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At least 55 records · Page 3Linked to original sources
PubMed1985

Comparison of carbamazepine, phenobarbital, phenytoin, and primidone in partial and secondarily generalized tonic-clonic seizures.

We conducted a 10-center, double-blind trial to compare the efficacy and toxicity of four antiepileptic drugs in the treatment of partial and secondarily generalized tonic-clonic seizures in 622 adults. Patients were randomly assigned to treatment with carbamazepine, phenobarbital, phenytoin, or primidone and were followed for two years or until the drug failed to control seizures or caused unacceptable side effects. Overall treatment success was highest with carbamazepine or phenytoin, intermediate with phenobarbital, and lowest with primidone (P less than 0.002). Differences in failure rates of the drugs were explained primarily by the fact that primidone caused more intolerable acute toxic effects, such as nausea, vomiting, dizziness, and sedation. Decreased libido and impotence were more common in patients given primidone. Phenytoin caused more dysmorphic effects and hypersensitivity. Control of tonic-clonic seizures did not differ significantly with the various drugs. Carbamazepine provided complete control of partial seizures more often than primidone or phenobarbital (P less than 0.03). Overall, carbamazepine and phenytoin are recommended drugs of first choice for single-drug therapy of adults with partial or generalized tonic-clonic seizures or with both.

Adolescent↗
PubMed1982

Teratogenic and pharmacokinetic studies of primidone during pregnancy and in the offspring of epileptic women.

Fourteen epileptic women treated with primidone, either alone or in combination with other antiepileptic drugs, were studied prospectively during their pregnancy. Plasma levels of primidone and its metabolites were monitored and correlated to findings in the offspring. Maternal serum concentrations of primidone and metabolites were generally low during pregnancy. The levels of its main metabolites--phenobarbital and PEMA--were found to drop within the first month of pregnancy in two cases. The plasma concentrations remained low until birth and rose sharply thereafter. The phenobarbital/primidone ratio (mean 0.84) and PEMA/primidone ratio (mean 0.56) in pregnant patients were found to be lower than in non-pregnant patients, except when primidone was given in combination with phenytoin in which case the expected phenobarbital/primidone (mean 2.5) and PEMA/primidone (mean 1.5) ratios were found. A ventricular septal defect was found in one of the offspring of the fourteen mothers and five children had microcephaly. There was a high incidence of poor somatic development with dystrophy (n=3) and short stature (n=2). Head circumferences (n=8), lengths (n=4) and/or weights (n=8) were below the 10th percentile in a number of children. Four children showed marked facial dysmorphy. Our preliminary data suggest that primidone intake during pregnancy may be important in the pathogenesis of minor anomalies and in the induction of poor somatic development.

Abnormalities, Drug-Induced↗
PubMed1975

Interaction of phenytoin and primidone.

The ratio of derived phenobarbitone to unmetabolized primidone in the serum was significantly higher in 50 epileptic patients on a combination of primidone and phenytoin than in 12 patients on primidone alone, though the dose and serum levels of primidone were similar in the two groups. Out of 253 patients attending a seizure clinic 47% were taking a combination of these two anticonvulsants. The effect of phenytoin on the metabolism of primidone may have clinical implications in view of the frequency of their combined use.

Adolescent↗
PubMed1985

Primidone in essential tremor of the hands and head: a double blind controlled clinical study.

Uncontrolled clinical studies have suggested that primidone may be effective in reducing essential tremor thus providing a valuable alternative to beta-adrenoreceptor antagonists which are currently the drugs of first choice. A double blind, placebo controlled trial of primidone in essential tremor of the hands and head was carried out using both clinical and objective methods of assessment. Primidone was significantly superior to placebo in reducing the magnitude of hand tremor, its efficacy being comparable to that of propranolol. In two patients tremor was reduced to non-symptomatic levels, an effect rarely seen with propranolol. No consistent attenuation of head tremor was found. There was no correlation between serum primidone or derived phenobarbitone concentrations and the reduction of hand tremor. An acute toxic reaction to an initial small dose (62.5 mg) of primidone was seen in six of 22 patients.

Adolescent↗
PubMed1986

Efficacy of primidone in essential tremor.

Primidone, 50 to 1,000 mg/d, reduced the amplitude of essential tremor in both untreated and propranolol-treated patients. Low doses were as effective as high doses. Primidone decreased tremor more than propranolol. There was no correlation between therapeutic response and serum levels. Acute reactions to the initial dose and side effects of higher doses caused drug intolerance. A single oral dose (250 mg) decreased tremor by 60% 1 to 7 hours after ingestion, with stable serum primidone levels but no detectable phenobarbital levels. Tremor control was lost when phenobarbital was substituted for primidone. Primidone is an effective agent for the treatment of essential tremor.

Dose-Response Relationship, Drug↗
PubMed1977

Plasma level studies of primidone and its metabolites in the mouse at various stages of pregnancy.

1. Mice were treated with a teratogenic dose of primidone (100 mg/kg) by gastric intubation at three different times during pregnancy, viz. days 6-14, days 12-14 on day 14 only. Blood samples were taken on day 14 at 1, 4, 8 and 24 h after dosage. Primidone and its metabolites phenylethylmalondiamide (PEMA), and phenobarbitone, were assayed by g.l.c. 2. There was no accumulation of the parent compound or the metabolites after repeated administration of primidone; each of the substances was cleared from the plasma within 24 h. 3. The rate of metabolism of primidone increased with prolonged treatment. The peak concentration of the metabolites was higher in the two multiple-dose groups than in the single dose group. 4. The concentration of PEMA exceeded that of primidone between 3-8 h and then began to decrease in the multiple-dose groups, a similar pattern was established for phenobarbitone also, although the concentrations were lower than those of PEMA.

Animals↗
PubMed1975

[Investigations of serum levels of drugs in children receiving anticonvulsant medication. I. General evaluation of serum concentrations of diphenylhydantoin, primidone and phenobarbitone (author's transl)].

With the aid of our own method of gas chromatography we determined serum concentrations of anticonvulsants in a large number of children who were being treated with diphenylhydantoin, primidone and phenobarbitone. The drugs were being prescribed either as monotherapy, or in combination with each other, or with other substances which have anticonvulsive activity. Regression lines showed good correlations between the quantity of drugs administered (total daily dose) and serum concentrations. The regression lines for diphenylhydantoin and primidone, however, showed no differences, irrespective of whether they were being given alone or in combination. In view of the frequency of symptoms of intoxication and of non-responders, we established a therapeutic range for diphenylhydantoin and primidone (diphenylhydantoin: 5--16 mcg/ml; primidone: 4--14 mcg/ml). The required serum concentrations could be obtained by giving 8--12 mg/kg of diphenylhydantoin, and 15-22 mg/kg of primidone. In spite of the satisfactory correlation between total daily dose and serum concentrations, however, many patients showed departures from this normal behaviour, especially where combination treatments were being conducted. This demonstrates the necessity for routine controls of serum levels.

Adolescent↗
PubMed1984

Efficacy of primidone in dogs with seizures unresponsive to phenobarbital.

Fifteen epileptic dogs had been treated with high dosages of phenobarbital but had not achieved adequate control of their seizures. Their treatment was switched to comparable and higher dosages of primidone. Serum concentrations of phenobarbital were measured in all dogs before and after primidone therapy was initiated, to ensure that the primidone dosage achieved comparable or higher values when derived from primidone. Only one dog experienced improvement in seizure control, indicating that there is no advantage to the use of primidone over the use of phenobarbital for the control of seizures in most dogs.

Animals↗
PubMed1984

Effects of primidone, phenobarbital and phenylethylmalonamide in the stimulated frog neuromuscular junction.

The effects of primidone (1.0 mM), phenobarbital (0.2 mM) and phenylethylmalonamide (PEMA) (1.0 mM) on nerve-stimulated transmitter release (quantal content) were determined for extracellular Ca++ concentrations ([Ca++]0) from 0.4 to 0.8 mM at 1.0 Hz nerve stimulation frequency. At these [Ca++]0, the relationship between the log of quantal content vs. the log of [Ca++]0 is linear. Both primidone and phenobarbital increased quantal content to 171% of controls. These drugs, however, caused parallel shifts of the log-log plot of quantal content vs. [Ca++]0 to the left. Thus, drug effects were not modified by varying [Ca++]0. These drugs were also examined on frequency facilitation. During frequency facilitation, the relationship between the log of quantal content vs. nerve-stimulation frequency (0.5-8.0 Hz) is linear. Both primidone and phenobarbital caused parallel shifts of this plot to the left. These drug effects, therefore, were not modified by nerve stimulation frequency. PEMA did not affect quantal content in either series of experiments. Finally, the sciatic nerve was not stimulated and spontaneous transmitter release was measured. Under these conditions, phenobarbital increased transmitter release in high external K+ (7.5 mM) (1.8 mM Ca++, no Mg++) and in normal K+ (2.5 mM) (1.8 mM Ca++, no Mg++) to the same magnitude (130% of control) in contrast to the reported effects of primidone and PEMA. In conclusion, the effects of primidone, phenobarbital and PEMA were different in the stimulated frog neuromuscular junction.

Action Potentials↗
PubMed1983

Therapeutic serum concentrations of primidone and its metabolites, phenobarbital and phenylethylmalonamide in epileptic dogs.

Fifteen dogs with idiopathic epilepsy were included in a 9-month clinical trial to determine the therapeutic serum concentrations of primidone and its active metabolites, phenobarbital and phenylethylmalonamide. Dogs with a seizure frequency greater than 1/mo or with a record of multiple seizures greater than 1/day were chosen for the study. Each dog was given primidone 3 times daily at dosages intended to maximize seizure control and to minimize undesired side effects. Maintenance period blood samples were taken from fasted dogs 7 hours after dosing in the 3rd, 5th, 7th, and 9th months of the trial to determine therapeutic serum concentrations of primidone and its metabolites. Two blood samples also were taken from all dogs 7 hours after dosing, during an enforced drowsy period, to establish upper limits of desirable serum concentrations of the drug. Seizure frequencies during the trial were controlled in 13 dogs, 7 of which had no seizures during the 9-month trial. The mean percentage reduction in seizure frequency from pretrial frequency was 85%. Two dogs appeared refractory to primidone therapy. Serum phenobarbital was the best metabolite of primidone to use to assess therapeutic serum concentrations. The therapeutic antiepileptic serum concentration of phenobarbital was found to be between 25 and 40 micrograms/ml of serum. Serum phenobarbital concentrations greater than 40 micrograms/ml resulted in side effects in most dogs.

Animals↗
PubMed1988

Primidone and essential tremor.

To clarify whether primidone itself, and not only its metabolite phenobarbitone, suppresses essential tremor, the effect of a high single dose of primidone was tested. Of 11 patients, 8 showed a reduction of their tremor by 54%-69% for up to 28 h. The serum concentration of primidone was as expected, whereas those of the metabolites phenyl-ethyl-malonamide and phenobarbitone were very low. The tremor suppression can thus be considered to be an effect of primidone. Three of the 11 patients did not show a reduction of tremor.

Adult↗
PubMedDate not supplied

Primidone crystalluria following overdose. A report of a case and an analysis of the literature.

Seven cases of crystalluria following primidone overdose have been reported since the 1950s. An eighth case of primidone crystalluria following overdose is presented. Because of low aqueous solubility (600 mg/L at 37 degrees C) which is directly proportional to temperature, any factor increasing renal excretion of unchanged primidone predisposes to crystal formation. Renal clearance is dependent on dosage because of negligible protein binding, zero-order conversion to phenobarbitone (phenobarbital) and first-order conversion to phenylethylmalonamide. Therapy with other anticonvulsants known to induce the metabolism to phenobarbitone does not appear to be protective against crystalluria in overdose situations. The critical serum primidone concentration for crystalluria presence seems to be 80 mg/L. There is evidence for nephrotoxicity of the crystals themselves if formed in vivo (actual crystal presence during voiding). The chemical phenomenon of supersaturation of a solution is protective against in vivo crystal formation with subsequent nephrotoxicity. Vigorous hydration to augment elimination and to lessen the propensity for renal toxicity is recommended.

Adult↗
PubMed2003

Use of primidone in low doses (250 mg/day) versus high doses (750 mg/day) in the management of essential tremor. Double-blind comparative study with one-year follow-up.

Essential tremor is the most common involuntary movement; we studied 113 affected subjects (54 men, 59 women) with an average age of 63.9 years and average duration of 9.05 years. These patients participated in a double-blind study with a 1-year follow-up to compare treatment efficiency using primidone dosages of 250 mg/day (G 250, 56 patients) versus 750 mg/day (G 750, 57 patients). The study was designed with an 80% power and 95% confidence level. The statistical analysis used was an ANOVA (with Bonferroni multiple comparison test corrections); a value of p<0.004 was accepted as significant. To compare other values, a chi-square test was used; p<0.05 was considered significant. To evaluate the efficacy of the drug, clinical protocol employed the 'clinical evaluation scale for tremor'. All of the patients were evaluated a total of 13 times, once prior to the introduction of primidone and the other 12 evaluations following the initiation of the treatment. Eighty-seven patients completed the study: 15 patients abandoned the study due to undesirable side effects, five due to negative response, and six who were lost to follow-up. The percentage of patients who didn't complete the study was significantly higher in the group that received 750 mg/day of primidone (p<0.04) and more frequent as well in this same group, due to undesirable side effects (p<0.03). The patients of both G250 and G750 showed a significant improvement in each of the controls compared to the basal value (p<0.0001). No significant differences (p<0.06) were found when the averages of the evaluations of each group were compared. These responses were maintained during the entire treatment period. Low doses of primidone (250 mg/day) were equally or more effective than high doses (750 mg/day) in the control of essential tremor; this response was maintained for 12 months and furthermore, demonstrated fewer undesirable effects.

Administration, Oral↗
PubMed1981

Valproic acid and plasma levels of primidone and derived phenobarbital.

Five patients were studied to determine whether kinetic interaction occurs between valproic acid and primidone. During concurrent administration of primidone and valproic acid no significant interaction was observed. Primidone and derived phenobarbital levels did not change significantly. No adjustment of primidone dose was required when valproic acid was used as adjunctive therapy.

Adult↗
PubMed1979

[The influence of primidone on thyroid function (author's transl)].

The influence of primidone on thyroxine level, T3 index, FT4 index, triiodothyronine level, T3 (RIA)/T4 (RIA) quotient as well as on the TSH basal and stimulated values was investigated in 30 children on long-term treatment. The values obtained were compared statistically with those of a normal group. During primidone treatment a drop in T4 level and in FT4 index as well as an increase in T3 (RIA)/T4 (RIA) quotient was observed. On the other hand the triiodothyronine level and the T3 index were not influenced. The TSH basal and stimulated values were not statistically different from the control group. Thus the primidone-treated children are euthyroid according to the TRH test. Primidone probably stimulates hepatocellular thyroxine breakdown.

Child↗
PubMed1987

Chronic treatment of rats with primidone causes depletion of pteroylpentaglutamates in liver.

Anticonvulsants have been shown to cause folacin deficiency in chronically treated epileptic patients. However, a mechanism for this depletion has not been established. In the present study, the effects of chronic primidone treatment on folates in the rat were investigated. Using a continuously protective relatively nontoxic regimen of oral administration, it was found that primidone (100 mg/kg, twice per day) caused a decrease of pteroylpentaglutamates in the liver to less than half the control value within 1 wk. Total liver folacin concentration decreased by 30% in the first week followed by a slow gradual further decline with continuing treatment. Plasma folacin exhibited essentially the same pattern but no effect was observed on brain folacin concentration. Primidone was not detectable in plasma 12 h after gavage but phenobarbital was detectable. These data are consistent with the hypothesis that the anticonvulsant primidone (and/or phenobarbital) cause folate depletion via interaction with folate metabolism.

Animals↗
PubMed1990

Primidone in the long-term treatment of essential tremor: a prospective study with computerized quantitative analysis.

The long-term efficacy of primidone (375-750 mg/day) in essential tremor was evaluated prospectively in 11 patients who had shown a favorable response to 4-week treatment with the drug under placebo-controlled conditions. On accelerometric evaluation, the magnitude of tremor after 3, 6, and 12 months on primidone was still significantly reduced compared with the initial placebo period. After discontinuation of primidone, tremor amplitude reverted to the placebo levels. Some loss of efficacy during long-term administration, however, was suggested by the results of self-assessment, physician's assessment, and performance tests. Three patients discontinued prematurely the drug because the sedative effects outweighed the potential therapeutic benefit. Side effects (especially drowsiness and sedation) were common at 4 weeks and 3 months but tended to subside thereafter. It is concluded that primidone retains at least part of its tremorolytic effect for up to 1 year, although the overall clinical benefit is limited in most patients.

Aged↗
PubMed1985

Dual-label fluoroimmunoassay for simultaneous determination of primidone and phenobarbital.

A dual-label magnetizable solid-phase fluoroimmunoassay for direct determination of serum levels of primidone and its main metabolite, phenobarbital, in a single tube was developed and optimized. Fluorescein isothiocyanate was used to label phenobarbital and a rhodamine 101 derivative (XRITC) to label primidone; these could be independently quantitated with no fluorimetric "cross-talk." The dual-label assay employs mixed immunochemical reagents but is otherwise similar in performance to conventional, single-drug, magnetizable solid-phase fluoroimmunoassays. The ability to measure simultaneously two related analytes, such as a drug and its metabolite, represents a useful extension of immunoassay. This was illustrated in the present work by assay of sera from patients on primidone therapy. Dual-label assay results correlated well with those by a conventional enzymoimmunoassay (for primidone) and by a polarization fluoroimmunoassay (for phenobarbital).

Fluorescent Antibody Technique↗