Sabril

• SABRIL can cause permanent bilateral concentric visual field constriction, including tunnel vision that can result in disability
  . In some cases, SABRIL also can damage the central retina and may decrease visual acuity

  [see Warnings and Precautions ].
• The onset of vision loss from SABRIL is unpredictable, and can occur within weeks of starting treatment or sooner, or at any time after starting treatment, even after months or years.
• Symptoms of vision loss from SABRIL are unlikely to be recognized by patients or caregivers before vision loss is severe. Vision loss of milder severity, while often unrecognized by the patient or caregiver, can still adversely affect function.
• The risk of vision loss increases with increasing dose and cumulative exposure, but there is no dose or exposure known to be free of risk of vision loss.
• Vision assessment is recommended at baseline (no later than 4 weeks after starting SABRIL), at least every 3 months during therapy, and about 3 to 6 months after the discontinuation of therapy.
• Once detected, vision loss due to SABRIL is not reversible. It is expected that, even with frequent monitoring, some patients will develop severe vision loss.
• Consider drug discontinuation, balancing benefit and risk, if visual loss is documented.
• Risk of new or worsening vision loss continues as long as SABRIL is used. It is possible that vision loss can worsen despite discontinuation of SABRIL.
• Because of the risk of visual loss, SABRIL should be withdrawn from patients with refractory complex partial seizures who fail to show substantial clinical benefit within 3 months of initiation and within 2-4 weeks of initiation for patients with infantile spasms, or sooner if treatment failure becomes obvious. Patient response to and continued need for SABRIL should be periodically reassessed.
• SABRIL should not be used in patients with, or at high risk of, other types of irreversible vision loss unless the benefits of treatment clearly outweigh the risks.
• SABRIL should not be used with other drugs associated with serious adverse ophthalmic effects such as retinopathy or glaucoma unless the benefits clearly outweigh the risks.
• Use the lowest dosage and shortest exposure to SABRIL consistent with clinical objectives

  [see Dosage and Administration ].

SABRIL is indicated for the
treatment of:

• Refractory Complex
  Partial Seizures as adjunctive therapy in patients 2 years of age and older who have
  responded inadequately to several alternative treatments; SABRIL is not
  indicated as a first line agent

• Infantile Spasms -
  monotherapy in infants 1 month to 2 years of age for whom the potential
  benefits outweigh the potential risk of vision loss

• Adults (17 years of age and older): Initiate at 1000 mg/day (500 mg twice daily); increase total daily dose weekly in 500 mg/day increments, to the recommended dose of 3000 mg/day (1500 mg twice daily)
• Pediatric (2 to 16 years of age): The recommended dosage is based on body weight and administered as two divided doses
• The dosage may be increased in weekly intervals, depending on response
• Dose patients weighing more than 60 kg according to adult recommendations

• Initiate at a daily dose of 50 mg/kg (25 mg/kg twice daily); increase total daily dose every 3 days,  in increments of 25 mg/kg/day to 50 mg/kg/day, up to a maximum daily dose of 150 mg/kg (75 mg/kg twice daily)

Tablet: 500 mg: white, oval, film-coated, biconvex, scored on one side, and debossed with OV 111 on the other. 

For oral solution: 500 mg packet containing a white to off-white granular powder.

• Pregnancy: Based on animal data, may cause fetal harm.
• Lactation: SABRIL is excreted in human milk