Abstract

Phenacemide (Phenurone®) is an older antiepileptic agent about which little modern clinical pharmacologic information has been available. As assay was developed to measure serum phenacemide levels, and kinetic parameters were studied. In the course of therapy of maximally severe epilepsy in 21 patients, clinical and pharmacologic data were gathered. The therapeutic range for phenacemide is 50–100 μg/ml. Mean dose to reach these levels is 56 mg/kg/day. It is not strongly bound to serum proteins (76% unbound in serum). Phenacemide clearance was significantly lower in the presence of valproic acid but was not changed by any other antiepileptic drug. Elimination T/2 in one patient was 15 h. Seizures were consistently better in 10 of 21 patients (4 with complex partial seizures, 5 with atypical absences with minor motor phenomena, and 1 with generalized convulsions). No idiosyncratic side effects were seen to affect marrow, liver, skin, kidney, etc. Mood-altering side effects were seen in seven patients: five showed a withdrawn syndrome and two showed a restless syndrome. This drug is not frequently useful, but the availability of modern pharmacologic information will maximize the success when it is used.

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