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<script type="text/javascript" src="/corehtml/pmc/jatsreader/ptpmc_3.22/js/jr.boots.min.js"> </script><title>Vigabatrin - LiverTox - NCBI Bookshelf</title>
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<meta name="citation_inbook_title" content="LiverTox: Clinical and Research Information on Drug-Induced Liver Injury [Internet]">
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<meta name="citation_title" content="Vigabatrin">
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<meta name="citation_publisher" content="National Institute of Diabetes and Digestive and Kidney Diseases">
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<meta name="citation_date" content="2020/07/31">
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yet</button><a id="jr-fip-next" class="wsprkl btn" title="Jump to next match">▶</a></nav></nav></div><div id="jr-epub-interstitial" class="hidden"></div><div id="jr-content"><article data-type="main"><div class="main-content lit-style" itemscope="itemscope" itemtype="http://schema.org/CreativeWork"><div class="meta-content fm-sec"><div class="fm-sec"><h1 id="_NBK548253_"><span class="title" itemprop="name">Vigabatrin</span></h1><p class="fm-aai"><a href="#_NBK548253_pubdet_">Publication Details</a></p></div></div><div class="body-content whole_rhythm" itemprop="text"><div id="Vigabatrin.OVERVIEW"><h2 id="_Vigabatrin_OVERVIEW_">OVERVIEW</h2><div id="Vigabatrin.Introduction"><h3>Introduction</h3><p>Vigabatrin is a GABA derivative that is used in combination with other agents as therapy of refractory complex partial seizures and as monotherapy for infantile spasms. Vigabatrin is associated with a paradoxical decrease in serum enzyme levels during therapy, explained by its direct inhibition of aminotransferase activity. Vigabatrin has not been convincingly linked to cases of clinically apparent liver injury, but was linked to a fatal case of Reye syndrome in a child with severe developmental delay.</p></div><div id="Vigabatrin.Background"><h3>Background</h3><p>Vigabatrin (vye ga' ba trin) is a vinyl derivative of gamma-aminobutyric acid (GABA) that acts as a competitive inhibitor of GABA transaminase. Vigabatrin prevents the breakdown of GABA and thus may increase GABAergic, neuroinhibitory activity. Vigabatrin has been shown to be effective in reducing seizure activity as add on therapy in patients with refractory partial onset seizures. It was available in other countries for more than a decade before it was approved for use in the United States in 2009. Current indications include as adjuvant therapy in patients with refractory complex partial seizures and as monotherapy for infantile spasms in children ages 1 month to 2 years. Vigabatrin is available in tablets of 500 mg and as a powder for oral solution generically and under the brand name Sabril. The typical initial dose is 500 mg twice daily, with subsequent increases to a recommended average dose of 3000 mg daily in adults and 2000 mg in children 10 to 16 years of age. Doses for children with infantile spasms are weight based. Side effects may include fatigue, somnolence, nystagmus, tremor, blurred vision, memory impairment, mood changes, confusion and weight gain. Rare, but severe adverse events include visual loss, visual field constriction and retinal dysfunction, for which reason vigabatrin is available only through a restricted program that requires prospective ophthalmologic monitoring.</p></div><div id="Vigabatrin.Hepatotoxicity"><h3>Hepatotoxicity</h3><p>In controlled clinical trials, addition of vigabatrin to standard anticonvulsant therapy was reported to cause an immediate and marked decrease in serum enzyme levels that could be reproduced by simply mixing vigabatrin with plasma. In some instances, markedly raised serum ALT levels were found to rapidly fall into the normal range with treatment. Vigabatrin inhibits GABA transaminase and is thus suspected of also being an inhibitor of alanine and aspartate aminotransferase, accounting for its unusual effects on liver associated enzymes. In prelicensure clinical trials, there were no reports of serum enzyme elevations during treatment and no instances of clinically apparent liver injury. After its general availability, however, there have been isolated case reports of severe liver injury and hepatitis associated with vigabatrin use. The onset of injury was 3 to 10 months after starting vigabatrin and was largely hepatocellular. One case resulted in rapid death from liver failure and a second worsened despite stopping and ultimately required a course of immunosuppression with prednisone and azathioprine (Case 1). Thus, clinically apparent liver injury from vigabatrin may occur and can be severe, but is rare.</p><p>Likelihood score: D (possible rare cause of clinically apparent liver injury).</p></div><div id="Vigabatrin.Mechanism_of_Injury"><h3>Mechanism of Injury</h3><p>Vigabatrin is an amino acid derivative and is metabolized by many tissues in the body. It is unlikely to be directly hepatotoxic and is not reported to cause drug-drug interactions. Instances of liver injury from vigabatrin are likely to be due to hypersensitivity.</p></div><div id="Vigabatrin.Outcome_and_Management"><h3>Outcome and Management</h3><p>Patients who have developed serious hypersensitivity reactions to aromatic anticonvulsants such as phenytoin, carbamazepine and lamotrigine have later tolerated therapy with vigabatrin without recurrence. The structure of vigabatrin would suggest that it does not share sensitivity to other anticonvulsant agents.</p><p>Drug Class: <a href="/books/n/livertox/Anticonvulsants/?report=reader">Anticonvulsants</a></p></div></div><div id="Vigabatrin.CASE_REPORT"><h2 id="_Vigabatrin_CASE_REPORT_">CASE REPORT</h2><div id="Vigabatrin.Case_1_Acute_hepatitis_attrib"><h3>Case 1. Acute hepatitis attributed to vigabatrin.(<a class="bibr" href="#Vigabatrin.REF.1" rid="Vigabatrin.REF.1">1</a>)</h3><p>A 25 year old woman was found to have abnormal liver tests 10 months after starting vigabatrin for partial onset seizures. The serum bilirubin was minimally raised (2.0 mg/dL), but ALT values were 10 times and AST 8 times the upper limit of normal (Table). Vigabatrin was continued, but several weeks later she developed symptoms of fatigue and nausea and repeat blood testing showed persistence of the liver test abnormalities. Vigabatrin was stopped and she was referred for further evaluation. She denied a history of liver disease, alcohol abuse or risk factors for viral hepatitis. She was not taking other medications and denied use of over-the-counter drugs or herbal supplements. Physical examination was unremarkable and showed no fever or rash. Tests for acute hepatitis A, B and C were negative as were tests for EBV and CMV infection. Autoantibodies were not detected. Imaging of the liver by ultrasound was normal. A liver biopsy showed panlobular hepatitis with hepatocellular necrosis and inflammatory infiltrates of lymphocytes and eosinophils. Plasma cells and neutrophils were not prominent and there was no fat or fibrosis. Despite stopping vigabatrin, she continued to worsen and serum bilirubin rose to 4.1 mg/dL and prothrombin index fell to 54%. Because of the worsening and the possibility of autoimmune liver injury, prednisone and azathioprine were started, but blood tests had already showed evidence of improvement. Thereafter, she improved rapidly, and she was asymptomatic and all tests were normal one month later. The immunosuppressive therapy was gradually tapered and was stopped after 4 months. In follow up 8 months later, all liver tests remained normal.</p><div id="Vigabatrin.Key_Points"><h4>Key Points</h4><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figVigabatrinTc"><a href="/books/NBK548253/table/Vigabatrin.Tc/?report=objectonly" target="object" title="Table" class="img_link icnblk_img figpopup" rid-figpopup="figVigabatrinTc" rid-ob="figobVigabatrinTc"><img class="small-thumb" src="/books/NBK548253/table/Vigabatrin.Tc/?report=thumb" src-large="/books/NBK548253/table/Vigabatrin.Tc/?report=previmg" alt="Image " /></a><div class="icnblk_cntnt"><h4 id="Vigabatrin.Tc"><a href="/books/NBK548253/table/Vigabatrin.Tc/?report=objectonly" target="object" rid-ob="figobVigabatrinTc">Table</a></h4></div></div></div><div id="Vigabatrin.Laboratory_Values"><h4>Laboratory Values</h4><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figVigabatrinTd"><a href="/books/NBK548253/table/Vigabatrin.Td/?report=objectonly" target="object" title="Table" class="img_link icnblk_img figpopup" rid-figpopup="figVigabatrinTd" rid-ob="figobVigabatrinTd"><img class="small-thumb" src="/books/NBK548253/table/Vigabatrin.Td/?report=thumb" src-large="/books/NBK548253/table/Vigabatrin.Td/?report=previmg" alt="Image " /></a><div class="icnblk_cntnt"><h4 id="Vigabatrin.Td"><a href="/books/NBK548253/table/Vigabatrin.Td/?report=objectonly" target="object" rid-ob="figobVigabatrinTd">Table</a></h4></div></div></div><div id="Vigabatrin.Comment"><h4>Comment</h4><p>A woman with partial onset seizures developed evidence of acute hepatitis 10 months after starting vigabatrin. She was taking no other medications and had no risk factors for viral hepatitis. Medical evaluation revealed no evidence for other forms of liver disease, and a liver biopsy was compatible with drug induced liver injury. Because of concerns over the severity of the injury and the possibility of an early autoimmune hepatitis, prednisone and azathioprine were started, but blood tests showed evidence of improvement even before these medications was started. In follow up, she was able to stop the immunosuppressive regimen without recurrence of injury, strong evidence against autoimmune hepatitis. This was a fairly convincing case of vigabatrin induced liver injury. The absence of other reports may merely reflect the fact that the drug is rarely used, particularly as monotherapy. Vigabatrin is approved in the United States, only as adjunctive therapy to be used with other anticonvulsant agents for partial seizures in adults. Its serious adverse events (particularly retinal) have limited it more wide scale use. Why a simple GABA derivative would cause liver toxicity is unclear. Despite the absence of signs of hypersensitivity, the most likely explanation is immunologic.</p></div></div></div><div id="Vigabatrin.PRODUCT_INFORMATION"><h2 id="_Vigabatrin_PRODUCT_INFORMATION_">PRODUCT INFORMATION</h2><p>
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<b>REPRESENTATIVE TRADE NAMES</b>
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</p><p>Vigabatrin – Generic, Sabril®</p><p>
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<b>DRUG CLASS</b>
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</p><p>Anticonvulsants</p><p>
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<a href="https://dailymed.nlm.nih.gov/dailymed/search.cfm?labeltype=all&query=Vigabatrin" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">COMPLETE LABELING</a>
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</p><p>Product labeling at DailyMed, National Library of Medicine, NIH</p></div><div id="Vigabatrin.CHEMICAL_FORMULAS_AND_STRUCTU"><h2 id="_Vigabatrin_CHEMICAL_FORMULAS_AND_STRUCTU_">CHEMICAL FORMULAS AND STRUCTURES</h2><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figVigabatrinTe"><a href="/books/NBK548253/table/Vigabatrin.Te/?report=objectonly" target="object" title="Table" class="img_link icnblk_img figpopup" rid-figpopup="figVigabatrinTe" rid-ob="figobVigabatrinTe"><img class="small-thumb" src="/books/NBK548253/table/Vigabatrin.Te/?report=thumb" src-large="/books/NBK548253/table/Vigabatrin.Te/?report=previmg" alt="Image " /></a><div class="icnblk_cntnt"><h4 id="Vigabatrin.Te"><a href="/books/NBK548253/table/Vigabatrin.Te/?report=objectonly" target="object" rid-ob="figobVigabatrinTe">Table</a></h4></div></div></div><div id="Vigabatrin.CITED_REFERENCE"><h2 id="_Vigabatrin_CITED_REFERENCE_">CITED REFERENCE</h2><dl class="temp-labeled-list"><dl class="bkr_refwrap"><dt>1.</dt><dd><div class="bk_ref" id="Vigabatrin.REF.1">Locher C, Zafrani ES, Dhumeaux D, Mallat A. <span><span class="ref-journal">Gastroenterol Clin Biol. </span>2001;<span class="ref-vol">25</span>:556–7.</span> [Vigabatrin-induced cytolytic hepatitis] French. [<a href="https://pubmed.ncbi.nlm.nih.gov/11521114" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 11521114</span></a>]</div></dd></dl></dl></div><div id="Vigabatrin.ANNOTATED_BIBLIOGRAPHY"><h2 id="_Vigabatrin_ANNOTATED_BIBLIOGRAPHY_">ANNOTATED BIBLIOGRAPHY</h2><p>References updated: 31 July 2020</p><p>Abbreviations used: SJS/TEN, Stevens-Johnson syndrome and toxic epidermal necrolysis.</p><ul class="first-line-outdent"><li><div class="bk_ref" id="Vigabatrin.REF.kaplowitz_zimmerman.1999">Kaplowitz Zimmerman HJ. Anticonvulsants. In, Zimmerman, HJ. Hepatotoxicity: the adverse effects of drugs and other chemicals on the liver. 2nd ed. Philadelphia: Lippincott, 1999: pp. 498-516.<div><i>(Expert review of anticonvulsants and liver injury published in 1999 before the availability of vigabatrin).</i></div></div></li><li><div class="bk_ref" id="Vigabatrin.REF.pirmohamed.2013">Pirmohamed M, Leeder SJ. Anticonvulsant agents. In, Kaplowitz N, DeLeve LD, eds. Drug-induced liver disease. 3rd ed. Amsterdam: Elsevier, 2013: pp 423-42.<div><i>(Review of anticonvulsant induced liver injury; vigabatrin is not discussed).</i></div></div></li><li><div class="bk_ref" id="Vigabatrin.REF.smith.2018">Smith MD, Metcalf CS, Wilcox KS. Pharmacology of the epilepsies. In, Brunton LL, Hilal-Dandan R, Knollman BC, eds. Goodman & Gilman’s the pharmacological basis of therapeutics. 13th ed. New York: McGraw-Hill, 2018, pp. 303-26.<div><i>(Textbook of pharmacology and therapeutics).</i></div></div></li><li><div class="bk_ref" id="Vigabatrin.REF.remy.1989.125s">Remy C, Beaumont D. Efficacy and safety of vigabatrin in the long-term treatment of refractory epilepsy. <span><span class="ref-journal">Br J Clin Pharmacol. </span>1989;<span class="ref-vol">27</span> Suppl 1:125S–129S.</span> [<a href="/pmc/articles/PMC1379691/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC1379691</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/2757903" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 2757903</span></a>]<div>
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<i>(Among 254 patients with refractory seizures treated with vigabatrin for an average of 23 months, “there was some alterations in liver transaminases” including a 30-50% decrease in ALT).</i>
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</div></div></li><li><div class="bk_ref" id="Vigabatrin.REF.benmenachem.1990.240">Ben-Menachem E, Persson L, Mumford J. Long-term evaluation of once daily vigabatrin in drug-resistant partial epilepsy. <span><span class="ref-journal">Epilepsy Res. </span>1990;<span class="ref-vol">5</span>:240–6.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/2116964" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 2116964</span></a>]<div>
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<i>(Among 35 patients with refractory partial onset seizures treated with adjunctive vigabatrin for up to 3 years, there were no changes in routine chemistry laboratory tests “that were considered to be clinically significant”).</i>
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</div></div></li><li><div class="bk_ref" id="Vigabatrin.REF.browne.1991.363">Browne TR, Mattson RH, Penry JK, Smith DB, Treiman DM, Wilder BJ, Ben-Menachem E, et al. Multicenter long-term safety and efficacy study of vigabatrin for refractory complex partial seizures: an update. <span><span class="ref-journal">Neurology. </span>1991;<span class="ref-vol">41</span>:363–4.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/2006001" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 2006001</span></a>]<div>
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<i>(Among 66 patients with refractory seizures who received vigabatrin as add on therapy for 5-72 months, there were no abnormalities in laboratory studies).</i>
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</div></div></li><li><div class="bk_ref" id="Vigabatrin.REF.tartara.1992.247">Tartara A, Manni R, Galimberti CA, Morini R, Mumford JP, Iudice A, Perucca E. Six-year follow-up study on the efficacy and safety of vigabatrin in patients with epilepsy. <span><span class="ref-journal">Acta Neurol Scand. </span>1992;<span class="ref-vol">86</span>:247–51.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/1414241" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 1414241</span></a>]<div>
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<i>(Among 25 patients with partial onset seizures with a favorable response to adjunctive vigabatrin therapy and who were continued on treatment for 2-6 years, “there were no significant changes in standard…blood chemistry…tests” and no serious adverse events or need for discontinuation due to liver injury).</i>
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</div></div></li><li><div class="bk_ref" id="Vigabatrin.REF.cocito.1993.301">Cocito L, Maffini M, Loeb C. Vigabatrin in chronic epilepsy: a 7-year follow-up study of responder patients. <span><span class="ref-journal">Seizure. </span>1993;<span class="ref-vol">2</span>:301–7.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/8162400" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 8162400</span></a>]<div>
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<i>(Among 35 adults with epilepsy treated with vigabatrin as add on therapy for refractory epilepsy, 23 were continued on drug in an extension study, among whom there were “no significant effects” on any of the routine laboratory tests).</i>
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</div></div></li><li><div class="bk_ref" id="Vigabatrin.REF.williams.1994.65">Williams A, Goldsmith R, Coakley J. Profound suppression of plasma alanine aminotransferase activity in children taking vigabatrin. <span><span class="ref-journal">Aust N Z J Med. </span>1994;<span class="ref-vol">24</span>:65.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/8002862" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 8002862</span></a>]<div>
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<i>(Among 12 children [ages 2 to 17 years] with poorly controlled seizures who were treated with vigabatrin, serum ALT levels decrease in all 12, from 13-72 U/L to 0-26 U/L, perhaps due to inhibition of alanine and aspartate as well as GABA transaminase).</i>
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</div></div></li><li><div class="bk_ref" id="Vigabatrin.REF.kellermann.1996.380">Kellermann K, Soditt V, Rambeck B, Klinge O. Fatal hepatotoxicity in a child treated with vigabatrin. <span><span class="ref-journal">Acta Neurol Scand. </span>1996;<span class="ref-vol">93</span>:380–1.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/8800351" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 8800351</span></a>]<div>
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<i>(3 year old boy with developmental delay and seizures treated with phenobarbital developed fever and coma 3 months after the addition of vigabatrin [bilirubin not given, AST 54 rising to 577 U/L, ammonia 214 μmol/L] and progressive coagulopathy leading to death in 3 days, autopsy showing massive necrosis without fat, although mitochondrial changes suggested Reye syndrome).</i>
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</div></div></li><li><div class="bk_ref" id="Vigabatrin.REF.williams.1998.395">Williams A, Sekaninova S, Coakley J. Suppression of elevated alanine aminotransferase activity in liver disease by vigabatrin. <span><span class="ref-journal">J Paediatr Child Health. </span>1998;<span class="ref-vol">34</span>:395–7.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/9727187" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 9727187</span></a>]<div>
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<i>(In a 16 month old boy with Alpers syndrome, severe developmental delay and liver disease, addition of vigabatrin to standard anticonvulsant therapy was followed by day 15 by a 91% decrease in ALT [247 to 18 U/L] and 19% decrease in Alk P levels [into the normal range], effects that could be reproduced in vitro, by addition of vigabatrin to plasma).</i>
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</div></div></li><li><div class="bk_ref" id="Vigabatrin.REF.bruni.2000.224">Bruni J, Guberman A, Vachon L, Desforges C. Vigabatrin as add-on therapy for adult complex partial seizures: a double-blind, placebo-controlled multicentre study. The Canadian Vigabatrin Study Group. <span><span class="ref-journal">Seizure. </span>2000;<span class="ref-vol">9</span>:224–32.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/10777431" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 10777431</span></a>]<div>
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<i>(Among 111 patients with refractory partial onset seizures who were treated with vigabatrin or placebo for 36 weeks, there were “no clinically significant abnormalities” of laboratory test results).</i>
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</div></div></li><li><div class="bk_ref" id="Vigabatrin.REF.guberman.2000.112">Guberman A, Bruni J. Long-term open multicentre, add-on trial of vigabatrin in adult resistant partial epilepsy. The Canadian Vigabatrin Study Group. <span><span class="ref-journal">Seizure. </span>2000;<span class="ref-vol">9</span>:112–8.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/10845734" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 10845734</span></a>]<div>
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<i>(Among 97 patients with refractory partial onset seizures who had completed participation in a placebo controlled trial and were continued on vigabatrin for up to 1 year, there were marked reductions in serum ALT, and no patient had a liver related serious adverse event or had to discontinue therapy because of liver injury).</i>
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</div></div></li><li><div class="bk_ref" id="Vigabatrin.REF.locher.2001.556">Locher C, Zafrani ES, Dhumeaux D, Mallat A. <span><span class="ref-journal">Gastroenterol Clin Biol. </span>2001;<span class="ref-vol">25</span>:556–7.</span> [Vigabatrin-induced cytolytic hepatitis] French. [<a href="https://pubmed.ncbi.nlm.nih.gov/11521114" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 11521114</span></a>]<div>
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<i>(25 year old woman with partial onset seizures developed acute hepatitis 10 months after starting vigabatrin [bilirubin 2.0 rising to 4.1 mg/dL, ALT 10 rising to 45 times ULN, Alk P 1.5 times ULN), ultimately treated with prednisone and azathioprine and improving rapidly, but able to stop all immunosuppression several months later without relapse: Case 1).</i>
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</div></div></li><li><div class="bk_ref" id="Vigabatrin.REF.galindo.2002.299">Galindo PA, Borja J, Gómez E, Mur P, Gudín M, García R, Encinas C, et al. Anticonvulsant drug hypersensitivity. <span><span class="ref-journal">J Investig Allergol Clin Immunol. </span>2002;<span class="ref-vol">12</span>:299–304.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/12926190" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 12926190</span></a>]<div>
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<i>(Among 15 patients with cutaneous hypersensitivity reactions to anticonvulsants [9 accompanied by liver test elevations] which were caused by carbamazepine [n=8], phenytoin [5], lamotrigine [4], phenobarbital [4], valproate [1] and felbamate [1], two patients later tolerated vigabatrin without recurrence).</i>
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</div></div></li><li><div class="bk_ref" id="Vigabatrin.REF.bj_rnsson.2008.281">Björnsson E. Hepatotoxicity associated with antiepileptic drugs. <span><span class="ref-journal">Acta Neurol Scand. </span>2008;<span class="ref-vol">118</span>:281–90.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/18341684" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 18341684</span></a>]<div>
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<i>(Review of the hepatotoxicity of anticonvulsants; no discussion of vigabatrin).</i>
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</div></div></li><li><div class="bk_ref" id="Vigabatrin.REF.camposano.2008.1186">Camposano SE, Major P, Halpern E, Thiele EA. Vigabatrin in the treatment of childhood epilepsy: a retrospective chart review of efficacy and safety profile. <span><span class="ref-journal">Epilepsia. </span>2008;<span class="ref-vol">49</span>:1186–91.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/18479386" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 18479386</span></a>]<div>
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<i>(Among 84 children treated with vigabatrin for infantile spasms or partial onset seizures or both, side effects were uncommon and usually mild, leading to discontinuation in only 3 children, all 3 for psychiatric symptoms).</i>
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</div></div></li><li><div class="bk_ref" id="Vigabatrin.REF19">Vigabatrin (Sabril) for epilepsy. <span><span class="ref-journal">Med Lett Drugs Ther. </span>2010;<span class="ref-vol">52</span>(1332):14–6.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/20208475" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 20208475</span></a>]<div>
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<i>(Concise summary of mechanism of action, clinical efficacy, adverse events and costs of vigabatrin shortly after its approval for use in the US mentions the serious adverse events of retinal dysfunction, intramyelinic edema and suicidal ideation as well as the common adverse events of anticonvulsants such as headache, fatigue, pain, ataxia, dizziness, somnolence, weight gain, depression and alterations in behavior, mood and thinking; no mention of ALT elevations or hepatotoxicity).</i>
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</div></div></li><li><div class="bk_ref" id="Vigabatrin.REF.walker.2011.72">Walker SD, Kälviäinen R. Non-vision adverse events with vigabatrin therapy. <span><span class="ref-journal">Acta Neurol Scand Suppl. </span>2011;(192):72–82.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/22061182" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 22061182</span></a>]<div>
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<i>(Review of the common adverse events of vigabatrin therapy does not mention ALT elevations or hepatotoxicity).</i>
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</div></div></li><li><div class="bk_ref" id="Vigabatrin.REF.gaitatzis.2013.435">Gaitatzis A, Sander JW. The long-term safety of antiepileptic drugs. <span><span class="ref-journal">CNS Drugs. </span>2013;<span class="ref-vol">27</span>:435–55.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/23673774" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 23673774</span></a>]<div>
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<i>(Review of the long term safety and adverse event profile of anticonvulsants mentions that valproate and felbamate can cause liver failure, but does not mention hepatotoxicity of other anticonvulsants).</i>
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</div></div></li><li><div class="bk_ref" id="Vigabatrin.REF22">Drugs for epilepsy. <span><span class="ref-journal">Treat Guidel Med Lett. </span>2013;<span class="ref-vol">11</span>:9–18.</span> Erratum in Treat Guidel Med Lett 2013; 11: 112. [<a href="https://pubmed.ncbi.nlm.nih.gov/23348233" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 23348233</span></a>]<div>
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<i>(Concise review of indications and side effects of anticonvulsants; vigabatrin is approved as add on therapy of Lennox-Gastaut syndrome in children and adults; discussion of adverse effects does not mention hepatotoxicity, but mentions that vigabatrin is a mild inducer of CYP 3A4).</i>
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</div></div></li><li><div class="bk_ref" id="Vigabatrin.REF.bj_rnsson.2013.1419">Björnsson ES, Bergmann OM, Björnsson HK, Kvaran RB, Olafsson S. Incidence, presentation and outcomes in patients with drug-induced liver injury in the general population of Iceland. <span><span class="ref-journal">Gastroenterology. </span>2013;<span class="ref-vol">144</span>:1419–25.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/23419359" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 23419359</span></a>]<div>
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<i>(In a population based study of drug induced liver injury from Iceland, 96 cases were identified over a 2 year period, but of the 96, none were attributed to vigabatrin).</i>
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</div></div></li><li><div class="bk_ref" id="Vigabatrin.REF.chalasani.2015.1340">Chalasani N, Bonkovsky HL, Fontana R, Lee W, Stolz A, Talwalkar J, Reddy KR, et al. United States Drug Induced Liver Injury Network. Features and outcomes of 899 patients with drug-induced liver injury: The DILIN Prospective Study. <span><span class="ref-journal">Gastroenterology. </span>2015;<span class="ref-vol">148</span>:1340–52.e7.</span> [<a href="/pmc/articles/PMC4446235/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC4446235</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/25754159" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 25754159</span></a>]<div>
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<i>(Among 899 cases of drug induced liver injury enrolled in a US prospective study between 2004 and 2013, 40 [4.5%] were attributed to anticonvulsants, but none to vigabatrin).</i>
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</div></div></li><li><div class="bk_ref" id="Vigabatrin.REF.vidaurre.2017.23">Vidaurre J, Gedela S, Yarosz S. Antiepileptic drugs and liver disease. <span><span class="ref-journal">Pediatr Neurol. </span>2017;<span class="ref-vol">77</span>:23–36.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/29097018" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 29097018</span></a>]<div><i>(Review of the use of anticonvulsants in patients with liver disease recommends use of agents that have little hepatic metabolism such as</i> <i>levetiracetam</i><i>, lacosamide, topiramate, gabapentin and pregabalin, levetiracetam, being an "ideal" first line therapy for patients with liver disease because of its safety and lack of pharmacokinetic interactions).</i></div></div></li><li><div class="bk_ref" id="Vigabatrin.REF26">Drugs for epilepsy. <span><span class="ref-journal">Med Lett Drugs Ther. </span>2017;<span class="ref-vol">59</span>(1526):121–30.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/28746301" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 28746301</span></a>]<div><i>(Concise review of the drugs available for therapy of epilepsy lists</i> <i>vigabatrin as being available only through a restricted distribution program because of concerns about retinal toxicity; no mention of hepatotoxicity or changes in ALT levels</i><i>).</i></div></div></li><li><div class="bk_ref" id="Vigabatrin.REF.borrelli.2018.2318">Borrelli EP, Lee EY, Descoteaux AM, Kogut SJ, Caffrey AR. Stevens-Johnson syndrome and toxic epidermal necrolysis with antiepileptic drugs: An analysis of the US Food and Drug Administration Adverse Event Reporting System. <span><span class="ref-journal">Epilepsia. </span>2018;<span class="ref-vol">59</span>:2318–24.</span> [<a href="/pmc/articles/PMC6420776/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC6420776</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/30395352" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 30395352</span></a>]<div>
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<i>(Review of adverse event reports to the FDA between 2014 and 2018 identified ~2.9 million reports, 1034 for SJS/TEN, the most common class of drugs being anticonvulsants with 17 of 34 having at least one report, those most frequently linked being lamotrigine [n=106], carbamazepine [22], levetiracetam [14], phenytoin [14], valproate [9], clonazepam [8] and zonisamide [7]; no mention of vigabatrin).</i>
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</div></div></li><li><div class="bk_ref" id="Vigabatrin.REF.somoza.2013.630">Somoza EC, Winship D, Gorodetzky CW, Lewis D, Ciraulo DA, Galloway GP, Segal SD, et al. A multisite, double-blind, placebo-controlled clinical trial to evaluate the safety and efficacy of vigabatrin for treating cocaine dependence. <span><span class="ref-journal">JAMA Psychiatry. </span>2013;<span class="ref-vol">70</span>:630–7.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/23575810" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 23575810</span></a>]<div>
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<i>(Among 186 adults with cocaine dependency treated with vigabatrin or placebo for 13 weeks, abstinence rates were similar [7.6% vs 5.3%] as were adverse event rates, although one vigabatrin treated subject developed acute hepatitis [specific data not provided]).</i>
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</div></div></li><li><div class="bk_ref" id="Vigabatrin.REF.jackson.2017.1575">Jackson MC, Jafarpour S, Klehm J, Thome-Souza S, Coughlin F, Kapur K, Loddenkemper T. Effect of vigabatrin on seizure control and safety profile in different subgroups of children with epilepsy. <span><span class="ref-journal">Epilepsia. </span>2017;<span class="ref-vol">58</span>:1575–85.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/28691157" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 28691157</span></a>]<div>
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<i>(Among 103 children treated with vigabatrin with electronic medical record follow up data, seizure frequency decreased by at least half in 73% of children while 20% of children had adverse events, the most common being visual changes [8.5%]; no mention of ALT abnormalities or hepatotoxicity).</i>
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</div></div></li><li><div class="bk_ref" id="Vigabatrin.REF.ohtsuka.2018.134">Ohtsuka Y. Efficacy and safety of vigabatrin in Japanese patients with infantile spasms: Primary short-term study and extension study. <span><span class="ref-journal">Epilepsy Behav. </span>2018;<span class="ref-vol">78</span>:134–41.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/29190579" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 29190579</span></a>]<div>
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<i>(Among 13 Japanese children with infantile spasms treated with vigabatrin, 8 [62%] had a 50% or greater decrease in seizure frequency and none had a serious adverse event or peripheral visual defect reported).</i>
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</div></div></li><li><div class="bk_ref" id="Vigabatrin.REF.hussain.2018.143">Hussain SA. Treatment of infantile spasms. <span><span class="ref-journal">Epilepsia Open. </span>2018;<span class="ref-vol">3</span> Suppl 2:143–54.</span> [<a href="/pmc/articles/PMC6293071/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC6293071</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/30564773" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 30564773</span></a>]<div>
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<i>(Review of the clinical features, natural history and therapy of infantile spasms, the most common form of epilepsy presenting in the first year of life, vigabatrin being a first line therapy which is limited by concerns of retinopathy and MRI evidence of central nervous system toxicity associated with long term use; no mention of hepatotoxicity or ALT elevations).</i>
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</div></div></li><li><div class="bk_ref" id="Vigabatrin.REF.canopaniagua.2019.501">Cano-Paniagua A, Amariles P, Angulo N, Restrepo-Garay M. Epidemiology of drug-induced liver injury in a University Hospital from Colombia: Updated RUCAM being used for prospective causality assessment. <span><span class="ref-journal">Ann Hepatol. </span>2019;<span class="ref-vol">18</span>:501–7.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/31053545" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 31053545</span></a>]<div>
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<i>(Among 286 patients with liver test abnormalities seen in a single hospital in Colombia over a 1 year period, 17 were diagnosed with drug induced liver injury, the most common cause being antituberculosis therapy [n=6] followed by anticonvulsants [n=3, 1 each due to phenytoin, gabapentin and valproate]).</i>
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</div></div></li></ul></div><div id="bk_toc_contnr"></div></div></div><div class="fm-sec"><h2 id="_NBK548253_pubdet_">Publication Details</h2><h3>Publication History</h3><p class="small">Last Update: <span itemprop="dateModified">July 31, 2020</span>.</p><h3>Copyright</h3><div><div class="half_rhythm"><a href="/books/about/copyright/">Copyright Notice</a></div></div><h3>Publisher</h3><p><a href="https://www.niddk.nih.gov/" ref="pagearea=page-banner&targetsite=external&targetcat=link&targettype=publisher">National Institute of Diabetes and Digestive and Kidney Diseases</a>, Bethesda (MD)</p><h3>NLM Citation</h3><p>LiverTox: Clinical and Research Information on Drug-Induced Liver Injury [Internet]. Bethesda (MD): National Institute of Diabetes and Digestive and Kidney Diseases; 2012-. Vigabatrin. [Updated 2020 Jul 31].<span class="bk_cite_avail"></span></p></div><div class="small-screen-prev"><a href="/books/n/livertox/ViekiraPak/?report=reader"><svg xmlns="http://www.w3.org/2000/svg" viewBox="0 0 100 100" preserveAspectRatio="none"><path d="M75,30 c-80,60 -80,0 0,60 c-30,-60 -30,0 0,-60"></path><text x="20" y="28" textLength="60" style="font-size:25px">Prev</text></svg></a></div><div class="small-screen-next"><a href="/books/n/livertox/Vilazodone/?report=reader"><svg xmlns="http://www.w3.org/2000/svg" viewBox="0 0 100 100" preserveAspectRatio="none"><path d="M25,30c80,60 80,0 0,60 c30,-60 30,0 0,-60"></path><text x="20" y="28" textLength="60" style="font-size:25px">Next</text></svg></a></div></article><article data-type="table-wrap" id="figobVigabatrinTc"><div id="Vigabatrin.Tc" class="table"><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK548253/table/Vigabatrin.Tc/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__Vigabatrin.Tc_lrgtbl__"><table><tbody><tr><th id="hd_b_Vigabatrin.Tc_1_1_1_1" scope="row" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Medication:</th><td headers="hd_b_Vigabatrin.Tc_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Vigabatrin</td></tr><tr><th id="hd_b_Vigabatrin.Tc_1_1_2_1" scope="row" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Pattern:</th><td headers="hd_b_Vigabatrin.Tc_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Hepatocellular (R ratio=6.6)</td></tr><tr><th id="hd_b_Vigabatrin.Tc_1_1_3_1" scope="row" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Severity:</th><td headers="hd_b_Vigabatrin.Tc_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Moderate (jaundice and hospitalization)</td></tr><tr><th id="hd_b_Vigabatrin.Tc_1_1_4_1" scope="row" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Latency:</th><td headers="hd_b_Vigabatrin.Tc_1_1_4_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">10 months</td></tr><tr><th id="hd_b_Vigabatrin.Tc_1_1_5_1" scope="row" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Recovery:</th><td headers="hd_b_Vigabatrin.Tc_1_1_5_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">2 months (with prednisone and azathioprine therapy)</td></tr><tr><th id="hd_b_Vigabatrin.Tc_1_1_6_1" scope="row" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Other medications:</th><td headers="hd_b_Vigabatrin.Tc_1_1_6_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">None</td></tr></tbody></table></div></div></article><article data-type="table-wrap" id="figobVigabatrinTd"><div id="Vigabatrin.Td" class="table"><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK548253/table/Vigabatrin.Td/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__Vigabatrin.Td_lrgtbl__"><table class="no_bottom_margin"><thead><tr><th id="hd_h_Vigabatrin.Td_1_1_1_1" scope="col" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">Time After<br />Starting</th><th id="hd_h_Vigabatrin.Td_1_1_1_2" scope="col" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">Time After<br />Stopping</th><th id="hd_h_Vigabatrin.Td_1_1_1_3" scope="col" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">ALT*<br />(U/L)</th><th id="hd_h_Vigabatrin.Td_1_1_1_4" scope="col" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">Alk P<br />(U/L)</th><th id="hd_h_Vigabatrin.Td_1_1_1_5" scope="col" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">Bilirubin*<br />(mg/dL)</th><th id="hd_h_Vigabatrin.Td_1_1_1_6" scope="col" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">Other</th></tr></thead><tbody><tr><td headers="hd_h_Vigabatrin.Td_1_1_1_1" scope="row" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">7 months</td><td headers="hd_h_Vigabatrin.Td_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">0</td><td headers="hd_h_Vigabatrin.Td_1_1_1_3" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">35</td><td headers="hd_h_Vigabatrin.Td_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"></td><td headers="hd_h_Vigabatrin.Td_1_1_1_5" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">0.6</td><td headers="hd_h_Vigabatrin.Td_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">On therapy</td></tr><tr><td headers="hd_h_Vigabatrin.Td_1_1_1_1" scope="row" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">10 months</td><td headers="hd_h_Vigabatrin.Td_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">0</td><td headers="hd_h_Vigabatrin.Td_1_1_1_3" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">400</td><td headers="hd_h_Vigabatrin.Td_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"></td><td headers="hd_h_Vigabatrin.Td_1_1_1_5" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">2.0</td><td headers="hd_h_Vigabatrin.Td_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"></td></tr><tr><td headers="hd_h_Vigabatrin.Td_1_1_1_1" scope="row" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">10.5 months</td><td headers="hd_h_Vigabatrin.Td_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">0</td><td headers="hd_h_Vigabatrin.Td_1_1_1_3" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">440</td><td headers="hd_h_Vigabatrin.Td_1_1_1_4" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">125</td><td headers="hd_h_Vigabatrin.Td_1_1_1_5" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">2.4</td><td headers="hd_h_Vigabatrin.Td_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Vigabatrin stopped</td></tr><tr><td headers="hd_h_Vigabatrin.Td_1_1_1_1" scope="row" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"></td><td headers="hd_h_Vigabatrin.Td_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">1 week</td><td headers="hd_h_Vigabatrin.Td_1_1_1_3" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">1680</td><td headers="hd_h_Vigabatrin.Td_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"></td><td headers="hd_h_Vigabatrin.Td_1_1_1_5" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">4.1</td><td headers="hd_h_Vigabatrin.Td_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"></td></tr><tr><td headers="hd_h_Vigabatrin.Td_1_1_1_1" scope="row" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">11 months</td><td headers="hd_h_Vigabatrin.Td_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">2 weeks</td><td headers="hd_h_Vigabatrin.Td_1_1_1_3" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">1200</td><td headers="hd_h_Vigabatrin.Td_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"></td><td headers="hd_h_Vigabatrin.Td_1_1_1_5" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">3.0</td><td headers="hd_h_Vigabatrin.Td_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Prednisone started</td></tr><tr><td headers="hd_h_Vigabatrin.Td_1_1_1_1" scope="row" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"></td><td headers="hd_h_Vigabatrin.Td_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">3 weeks</td><td headers="hd_h_Vigabatrin.Td_1_1_1_3" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">640</td><td headers="hd_h_Vigabatrin.Td_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"></td><td headers="hd_h_Vigabatrin.Td_1_1_1_5" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">2.2</td><td headers="hd_h_Vigabatrin.Td_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"></td></tr><tr><td headers="hd_h_Vigabatrin.Td_1_1_1_1" scope="row" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"></td><td headers="hd_h_Vigabatrin.Td_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">1 month</td><td headers="hd_h_Vigabatrin.Td_1_1_1_3" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">45</td><td headers="hd_h_Vigabatrin.Td_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"></td><td headers="hd_h_Vigabatrin.Td_1_1_1_5" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">1.3</td><td headers="hd_h_Vigabatrin.Td_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"></td></tr><tr><td headers="hd_h_Vigabatrin.Td_1_1_1_1" scope="row" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">1 year</td><td headers="hd_h_Vigabatrin.Td_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">2 months</td><td headers="hd_h_Vigabatrin.Td_1_1_1_3" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">35</td><td headers="hd_h_Vigabatrin.Td_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"></td><td headers="hd_h_Vigabatrin.Td_1_1_1_5" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">0.7</td><td headers="hd_h_Vigabatrin.Td_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"></td></tr><tr><td headers="hd_h_Vigabatrin.Td_1_1_1_1" scope="row" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"></td><td headers="hd_h_Vigabatrin.Td_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">4 months</td><td headers="hd_h_Vigabatrin.Td_1_1_1_3" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">30</td><td headers="hd_h_Vigabatrin.Td_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"></td><td headers="hd_h_Vigabatrin.Td_1_1_1_5" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">0.6</td><td headers="hd_h_Vigabatrin.Td_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Prednisone stopped</td></tr><tr><td headers="hd_h_Vigabatrin.Td_1_1_1_1" scope="row" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">2 years</td><td headers="hd_h_Vigabatrin.Td_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">1 year</td><td headers="hd_h_Vigabatrin.Td_1_1_1_3" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">30</td><td headers="hd_h_Vigabatrin.Td_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"></td><td headers="hd_h_Vigabatrin.Td_1_1_1_5" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">0.5</td><td headers="hd_h_Vigabatrin.Td_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Asymptomatic</td></tr><tr><td headers="hd_h_Vigabatrin.Td_1_1_1_1 hd_h_Vigabatrin.Td_1_1_1_2" colspan="2" scope="row" rowspan="1" style="text-align:center;vertical-align:top;">
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<b>Normal Values</b>
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</td><td headers="hd_h_Vigabatrin.Td_1_1_1_3" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">
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<b><40</b>
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</td><td headers="hd_h_Vigabatrin.Td_1_1_1_4" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">
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<b><125</b>
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</td><td headers="hd_h_Vigabatrin.Td_1_1_1_5" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">
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<b><1.2</b>
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</td><td headers="hd_h_Vigabatrin.Td_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"></td></tr></tbody></table></div><div class="tblwrap-foot"><div><dl class="temp-labeled-list small"><dl class="bkr_refwrap"><dt>*</dt><dd><div id="Vigabatrin.TF.d.1"><p class="no_margin">Estimated from Figure 1 and converted to U/L based upon default normal values.</p></div></dd></dl></dl></div></div></div></article><article data-type="table-wrap" id="figobVigabatrinTe"><div id="Vigabatrin.Te" class="table"><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK548253/table/Vigabatrin.Te/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__Vigabatrin.Te_lrgtbl__"><table><thead><tr><th id="hd_h_Vigabatrin.Te_1_1_1_1" scope="col" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">DRUG</th><th id="hd_h_Vigabatrin.Te_1_1_1_2" scope="col" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">CAS REGISTRY NO.</th><th id="hd_h_Vigabatrin.Te_1_1_1_3" scope="col" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">MOLECULAR FORMULA</th><th id="hd_h_Vigabatrin.Te_1_1_1_4" scope="col" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">STRUCTURE</th></tr></thead><tbody><tr><td headers="hd_h_Vigabatrin.Te_1_1_1_1" scope="row" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Vigabatrin</td><td headers="hd_h_Vigabatrin.Te_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<a href="https://pubchem.ncbi.nlm.nih.gov/substance/135311191" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubchem">68506-86-5</a>
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</td><td headers="hd_h_Vigabatrin.Te_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">C6-H11-N-O2</td><td headers="hd_h_Vigabatrin.Te_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<a href="https://pubchem.ncbi.nlm.nih.gov/substance/135311191" title="View this structure in PubChem" class="img_link" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubchem"><img src="https://pubchem.ncbi.nlm.nih.gov/image/imgsrv.fcgi?t=l&sid=135311191" alt="image 135311191 in the ncbi pubchem database" /></a>
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</td></tr><tr><td headers="hd_h_Vigabatrin.Te_1_1_1_1" scope="row" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">GABA (Gamma-Aminobutyric Acid)</td><td headers="hd_h_Vigabatrin.Te_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<a href="https://pubchem.ncbi.nlm.nih.gov/substance/134972453" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubchem">56-12-2</a>
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</td><td headers="hd_h_Vigabatrin.Te_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">C4-H9-N-O2</td><td headers="hd_h_Vigabatrin.Te_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<a href="https://pubchem.ncbi.nlm.nih.gov/substance/134972453" title="View this structure in PubChem" class="img_link" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubchem"><img src="https://pubchem.ncbi.nlm.nih.gov/image/imgsrv.fcgi?t=l&sid=134972453" alt="image 134972453 in the ncbi pubchem database" /></a>
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