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Topiramate
Value health 2005; 8 4 ; : 471- glick id, suppes t, debattista c, et al psychopharmacologic treatment strategies for depression, bipolar disorder, and schizophrenia.
Valproate in North America and carbamazepine in other parts of the world have been widely used by clinicians for treating bipolar disorder. Given the utility of carbamazepine and valproate for bipolar disorder, almost all newer anticonvulsants that have become available over the past decade have been assessed in open-label and controlled trials for their efficacy in the treatment of the various phases of bipolar disorder. These studies indicate that some anticonvulsants have efficacy in treating bipolar disorder e.g., lamotrigine1015 ; while others appear to have no role in treating core bipolar symptoms e.g., tiagabine16 ; . Interestingly, although some anticonvulsants do not have efficacy in treating the core bipolar symptoms of mania or depression, they seem to have efficacy in treating conditions that commonly co-occur with bipolar disorder such as anxiety e.g., pregabalin17 ; , panic disorder and social phobia e.g., gabapentin18, 19 ; , and binge-eating disorder and alcohol dependence e.g., topiramate20, 21 ; . This article will review current data and make recommendations for the clinical use of anticonvulsants in bipolar disorder. Owing to the lack of controlled studies, many of the anticonvulsants discussed in this article will need further study before their routine use in bipolar disorder can be recommended. PROVEN TREATMENT FOR BIPOLAR DISORDER: LAMOTRIGINE Lamotrigine is the most widely investigated anticonvulsant for the treatment of bipolar disorder. Lamotrigine was examined for its efficacy in treating acute mania, acute bipolar depression, and maintenance in bipolar disorder as well as rapid cycling. On the basis of 2 positive doubleblind maintenance trials, 10, 11 lamotrigine was recently approved by the U.S. Food and Drug Administration FDA ; for maintenance treatment of bipolar disorder. Although the data support its use in maintenance treatment, particularly in preventing depressive episodes, data for treating patients in other phases of bipolar disorder have been mixed, inadequate, or negative. Mania In the only double-blind study that supports the efficacy of lamotrigine in patients with acute mania, 12 45 patients were randomly assigned to treatment with lamotrigine, olanzapine, or lithium for 4 weeks. Reductions in scores on the Mania Rating Scale indicated that lamotrigine was as effective as olanzapine or lithium in treating acute manic symptoms. Although these results were positive, this study was not properly powered to show equivalence. Conversely, the results of 3 double-blind studies22, 23 did not support the use of lamotrigine in mania. Anand et al.22 conducted an 8-week double-blind study in lithium-refractory manic or hypomanic patients N 16 ; to examine the effi.
A 50-year-old male patient visited the emergency room with bilateral eye pain, headache, and bullring vision approximately two weeks after starting topiramate for a bipolar disorder. Topiraate dosing was 50 mg in the morning and 100 mg in the evening. Additional medications included glimiperide and metformin no dosages provided ; . Treatment with intravenous acetazolamide 1500 mg ; , topical pilocarpine 1%, prednisolone acetate 1%, and intravenous mannitol 1.5 mg kg ; was unsuccessful in reducing attacks. An ophthalmological examination revealed visual acuity of 20 200 and increased intraocular pressure 32, LE: 38 ; . Slit lamp examination demonstrated microcytic corneal edema, conjunctival chemosis, and a markedly shallow anterior chamber. Topiramatte was discontinued, and treatment was initiated with topical brimonidine tartrate 0.2% ; , timolol maleate 0.5% ; , and prednisolone acetate 1% ; . Symptoms gradually resolved over a two-week period after topiramate was discontinued. The authors concluded that topiramate was most likely the cause of acute glaucoma in this patient. They suggested that this type of reaction has also been reported with other sulfa-like drugs. Topiramaet is a sulfamate-substituted monosaccharide. Topiramste ["Topamax"] Banta JT et al Budenz DL: 900 NW 17th St, Miami, FL 33136; e-mail: dbudenz bpei.medmiami ; Presumed topiramate induced bilateral acute angle closure glaucoma. J Ophthalmol 132 1 ; : 112 114 Jul ; 2001.
By then, i had used up my medications, because topiramate chemical.
TENORETIC 50 25. 42 TENORETIC 100 25. 42 TENORMIN . 28 TENOXICAM. 56 TERAZOSIN HCL. 47 TERBINAFINE HCL . 138 TERBINAFINE HCL . 4 TERBUTALINE SULFATE . 21 TESTOSTERONE . SEC 3.50 TESTOSTERONE CYPIONATE . 122 TESTOSTERONE ENANTHATE . 122 TESTOSTERONE UNDECANOATE. SEC 3.51 TETRABENAZINE. SEC 3.51 TETRACYCLINE HCL. 10 TEVETEN. 43 TEVETEN PLUS . 43 THEOLAIR . 147 THEOPHYLLINE . 147 THIAMIJECT . 149 THIAMINE HCL . 149 THIOPROPERAZINE MESYLATE. 80 THIOTHIXENE . 80 THYROID . 131 TIAMOL. 141 TIAPROFENIC ACID. 56 TIAZAC . 31 TIAZAC XC . 30 TICLOPIDINE HCL. 155 TIMOLOL MALEATE. 105 TIMOLOL MALEATE. 36 TIMOPTIC . 105 TIMOPTIC-XE . 105 TINZAPARIN SODIUM. 24 TIOTROPIUM BROMIDE MONOHYDRATE. 19 TIZANIDINE HCL . SEC 3.51 TOBI. 3 TOBRADEX . 102 TOBRAMYCIN . 3 TOBRAMYCIN . 99 TOBRAMYCIN SULFATE . 3 TOBREX . 99 TOFRANIL . 71 TOLBUTAMIDE. 128 TOLTERODINE L-TARTRATE. SEC 3.51 TOPAMAX. 67 TOPAMAX SPRINKLE . 67 TOPICORT. 140 TOPICORT MILD . 140 TOPIRAMATE. 67 TORADOL. 54 TORADOL IM. 54 TRANDATE. 44 TRANDOLAPRIL. 36 TRANEXAMIC ACID . 25.
Alternative mood stabilisers include Lithium and Carbamazepine. There are lots of antiepileptic medicines which include: Carbamazepine, Phenytoin, Gabapentin, Lamotrigine, Levetiracetam, Topiramate, Vigabatrin, Tiagabine, Zonisamide, Primadone, Phenobarbital, Pregabalin, Oxcarbazepine and and tramadol.
Effects of ph, organic solvents and foreign ions on the determination of both drugs were studied.
Difficulty with concentration, and speech or language problems in particular, difficulty finding words and 2 ; somnolence or fatigue. Additional nonspecific CNS effects occasionally observed with topiramate therapy include dizziness or imbalance, confusion, memory problems, and exacerbation of mood disturbances such as irritability and depression. Medical Letter observed that, except for divalproex in the treatment of acute mania an FDA-approved use ; , the effectiveness of anti-seizure medications for the treatment of psychiatric illness, including bipolar disorder, has not been well established by controlled clinical trials. Still, the mood stabilizing effects of these drugs may be useful. Most of the prescribing of antiseizure drugs for bipolar disorder and other psychiatric illness is termed "offlabel" as these uses have not been approved by the FDA. Only FDAapproved uses can appear on a drug's package insert, which is why nonapproved use is said to be off-label. A study published in a medical journal, even a well-known one, is no substitute for the FDA's drug approval process. Medical journal editors must accept the veracity of data submitted for publication, but the FDA has the responsibility of ensuring that data used by agency scientists and outside advisory committees in approving new drugs or new uses for old ones are valid. To complicate matters now, intense competition in the pharmaceutical marketplace has blurred the oncesharp boundaries between medical journal articles and promotional hype by drug companies. What You Can Do and valaciclovir.
The left sided weakness slowly resolved over eight weeks after topiramate treatment was withdrawn. A 59 year old woman had poorly controlled secondary generalised seizures after herpes simplex encephalitis despite treatment with carbamazepine slow release and phenytoin. Magnetic resonance imaging showed extensive anterior infarction in the left temporal lobe. T0piramate treatment was introduced over two months up to a dose of 100 mg twice daily. During this time she developed reduced tone and power in her right arm and leg. Repeat magnetic resonance imaging showed no further changes. She regained normal power within two weeks of topiramate withdrawal. To our knowledge, these are the first reported cases of hemiparesis linked with topiramate treatment. It may be relevant that both patients already had compromised neurological function. The Committee on Safety of Medicines and the drug manufacturer have been informed. Awareness of this side effect will avoid inappropriate investigation and encourage rapid withdrawal of topiramate treatment.
The Human Medicines Information day was held in the Citywest Hotel, Co Dublin on Monday, 15th April, 2002 and was attended by approximately 167 delegates. The morning was devoted to labels and patient information leaflets and was chaired by Dr Joan Gilvarry, Medical Director of the IMB. The presentations on patient leaflets focussed on regulatory requirements and on readability issues. The session's guest speaker from the University of Cardiff, Dr Patricia Wright, spoke about the key areas of readability, usability and likeability and the valuable lessons to be learnt from studies into leaflets for the public. The guest speaker for the session on labels was Ms Aileen Barry MPSI from the Pharmacy Department in the Adelaide and Meath Hospital, who gave illustrated examples from pharmacy practice of medication errors arising from label deficiencies. This was followed by a presentation on the IMB's new policy regarding the provision of mock ups of labels and leaflets. During the afternoon session chaired by Mr Tom McGuinn, Chief Pharmacist in the Department of Health and Children, a number of current topics of interest were discussed, including the IMB's views on the Commission's proposals for review of the pharmaceutical legislation, an update on company compliance with pharmacovigilance requirements and TSE issues and a presentation on the IMB's new Information Technology strategic plan for details, see separate article on page 12 ; . Prior to the close of the meeting, there was a question and answer session which allowed for active discussion between the audience and IMB staff. Manufacturers was launched at this meeting and an overview was given to attendees on how to meet the essential requirements of the medical device legislation. The next Information Day for the Medical Devices Sector will be held in October aimed at general medical device sector. Details will follow on the venue and agenda in the next newsletter and vardenafil.
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ILLINOIS DEPARTMENT OF HEALTHCARE AND FAMILY SERVICES HFS ; PRIOR AUTHORIZATION REQUEST FORM TOPAMAX Topiramate ; A. PHYSICIAN INFORMATION - Complete ALL Information Below: Physician Name: Is Prescriber a Neurologist? Yes No If not, list specialty. B. PHARMACY INFORMATION - Complete ALL Information Below: Pharmacy Name: Pharmacy ID: DEA #: Office Phone #: License and voltaren.
Epilepsia 1999; 40 suppl 5 ; : s71-8 marcotte use of topiramate, a new anti-epileptic as a mood stabilizer.
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Objectives: To examine the clinical effectiveness, tolerability and cost-effectiveness of gabapentin GBP ; , lamotrigine LTG ; , levetiracetam LEV ; , oxcarbazepine OXC ; , tiagabine TGB ; , topiramate TPM ; and vigabatrin VGB ; for epilepsy in adults. Data sources: Electronic databases. Internet resources. Pharmaceutical company submissions. Review methods: Selected studies were screened and quality assessed. Separate analyses assessed clinical effectiveness, serious, rare and long-term adverse events and cost-effectiveness. An integrated economic analysis incorporating information on costs and effects of newer and older antiepileptic drugs AEDs ; was performed to give direct comparisons of long-term costs and benefits. Results: A total of 212 studies were included in the review. All included systematic reviews were Cochrane reviews and of good quality. The quality of randomised controlled trials RCTs ; was variable. Assessment was hampered by poor reporting of methods of randomisation, allocation concealment and blinding. Few of the non-randomised studies were of good quality. The main weakness of the economic evaluations was inappropriate use of the costminimisation design. The included systematic reviews reported that newer AEDs were effective as adjunctive therapy compared to placebo. For newer versus older drugs, data were available for all three monotherapy AEDs, although data for OXC and TPM were limited. There was limited, poor-quality evidence of a significant improvement in cognitive function with LTG and OXC compared with older AEDs. However, there were no consistent statistically significant differences in other clinical outcomes, including proportion of seizure-free patients. No studies assessed effectiveness of AEDs in and zantac.
Made about the relative efficacies of these agents, the weight of clinical evidence or value-based arguments supporting their use, or about the manufacturer. Additionally, any test strips that were in tier 2 or 3 eg, Accu-Chek, OneTouch Ultra ; were also shifted to tier 1. Although the company was also enhancing its diabetes disease management and wellness efforts in parallel with these pharmacy benefit changes--for, for example, topiramate treatment.
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Depression medication effect vs. misdiagnosis Social withdrawal excessive dosage? Growth suppression? and ceclor.
| Topiramate for alcohol abusePlasma clearance of topiramate is unchanged in elderly subjects in the absence of underlying renal disease.
West haven, ct: bayer health care, 200 product information and celecoxib.
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Topiramate indications
| Participating Pharmacy A participating pharmacy is a pharmacy in the Express Scripts nationwide network. All major pharmacy chains and most independently owned pharmacies participate. Preferred Brand Name Drugs A preferred brand name drug, also known as a formulary drug, is a medication that has been reviewed and approved by a group of physicians and pharmacists, the Express Scripts Pharmacy and Therapeutics Committee, and has been selected by Express Scripts for formulary inclusion based on its proven clinical and cost effectiveness. Prescription Drug A prescription drug is any medical substance, the label of which under the Federal Food, Drug, and Cosmetic Act, must bear the legend: "Caution Federal Law prohibits dispensing without a prescription." The term prescription drug includes allergy extracts and insulin. Prior Authorization Prior Authorization means determination of medical necessity. It is required before prescriptions for certain drugs will be paid by the plan. Special Medical Formulas or Food Products Special medical formulas or food products means nonprescription enteral formulas for home use for which a physician has issued a written order and which are medically necessary for the treatment of malabsorption caused by Crohn's disease, ulcerative colitis, gastroesophageal reflux, gastrointestinal motility, chronic intestinal pseudo-obstruction, and inherited diseases of amino acids and organic acids. For inherited diseases of amino acids and organic acids, food products modified to be low protein are covered up to $2, 500 per calendar year per member. To access the benefit for special medical formulas or food products, members must first call the Group Insurance Commission at 1-617-727-2310, extension 1 and cleocin.
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Reife ra, “ topiramate: a novel antiepileptic agent, ” the treatment of epilepsy , chapter 38, shorvan sd, et al, eds, cambridge, massachusetts: blackwell science, 199 may tw, rambeck b, and jurgens u, “ serum concentrations of topiramxte in patients with epilepsy: influence of dose, age, and comedication, ” ther drug monit , 2002, 24 3 ; : 366-7 ferrari ar, guerrini r, gatti g, et al, “ influence of dosage, age, and comedication on plasma topiramahe concentrations in children and adults with severe epilepsy and preliminary observations on correlations with clinical response, ” ther drug monit , 2003, 25 6 ; : 700-8 bourgeois bf, “ pharmacokinetic properties of current antiepileptic drugs and clomid and topiramate.
Namely, tooiramate has the propensity to elevate the release and subsequent circulation of norepinephrine noradrenaline through gaba-a activation ; , a neurotransmitter in the catecholamine family that most are familiar with for its ability to increase lipolysis through inter-signaling with the sympathetic nervous system or sns 16, 17, 18.
Suicide attempts occurred in 3% 33 reports 10, 846 patients ; of the topiramate-treated patients compared to 0% in placebo groups and colchicine.
Pharmacist: dispense with a suitable calibrated measuring device to assure proper measuring of dose.
By Harold H. Harsch, MD, FAPM There continues to be an annual push for psychologists to gain prescription rights by state legislation. Of course this is justified by the call for qualifications and extra training, but most of the proposals that I have seen involve a one or two year "training" program. Most official statements from the American Psychiatric Association strongly oppose this and many have claimed that this action would trivialize mental illness. In a recent discussion with a psychiatric colleague the notion of a psychopharmacologist resulted in a surprising response. He stated, in a very matter of fact way, that all psychiatrists are psychopharmacologists. While in a general way this is true, I think that as a profession we need to revisit the motion of sub-specialization, given the advancement of drug development. Although all internists are able to use antibiotics, infectious disease specialists continue to be needed. I was asked, a few months ago, by the Department of Neurology at the Medical College of Wisconsin, to review psychopharmacology in an hour seminar for their residents. I did my best but no one should be under the impression that my one-hour talk was even somewhat of a review of the field. Eighteen years ago I felt that I gave a good review about antidepressants for internal medicine residents in an hour. That was essentially coverage of the tricyclic antidepressants and a mention of MAOI inhibitors knowing that internists would not use these drugs ; . Where has the field progressed in these few years? Let's look at antidepressants from about eight TCA's and three less commonly used MAOIs we have five SSRI's being tested and marketed for an ever expanding list of indications. We have the atypical agents such as mirtazapine, bupropion, venlafaxine, nefazadone, and trazodone. We will soon have a selective norepinephrinc uptake inhibitor marketed. There are at least three other unique agents of which I aware ; in clinical testing. In the area of antipsychotics we have moved from a dozen or so agents that are primarily dopamine blockers to the new serotonin-dopamine antagonists. These, the atypical antipsychotics, represent a significant advance in the treatment of schizophrenia as they presumably influence both negative symptoms and cognition. Five different agents will be marketed by the middle of 2001 and at least three new agents are actively being clinically tested. One of these may have an even more novel mode of action. The world of "mood stabilizers" has had the most expansive growth of any category. In addition to lithium we have added valproic acid in four types of formulations, and carbamazepinc in three types of formulations. From these older accepted agents we now also have lamotrigine, oxcarbazepine, tiagabine, topiramate, and gabapetin which are currently being tested and have shown some promise in bipolar disorder, depression, social phobia, anxiety disorders and chronic pain syndromes. About eight other compounds are being clinically tested for epilepsy and some of these may also have other psychoactive properties. In dementia we moved from almost nothing some of you may remember Hydergine ; to four acctylcholinesterase inhibitors available by the middle of 2001. At least six other agents are now being tested. We have clinical data on vitamin E and estrogen replacement that allows for a rational approach to the care of Alzheimer's disease. In addition there are new sleep aids that are selective benzodiazepine receptor agonists. There are also many new dopamine agonists and centrally acting stimulants such as modafinil. In addition to the new agents that I mention above in current clinical trials, there are over one hundred psychoactive compounds in pre-clinical development. There are many other old and new drugs that are used in the treatment of psychiatric and neurological syndromes that a psychiatrist should have experience in using. In a psychiatric residency a person spends four years in a full time training program attempting to gain experience and knowledge of disease states and the use of this plethora of psychoactive and many non-psychoactive medications. In our residency program we had questions several years ago about the adequacy of the exposure that a trainee would have with the use of TCAs and MAOIs over a four-year period. Today I would begin to extend that concern to the use of lithium, carbamazepine, most of the newer anticonvulsants, and even a broad experience in the use of the, soon to be, five unique atypical antipsychotics. An internist that I know well, once told me that after a year of not working in the ICU he did not feel competent to just return to the ICU, given the degree of change in the technology. Psychopharmacology is now advancing with the same speed. The idea that a psychologist, who has no medicontinued on page 11.
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Replacement: prospective before and after study. BMJ 2004; 328 7445 ; : 934-8. IF: 7.585, MR: 0.953 ; 27. * Mller U, Roeder C, Dubs L, Duetz MS, Greenough CG. Conditionspecific outcome measures for low back pain. Part II: scale construction. Eur Spine J 2004; 13 4 ; : 314-24. IF: 1.232, MR : 0.762 ; 28. * Niemann S, Meer A, Simonin C, Abel T. Medical telephone triage and patient behaviour: How do they compare? Swiss Med Wkly 2004; 134 9-10 ; : 126-31. IF: 0.770, MR: 0.533 ; 29. Pewsner D, Battaglia M, Minder C, Marx A, Bucher HC, Egger M. Ruling a diagnosis in or out with "SpPIn" and "SnNOut": a note of caution. BMJ 2004; 329 7459 ; : 209-13. IF: 7.585, MR: 0.953 ; 30. Pjetursson BE, Tan K, Lang NP, Brgger U, Egger M, Zwahlen M. A systematic review of the survival and complication rates of fixed partial dentures FPDs ; after an observation period of at least 5 years. I. Implant-supported FPDs. Clin Oral Implan Res 2004; 15: 62542. IF: 1.503, MR: 0.837 ; 31. Pjetursson BE, Tan K, Lang NP, Brgger U, Egger M, Zwahlen M. A systematic review of the survival and complication rates of fixed partial dentures FPDs ; after an observation period of at least 5 years. IV. Cantilever or extension FPDs. Clin Oral Implan Res 2004; 15: 667-76. IF: 1.503, MR: 0.837 ; 32. Puhan MA, Schunemann HJ, Frey M, Bachmann LM. Value of supplemental interventions to enhance the effectiveness of physical exercise during respiratory rehabilitation in COPD patients. A systematic review. Resp Res 2004; 5 1 ; : 25. IF: 5.537, MR: 0.968 ; 33. Renehan AG, Zwahlen M, Minder C, O'Dwyer ST, Shalet SM, Egger M. Insulin-like growth factor IGF ; -I, IGF binding protein-3, and cancer risk: systematic review and meta-regression analysis. Lancet 2004; 363 9418 ; : 1346-53. IF: 15.390, MR: 0.981 ; 34. Roberts T, Robinson S, Barton P, Bryan S, McCarthy A, Macleod J, Egger M, Low N. The correct approach to modelling and evaluating chlamydia screening. Sex Transm Infect 2004; 80 4 ; : 324-5. IF: 2.181, MR: 0.850 ; 35. Rsli M, Knzli N, Braun-Fahrlnder C. Use of air pollution "intervention-type" studies in health risk assessment. Epidemiology 2004; 15 4 ; : 194. IF: 3.962, MR: 0.956, for example, topiramate for migraine.
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Were randomized to 10 weeks of treatment with either topiramate, started at 25 mg day and increased to 200 mg day, or placebo. Patients were assessed weekly using the Symptom Checklist SCL-90-R ; , which includes 9 scales of mental symptoms; the SF-36 Health Survey, a quality-of life instrument; and the Inventory of Interpersonal Problems, an 8-item inventory of interpersonal behavior. Results: On the SCL-90-R assessment, patients who received topiramate experienced 1017% reductions in global symptom severity; somatization; interpersonal sensitivity; anxiety; hostility; and phobic anxiety p 0.01 ; . These changes were significantly greater than the 49% improvements seen in the placebo group p 0.001 ; . No improvements were seen in obsessive-compulsive, depression, paranoid ideation, and psychoticism subscale scores. On the SF-36 assessment of health-related quality of life, topiramate was associated with improvements of 714% p0.01 ; . These were also significantly greater than 3% with placebo p 0.01 ; . Topiramate also improved 4 of the 8 interpersonal behavior domains: overly autocratic dominant; quarrelsome competitive; introverted socially avoiding; expressive importunate scales p 0.001 ; . Other scales on this instrument, including difficulty setting boundaries with others, a typical feature of borderline personality disorder, were not affected. After 10 weeks, patients receiving topiramate lost an average of 12.5 lbs, which they perceived as a benefit, while placebo-treated patients lost an average of 3 lbs p 0.001 ; . Adverse effects, such as memory problems and difficulty concentrating, were infrequent and did not occur significantly more often than with placebo. No patient became psychotic or exhibited suicidal or self-injurious behavior. Discussion: Based on this and other studies in women with borderline personality disorder, topiramate appears to be effective in treating aggression, anxiety, and phobias, but not obsessivecompulsive symptoms, paranoid thinking, or psychoticism. Results with depressive symptoms have been mixed.
Topiramate is a more recent antiepileptic that may be efficacious in both migraine and cluster headache prevention. Lainez et al. treated 26 patients 12 episodic, 14 chronic ; with topiramate to a maximum dose of 200mg. Topiramate rapidly induced cluster remission in 15 patients, reduced the number of attacks by more than 50% in six patients, and reduced the cluster period duration in 12.The mean time to remission was 14 days, but in seven patients remission was obtained within the first days of treatment with very low dosages 2575mg a day ; . Six patients discontinued treatment due to side effects all with daily dosages over 100mg ; or lack of efficacy. This article is continued, with references, in the Reference Section on the website supporting this business briefing touchbriefings.
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Only oxcarbazepine, topiramate and possibly lamotrigine are effective in preventing refractory partial seizures when taken as single drug therapy, the experts said.
Doljanac and Zimmerman conducted interviews with 824 mostly African-American 9th graders all of whom had a grade point average of 3.0 or less ; and did not find an association between general alcohol or drug use and condom use for either African-Americans or whites after controlling for other variables.2 Dermen, Cooper and Agoch's study of adolescents found that level of risk at last intercourse which included nonuse of condoms, sex with someone of unknown HIV status and sex with multiple partners ; was related to alcohol use only for those teens who held high expectancies that alcohol would be a disinhibiting or promoting factor in sexual behavior. When looking at the first time the adolescent had had sex, alcohol was found to be associated with risk-taking for teens with both high and with low expectancies that alcohol would facilitate sex. However, the relationship was stronger for those teens with high expectancies.3.
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