|AHFS/Drugs.com||International Drug Names|
|ATC code||N03AX17 (WHO)|
|Chemical and physical data|
|Molar mass||234.30 g·mol−1|
|3D model (Jmol)||Interactive image|
|(what is this?)|
Stiripentol (marketed as Diacomit by Laboratoires Biocodex) is an anticonvulsant drug used in the treatment of epilepsy. It is approved for the treatment of Dravet syndrome, an epilepsy syndrome. It is unrelated to other anticonvulsants and belongs to the group of aromatic allylic alcohols.
Mechanism of action
As with most anticonvulsants, the precise mechanism of action is unknown. Regardless, stiripentol has been shown to have anticonvulsant effects of its own.
Stiripentol increases GABAergic activity. At clinically relevant concentrations, it enhances central GABA neurotransmission through a barbiturate-like effect, since it increases the duration of opening of GABA-A receptor channels in hippocampal slices. It has also been shown to increase GABA levels in brain tissues by interfering with its reuptake and metabolism. Specifically, it has been shown to inhibit lactate dehydrogenase, which is an important enzyme involved in the energy metabolism of neurons. Inhibition of this enzyme can make neurons less prone to fire action potentials, likely through activation of ATP-sensitive potassium channels.
Stiripentol also improves the effectiveness of many other anticonvulsants, possibly due to its inhibition of certain enzymes, slowing the drugs' metabolism and increasing blood plasma levels.
In December 2001 the European Medicines Agency (EMA) granted stiripentol orphan drug status (designation number EU/3/01/071) for the treatment of severe myoclonic epilepsy of infancy (SMEI, also known as Dravet's syndrome). On 4 January 2007, the EMA granted the drug a marketing authorisation that is valid throughout the European Union.
Indications and usage
It is indicated as an adjunctive therapy with sodium valproate and clobazam for treating Dravet syndrome whose seizures are not adequately controlled with clobazam and valproate. Children with SMEI develop often intractable seizures during their first year of life and developmental delay follows. Small-scale trials have shown remarkably high response rates, with a significant minority of those treated becoming seizure free.
In addition, it may be used to treat refractory childhood epilepsy in conjunction with carbamazepine. It appears to be less effective in adolescents and adults.
Stiripentol is available as a gelatine capsule (250 mg, 500 mg) and as a sachet of powder to make a drinkable suspension (250 mg, 500 mg).
Initial dose is 50 mg/kg per day. This may be increased up to 100 mg/kg per day, with a maximum of 4 g/day. The dose is to be divided into two or three and to be taken with meals. The dose of other anticonvulsants may have to be reduced (possibly down to 50%).
Side effects are largely due to the increase in plasma concentrations of other anticonvulsants and can be reduced by lowering the dose of those drugs. Nausea and vomiting are particularly noted when used in combination with sodium valproate.
Stiripentol inhibits several cytochrome P450 isoenzymes and so interacts with many anticonvulsants and other medicines. This is both a strength and weakness. It appears to increase the potency of phenobarbital, primidone, phenytoin, carbamazepine, clobazam and diazepam. For example, blood levels of carbamazepine can be maintained while reducing the dose by 50%.
- Quilichini PP, Chiron C, Ben-Ari Y, Gozlan H (2006). "Stiripentol, a putative antiepileptic drug, enhances the duration of opening of GABA-A receptor channels". Epilepsia : PR. 47 (4): 704–16. doi:10.1111/j.1528-1167.2006.00497.x. PMID 16650136.
- Trojnar MK, Wojtal K, Trojnar MP, Czuczwar SJ (2005). "Stiripentol. A novel antiepileptic drug" (PDF). Pharmacological reports : PR. 57 (2): 154–60. PMID 15886413.
- Sada N, Lee S, Katsu T, Otsuki T, Inoue T (2015). "Targeting LDH enzymes with a stiripentol analog to treat epilepsy". Science. 347 (6228): 1362–67. doi:10.1126/science.aaa1299. PMID 25792327.
- Thanh TN, Chiron C, Dellatolas G, et al. (November 2002). "[Long-term efficacy and tolerance of stiripentaol in severe myoclonic epilepsy of infancy (Dravet's syndrome)]". Archives de Pédiatrie (in French). 9 (11): 1120–7. PMID 12503502.
- Tran A, Vauzelle-Kervroedan F, Rey E, et al. (1996). "Effect of stiripentol on carbamazepine plasma concentration and metabolism in epileptic children". European journal of clinical pharmacology. 50 (6): 497–500. doi:10.1007/s002280050147. PMID 8858278.
- Perez J, Chiron C, Musial C, et al. (November 1999). "Stiripentol: efficacy and tolerability in children with epilepsy". Epilepsia. 40 (11): 1618–26. doi:10.1111/j.1528-1157.1999.tb02048.x. PMID 10565591.
- Chiron C, Marchand MC, Tran A, et al. (November 2000). "Stiripentol in severe myoclonic epilepsy in infancy: a randomised placebo-controlled syndrome-dedicated trial. STICLO study group". Lancet. 356 (9242): 1638–42. doi:10.1016/S0140-6736(00)03157-3. PMID 11089822.
- Chiron C (July 2005). "Stiripentol". Expert Opinion on Investigational Drugs. 14 (7): 905–11. doi:10.1517/135437220.127.116.115. PMID 16022579.
- Diacomit: Summary of Product Characteristics (Article in French).
- The Comparative Toxicogenomics Database: Stiripentol