to result in worsening abnormal brain waves in people with an abnormal electroencephalogram (EEG) called "spike-wave."

Dosage: How Much Gabitril Should I Take?

Modifications

The following modifications (changes) should be kept in mind when using Gabitril:

Severe allergic reaction: Avoid using Gabitril if you have a known allergy to it or any of its ingredients. Ask your healthcare provider for a complete list of the ingredients if you're unsure.

Pregnancy: In rat and rabbit animal studies, Gabitril was found to have adverse effects on the fetus. However, we don't know enough about the safety and effects of Gabitril on pregnant people and their unborn fetus.

Discuss with your healthcare provider if you plan to become pregnant or are pregnant. They can help you weigh the benefits and risks of tiagabine during your pregnancy. You can also consider enrolling in the North American Antiepileptic Drug (NAAED) pregnancy registry by calling 1-888-233-2334 or visiting the NAAED website.

Breastfeeding: In rat animal studies, tiagabine was present in breast milk. However, we don't know enough about the effects and safety of tiagabine in human breast milk and nursing babies.

If you're taking Gabitril while breastfeeding, monitor your baby for drowsiness and problems with weight gain. Your healthcare provider will also check on any developmental milestones.

Talk with your healthcare provider if you plan to breastfeed. They will help you weigh the benefits and harms of tiagabine while nursing. They can also discuss the different ways available to feed your baby.

Older adults over 65: Clinical studies haven't included enough people in this age group to see whether they respond differently from younger adults.

However, older adults with several medical conditions or taking several medications should use caution. Older adults tend to be more sensitive to side effects from medications.

Children: The FDA approved Gabitril for people 12 and older.

Liver problems: If you have liver impairment, your liver may have trouble clearing tiagabine from your body. For this reason, your healthcare provider may adjust your tiagabine dose or how often you take this medication.

People with an abnormal "spike-wave" brain activity: Your healthcare provider will likely adjust your tiagabine dosage if you experience an abnormal "spike-wave" brain activity with certain brain-related side effects, such as confusion and problems with concentration (focus), speech, or language.

Other side effects may also include excessive drowsiness, sleepiness, and tiredness.

Missed Dose

If you accidentally forget your Gabitril dose, take it as soon as you remember. If it's already close to your next scheduled dose, skip the missed dose and take the following dose at your next scheduled dosing time.

Don't try to double up to make up for the missed dose.

Try to find ways that work for you to help yourself remember to routinely keep your appointments and take your medication. If you miss too many doses, Gabitril might be less effective. In fact, abruptly stopping this medication might result in more seizures.

If you miss two or more doses in a row, reach out to your healthcare provider. They may need to start you at a lower dose and slowly increase your dose again.

Overdose: What Happens If I Take Too Much Gabitril?

There is limited information available about Gabitril overdose. Symptoms of a suspected overdose, however, may include:

• Abnormal brain function or structure
• Abnormal brain wave activity
• Breathing problems
• Coma
• Confusion or disorientation
• Depression
• Impaired awareness or consciousness
• Memory problems
• Problems with speech
• Psychosis (e.g., hallucinations, delusions)
• Seizures
• Temporary paralysis
• Uncontrollable muscle twitches or movements
• Unsteady balance
• Vomiting
• Weakness

If you think you're experiencing an overdose or life-threatening symptoms, seek immediate medical attention.

Precautions

What Are Reasons I Shouldn’t Take Gabitril?

Before taking Gabitril, talk with your healthcare provider if any of the following applies to you:

• Severe allergic reaction: If you have a severe allergic reaction to tiagabine or any of its components (ingredients), this medication isn't a viable option for you.
• Pregnancy: Not enough is known about the safety and effects of Gabitril on pregnant people and their unborn fetus. Discuss the benefits and risks of Gabitril during pregnancy with your healthcare provider.
• Breastfeeding: Not enough is known about the effects and safety of Gabitril in human breast milk and nursing babies. If you're taking Gabitril while breastfeeding, monitor your baby for drowsiness and problems with weight gain. Your healthcare provider will also check on any developmental milestones.
• Older adults over 65: Clinical studies haven't included enough people in this age group to see whether they respond differently from younger adults. In general, however, older adults should use caution.
• Children: The FDA has approved Gabitril for people 12 and older.

What Other Medications Interact With Gabitril?

Use caution when taking Gabitril with the following medications:

Carbamazepine, phenytoin, or phenobarbital: Tegretol (carbamazepine), Dilantin (phenytoin), or phenobarbital may result in lower levels of Gabitril, leading to reduced effectiveness. For this reason, your healthcare provider will likely recommend a higher Gabitril dosage if you take anti-seizure medications.

Valproate: Valproate is an anti-seizure medication that can also be used for bipolar disorder or migraines. It might lower the amount of Gabitril that's bound to protein. This may result in higher levels of tiagabine that's not bound to protein.

Generally, medication isn't typically active when it's protein-bound. When it isn't protein-bound, it's considered free and potentially active. So, higher levels of free tiagabine might increase the chances of side effects.

Triazolam: Halcion (triazolam) is typically used for the short-term treatment of insomnia (sleeping problems). Gabitril might have additive slowing effects on the brain. For this reason, caution should be used when combining triazolam with Gabitril.

Alcohol: Similar to triazolam, alcohol may also have additive slowing effects on the brain. For this reason, mixing alcohol and tiagabine isn't typically recommended.

Talk with your pharmacist or healthcare provider for more detailed information about medication interactions with Gabitril.

Be sure to discuss other medicines you take or plan to take with your healthcare provider, including over-the-counter (OTC), nonprescription products, vitamins, herbs, or plant-based medicines.

What Medications Are Similar?

Several AEDs are available to treat seizures.

In general, AEDs are divided into two groups: broad-spectrum and narrow-spectrum AEDs. Broad-spectrum AEDs can typically be used for various seizure types. Narrow-spectrum AEDs are generally only used for specific seizure types.

Gabitril is likely considered a narrow-spectrum AED because it's generally only used for focal (partial) seizures. Other narrow-spectrum AEDs may also include:

• Dilantin (phenytoin)
• Lyrica (pregabalin)
• Neurontin (gabapentin)
• Phenobarbital
• Trileptal (oxcarbazepine)
• Vimpat (lacosamide)

The FDA has only approved tiagabine as an add-on medication for focal seizures, so unlike other AEDs, it's not typically used by itself.

How Can I Stay Healthy While Taking Gabitril?

If you're taking Gabitril, chances are seizures have been negatively affecting your quality of life. You may have tried different approaches or treatments.

While living with epilepsy has its challenges, there are ways to help improve your quality of life. Refer below for some general tips to support your health:

• Take AEDs as recommended by your healthcare provider.
• Having seizures is linked to osteoporosis (weak and brittle bones). Eat a healthy diet with adequate calcium and vitamin D to lower your risk of bone loss.
• Staying physically active may also lower your risk of osteoporosis. Consider weight-bearing exercises (e.g., walking, dancing, lifting weights) and balancing activities (e.g., tai chi, yoga, swimming).
• Avoid drinking and smoking to limit your osteoporosis risk.
• People with epilepsy are more likely to get bone fractures (breaks). You can limit your risk for falls and fractures by making your home safer. Consider steps like wearing non-slip shoes and having skid-proof carpets or rugs.
• Consider support groups or work with a mental health professional to help you find coping strategies that change how you think, feel, react, or respond to living with seizures.