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2D Structure
Also known as: 25451-15-4, Felbatol, 2-phenylpropane-1,3-diyl dicarbamate, 2-phenyl-1,3-propanediol dicarbamate, Taloxa, Felbamyl
Molecular Formula
C11H14N2O4
Molecular Weight
238.24  g/mol
InChI Key
WKGXYQFOCVYPAC-UHFFFAOYSA-N
FDA UNII
X72RBB02N8

A PEGylated phenylcarbamate derivative that acts as an antagonist of NMDA RECEPTORS. It is used as an anticonvulsant, primarily for the treatment of SEIZURES in severe refractory EPILEPSY.
Felbamate is an Anti-epileptic Agent. The physiologic effect of felbamate is by means of Decreased Central Nervous System Disorganized Electrical Activity.
1 2D Structure

2D Structure

2 Identification
2.1 Computed Descriptors
2.1.1 IUPAC Name
(3-carbamoyloxy-2-phenylpropyl) carbamate
2.1.2 InChI
InChI=1S/C11H14N2O4/c12-10(14)16-6-9(7-17-11(13)15)8-4-2-1-3-5-8/h1-5,9H,6-7H2,(H2,12,14)(H2,13,15)
2.1.3 InChI Key
WKGXYQFOCVYPAC-UHFFFAOYSA-N
2.1.4 Canonical SMILES
C1=CC=C(C=C1)C(COC(=O)N)COC(=O)N
2.2 Other Identifiers
2.2.1 UNII
X72RBB02N8
2.3 Synonyms
2.3.1 MeSH Synonyms

1. (3-carbamoyloxy-2-phenyl-propyl) Carbamate

2. 2 Phenyl 1,3 Propanediol Dicarbamate

3. 2-phenyl-1,3-propanediol Dicarbamate

4. Add 03055

5. Add-03055

6. Add03055

7. Felbamyl

8. Felbatol

9. Taloxa

10. W 554

11. W-554

12. W554

2.3.2 Depositor-Supplied Synonyms

1. 25451-15-4

2. Felbatol

3. 2-phenylpropane-1,3-diyl Dicarbamate

4. 2-phenyl-1,3-propanediol Dicarbamate

5. Taloxa

6. Felbamyl

7. W-554

8. Felbamato

9. Felbamatum

10. 1,3-propanediol, 2-phenyl-, Dicarbamate

11. Add-03055

12. W 554

13. Carbamic Acid 2-phenyltrimethylene Ester

14. Chebi:4995

15. Nsc-759866

16. 3-(carbamoyloxy)-2-phenylpropyl Carbamate

17. Mls000028465

18. X72rbb02n8

19. (3-carbamoyloxy-1,1,3,3-tetradeuterio-2-phenylpropyl) Carbamate

20. Felbamatum [latin]

21. Ncgc00015429-08

22. W-554;add-03055

23. Felbamato [spanish]

24. Smr000058448

25. Dsstox_cid_3041

26. Felbamate [usan:inn]

27. Dsstox_rid_76847

28. Dsstox_gsid_23041

29. Carbamic Acid 3-carbamoyloxy-2-phenyl-propyl Ester

30. (3-carbamoyloxy-2-phenylpropyl) Carbamate

31. Felbatol (tn)

32. Cas-25451-15-4

33. Carbamic Acid, 2-phenyltrimethylene Ester

34. Sr-01000000089

35. Einecs 247-001-4

36. Brn 3345236

37. Unii-x72rbb02n8

38. Hsdb 7525

39. Felbamate Solution

40. Add 03055

41. Mfcd00865296

42. Felbamate (uspinn)

43. Tocris-0869

44. Felbamate [inn]

45. Felbamate [mi]

46. Felbamate [hsdb]

47. Felbamate [usan]

48. 2-phenyl-1,3-propanediol 1,3-dicarbamate

49. Opera_id_1738

50. Prestwick0_000919

51. Felbamate [vandf]

52. Lopac-f-0778

53. Biomol-nt_000203

54. Felbamate [mart.]

55. F 0778

56. Felbamate [usp-rs]

57. Felbamate [who-dd]

58. Chembl1094

59. Lopac0_000524

60. Schembl34947

61. 4-06-00-05993 (beilstein Handbook Reference)

62. Mls001077299

63. Bidd:gt0463

64. Bpbio1_001258

65. Gtpl5473

66. Felbamate [orange Book]

67. Dtxsid9023041

68. Ex-a591

69. Felbamate [usp Monograph]

70. Hms2093p19

71. Hms2234h06

72. Hms3261j09

73. Hms3266l12

74. Hms3370i06

75. Hms3411p21

76. Hms3657i11

77. Hms3675p21

78. Hms3715d20

79. Hms3884e11

80. Pharmakon1600-01505600

81. Bcp27941

82. Hy-b0184

83. Zinc1530803

84. Tox21_110145

85. Tox21_302368

86. Tox21_500524

87. 2-phenyl-1,3-propanedioldicarbamate

88. Bdbm50088430

89. Nsc759866

90. S1330

91. Akos015895100

92. Tox21_110145_1

93. Ac-8197

94. Ccg-204614

95. Cs-2068

96. Db00949

97. Ks-1171

98. Lp00524

99. Nsc 759866

100. Sdccgsbi-0050507.p003

101. Ncgc00015429-01

102. Ncgc00015429-02

103. Ncgc00015429-03

104. Ncgc00015429-04

105. Ncgc00015429-05

106. Ncgc00015429-06

107. Ncgc00015429-07

108. Ncgc00015429-09

109. Ncgc00015429-10

110. Ncgc00015429-11

111. Ncgc00015429-14

112. Ncgc00015429-24

113. Ncgc00023092-02

114. Ncgc00023092-04

115. Ncgc00023092-05

116. Ncgc00023092-06

117. Ncgc00255275-01

118. Ncgc00261209-01

119. Sbi-0050507.p002

120. Db-046702

121. Eu-0100524

122. Ft-0630517

123. Sw197633-2

124. (3-aminocarbonyloxy-2-phenyl-propyl) Carbamate

125. C07501

126. D00536

127. Ab00382985-18

128. Ab00382985_19

129. 451f154

130. A817858

131. Q421301

132. Carbamic Acid (3-carbamoyloxy-2-phenylpropyl) Ester

133. Q-100326

134. Sr-01000000089-2

135. Sr-01000000089-4

136. Sr-01000000089-7

137. Brd-k99107520-001-01-9

138. Brd-k99107520-001-09-2

139. Brd-k99107520-001-18-3

140. Z1541638522

141. Felbamate, United States Pharmacopeia (usp) Reference Standard

2.4 Create Date
2005-03-25
3 Chemical and Physical Properties
Molecular Weight 238.24 g/mol
Molecular Formula C11H14N2O4
XLogP30.6
Hydrogen Bond Donor Count2
Hydrogen Bond Acceptor Count4
Rotatable Bond Count7
Exact Mass238.09535693 g/mol
Monoisotopic Mass238.09535693 g/mol
Topological Polar Surface Area105 Ų
Heavy Atom Count17
Formal Charge0
Complexity246
Isotope Atom Count0
Defined Atom Stereocenter Count0
Undefined Atom Stereocenter Count0
Defined Bond Stereocenter Count0
Undefined Bond Stereocenter Count0
Covalently Bonded Unit Count1
4 Drug and Medication Information
4.1 Drug Information
1 of 4  
Drug NameFelbatol
PubMed HealthFelbamate (By mouth)
Drug ClassesAnticonvulsant
Drug LabelFelbatol (felbamate) is an antiepileptic available as 400 mg and 600 mg tablets and as a 600 mg/5 mL suspension for oral administration. Its chemical name is 2-phenyl-1,3-propanediol dicarbamate.Felbamate is a white to off-white crystalline powder...
Active IngredientFelbamate
Dosage FormTablet; Suspension
RouteOral
Strength600mg/5ml; 600mg; 400mg
Market StatusPrescription
CompanyMeda Pharms

2 of 4  
Drug NameFelbamate
PubMed HealthFelbamate (By mouth)
Drug ClassesAnticonvulsant
Drug LabelFelbatol (felbamate) is an antiepileptic available as 400 mg and 600 mg tablets and as a 600 mg/5 mL suspension for oral administration. Its chemical name is 2-phenyl-1,3-propanediol dicarbamate.Felbamate is a white to off-white crystalline powder...
Active IngredientFelbamate
Dosage FormTablet; Suspension
RouteOral
Strength600mg/5ml; 600mg; 400mg
Market StatusPrescription
CompanyAmneal Pharms

3 of 4  
Drug NameFelbatol
PubMed HealthFelbamate (By mouth)
Drug ClassesAnticonvulsant
Drug LabelFelbatol (felbamate) is an antiepileptic available as 400 mg and 600 mg tablets and as a 600 mg/5 mL suspension for oral administration. Its chemical name is 2-phenyl-1,3-propanediol dicarbamate.Felbamate is a white to off-white crystalline powder...
Active IngredientFelbamate
Dosage FormTablet; Suspension
RouteOral
Strength600mg/5ml; 600mg; 400mg
Market StatusPrescription
CompanyMeda Pharms

4 of 4  
Drug NameFelbamate
PubMed HealthFelbamate (By mouth)
Drug ClassesAnticonvulsant
Drug LabelFelbatol (felbamate) is an antiepileptic available as 400 mg and 600 mg tablets and as a 600 mg/5 mL suspension for oral administration. Its chemical name is 2-phenyl-1,3-propanediol dicarbamate.Felbamate is a white to off-white crystalline powder...
Active IngredientFelbamate
Dosage FormTablet; Suspension
RouteOral
Strength600mg/5ml; 600mg; 400mg
Market StatusPrescription
CompanyAmneal Pharms

4.2 Therapeutic Uses

Felbamate is indicated as monotherapy or as an adjunct to other anticonvulsants for the treatment of partial seizures with or without generalization in adults with severe epilepsy that has not responded to other treatment. /Included in US product labe/

Thomson/Micromedex. Drug Information for the Health Care Professional. Volume 1, Greenwood Village, CO. 2007.


Felbamate is indicated as adjunctive therapy in the treatment of partial and generalized seizures associated with Lennox-Gastaut syndrome in children who have not responded to other treatment. /Included in US product label/

Thomson/Micromedex. Drug Information for the Health Care Professional. Volume 1, Greenwood Village, CO. 2007.


4.3 Drug Warning

Because use of felbamate has been associated with marked increases in the incidences of aplastic anemia and acute hepatic failure, the manufacturer (Carter-Wallace) in conjunction with FDA warns that the drug should only be initiated or continued in the management of seizures in patients for whom, in the clinician's judgment, the seizure disorder is refractory to alternative safer therapy and is so severe that the benefits of felbamate therapy are believed to outweigh the possible risk of aplastic anemia or acute hepatic failure. For patients already receiving the drug, the likelihood that abrupt withdrawal would pose an even greater risk than that of possible felbamate-associated aplastic anemia or acute hepatic failure also should be considered in the decision to discontinue therapy with the drug. Decisions about the potential benefits and risks of felbamate therapy generally should be made in consultation with appropriate hematologic and hepatic disease experts.

McEvoy, G.K. (ed.). American Hospital Formulary Service. AHFS Drug Information. American Society of Health-System Pharmacists, Bethesda, MD. 2007., p. 2226


At least 21 reported cases (20 of which occurred in the US) of aplastic anemia have developed in association with felbamate therapy. The rate of aplastic anemia cases currently reported with the drug appears to be at least 40-100 times higher than the expected rate of 2-5 cases per million untreated individuals per year. However, because the onset of felbamate-induced aplastic anemia typically is delayed for weeks to months after initiation of the drug and a substantial fraction of patients had felbamate therapy withdrawn for other reasons prior to this period, the absolute rate of this anemia associated with felbamate probably is higher than the currently reported rate of 1 case per 5000 patients per year. Based on this probability, the manufacturer estimates that the actual risk of aplastic anemia associated with felbamate therapy may be as high as 1 case per 2000 patients (500 cases per million patients) per year or more among those who remain on the drug for longer than a few weeks. While postmarketing surveillance usually captures only a fraction of incident cases, the syndrome is still relatively rare, and no cases were observed during premarket testing in which more than 1600 patients received felbamate therapy. All reports of aplastic anemia associated with felbamate therapy to date have occurred in patients receiving the drug for at least 5 weeks.

McEvoy, G.K. (ed.). American Hospital Formulary Service. AHFS Drug Information. American Society of Health-System Pharmacists, Bethesda, MD. 2007., p. 2226


Of the 21 patients who developed aplastic anemia while receiving felbamate therapy, 5 (all from the US) have died. While current experience and data are too limited to estimate reliably the fatality rate associated with felbamate-induced aplastic anemia, the estimated case fatality rate for untreated individuals with aplastic anemia from any cause ranges from 20-30%. However, historical fatality rates as high as 70% have been reported for aplastic anemia, and the risk of death secondary to this anemia generally varies with severity and etiology. Although most reported cases have been in white females, risk factors for the development of aplastic anemia in patients receiving felbamate therapy have not been identified. Whether age (range for cases to date: 12-68 years old), gender, or race of the patient, duration of exposure to the drug, dosage, or concomitant use of other anticonvulsant agents or drugs affects the incidence of aplastic anemia in patients receiving felbamate remains to be established. Therefore, the manufacturer recommends that felbamate therapy be discontinued in any patient receiving the drug and alternative therapy initiated as necessary, unless in the clinician's judgment continued felbamate therapy outweighs the risk for aplastic anemia.

McEvoy, G.K. (ed.). American Hospital Formulary Service. AHFS Drug Information. American Society of Health-System Pharmacists, Bethesda, MD. 2007., p. 2226


Of the 10 patients who developed acute hepatic failure while receiving felbamate therapy, 4 have died, and 1 has received a liver transplant. Whether preexisting hepatic impairment increases the risk of fulminant hepatic failure is unknown; however, the manufacturer recommends that all patients be evaluated for evidence of hepatic impairment prior to initiation of felbamate therapy, and use of the drug is not recommended in patients with preexisting hepatic abnormalities. Other risk factors for the development of acute hepatic failure in patients receiving felbamate have not been identified. Whether age (range for cases to date: 5-78 years old), gender, or race of the patient, duration of exposure to the drug, dosage, or concomitant use of other anticonvulsant agents or drugs affects the incidence of acute hepatic failure in patients receiving felbamate remains to be established.

McEvoy, G.K. (ed.). American Hospital Formulary Service. AHFS Drug Information. American Society of Health-System Pharmacists, Bethesda, MD. 2007., p. 2226


For more Drug Warnings (Complete) data for 2-PHENYL-1,3-PROPANEDIOL DICARBAMATE (29 total), please visit the HSDB record page.


4.4 Drug Indication

For use only in those patients who respond inadequately to alternative treatments and whose epilepsy is so severe that a substantial risk of aplastic anemia and/or liver failure is deemed acceptable in light of the benefits conferred by its use.


5 Pharmacology and Biochemistry
5.1 Pharmacology

Felbamate is an antiepileptic indicated as monotherapy or as an adjunct to other anticonvulsants for the treatment of partial seizures resulting from epilepsy. Receptor-binding studies in vitro indicate that felbamate has weak inhibitory effects on GABA-receptor binding, benzodiazepine receptor binding, and is devoid of activity at the MK-801 receptor binding site of the NMDA receptor-ionophore complex. However, felbamate does interact as an antagonist at the strychnine-insensitive glycine recognition site of the NMDA receptor-ionophore complex.


5.2 MeSH Pharmacological Classification

Anticonvulsants

Drugs used to prevent SEIZURES or reduce their severity. (See all compounds classified as Anticonvulsants.)


Excitatory Amino Acid Antagonists

Drugs that bind to but do not activate excitatory amino acid receptors, thereby blocking the actions of agonists. (See all compounds classified as Excitatory Amino Acid Antagonists.)


5.3 FDA Pharmacological Classification
5.3.1 Active Moiety
FELBAMATE
5.3.2 FDA UNII
X72RBB02N8
5.3.3 Pharmacological Classes
Decreased Central Nervous System Disorganized Electrical Activity [PE]; Anti-epileptic Agent [EPC]
5.4 ATC Code

N03AX10

S76 | LUXPHARMA | Pharmaceuticals Marketed in Luxembourg | Pharmaceuticals marketed in Luxembourg, as published by d'Gesondheetskeess (CNS, la caisse nationale de sante, www.cns.lu), mapped by name to structures using CompTox by R. Singh et al. (in prep.). List downloaded from https://cns.public.lu/en/legislations/textes-coordonnes/liste-med-comm.html. Dataset DOI:10.5281/zenodo.4587355


N - Nervous system

N03 - Antiepileptics

N03A - Antiepileptics

N03AX - Other antiepileptics

N03AX10 - Felbamate


5.5 Absorption, Distribution and Excretion

Absorption

>90%


Volume of Distribution

75682 mL/kg


Clearance

26 +/- 3 mL/hr/kg [single 1200 mg dose]

30 +/- 8 mL/hr/kg [multiple daily doses of 3600 mg]


/Absorption is/ complete (>90%). Absorption is unaffected by food, and both tablet and suspension dosage forms exhibit similar kinetics.

Thomson/Micromedex. Drug Information for the Health Care Professional. Volume 1, Greenwood Village, CO. 2007.


Felbamate enters the central nervous system (CNS), with a brain/plasma coefficient of approximately 0.9. The apparent volume of distribution (Vol D) ranged from 0.73 to 0.85 L per kg of body weight (L/kg) in single and multiple dose studies.

Thomson/Micromedex. Drug Information for the Health Care Professional. Volume 1, Greenwood Village, CO. 2007.


/Protein binding of felbamate is/ low (20-36%).

Thomson/Micromedex. Drug Information for the Health Care Professional. Volume 1, Greenwood Village, CO. 2007.


Clearance after a single 1200 mg dose is 26+/- 3 mL/hr/kg, and after multiple daily doses og 3600 mg is 30 +/- 8 mL/hr/kg. ... Felbamate Cmax and AUC are proportionate to dose after single and multiple doses over a range of 100-800 mg single doses and 1200-3600 mg daily doses. Cmin (trough) blood levels are also dose proportionate. ... Felbamate gave dose proportional steady-state peak plasma concentrations in children age 4-12 over a range of 15, 30, and 45 mg/kg/day with peak concentrations of 17, 32, and 49 ug/mL.

Medical Economics Co; Physicians Desk Reference: Generics 2nd ed p.1280 (1996)


For more Absorption, Distribution and Excretion (Complete) data for 2-PHENYL-1,3-PROPANEDIOL DICARBAMATE (8 total), please visit the HSDB record page.


5.6 Metabolism/Metabolites

Hepatic


/Biotransformation is/ hepatic, probably by the cytochrome P-450 system; primarily by hydroxylation and conjugation to metabolites that are neither pharmacologically active nor neurotoxic.

Thomson/Micromedex. Drug Information for the Health Care Professional. Volume 1, Greenwood Village, CO. 2007.


About 40-50% of absorbed dose appears in unchanged in urine, an additional 40% is present as unidentified metabolites and conjugates. About 15% is present parahydroxyfelbamate, 2-hydroxyfelbamate, and felbamate monocarbamate, none of which have significant anticonvulsant activity.

Medical Economics Co; Physicians Desk Reference: Generics 2nd ed p.1280 (1996)


Felbamate (FBM; 2-phenyl-1,3-propanediol dicarbamate) is an approved antiepileptic drug shown to be effective in a variety of seizure disorders refractory to other treatments. However, its use has been restricted because of association with occurrence of rare cases of aplastic anemia and hepatic failure. Since it was shown that FBM metabolism requires glutathione (GSH), we used two experimental protocols to determine if the effects of specific metabolites were sensitive to redox pathways. FBM and its metabolite W873 (2-phenyl-1,3-propanediol monocarbamate), at 0.1 mg/mL, induced increased apoptosis of bone marrow cells from B10.AKM mice as compared with B10.BR mice. Study of the effects of the drug on human promonocytic cell line U937 cells showed that FBM and the metabolite W2986 [2-(4-hydroxyphenyl)-1,3 propanediol dicarbamate], at higher concentrations (0.5 mg/mL), induced apoptosis in this cell line. We also observed that while FBM and its metabolites induced increased apoptosis of B cells with reduced intracellular GSH levels, addition of exogenous GSH decreased apoptosis induced by W873 but did not significantly affect apoptosis induced by FBM or W2986. /The authors/ results suggest that, at concentrations used during the present investigations, FBM metabolites induce apoptosis via redox-sensitive and redox-independent pathways.

PMID:11823110 Husain Z et al; Epilepsy Res 48 (1-2): 57-69 (2002)


Antiepileptic therapy with a broad spectrum drug felbamate (FBM) has been limited due to reports of hepatotoxicity and aplastic anemia associated with its use. It was proposed that a bioactivation of FBM leading to formation of alpha,beta-unsaturated aldehyde, atropaldehyde (ATPAL) could be responsible for toxicities associated with the parent drug. Other members of this class of compounds, acrolein and 4-hydroxynonenal (HNE), are known for their reactivity and toxicity. It has been proposed that the bioactivation of FBM to ATPAL proceeds though a more stable cyclized product, 4-hydroxy-5-phenyltetrahydro-1,3-oxazin-2-one (CCMF) whose formation has been shown recently. Aldehyde dehydrogenase (ALDH) and glutathione transferase (GST) are detoxifying enzymes and targets for reactive aldehydes. This study examined effects of ATPAL and its precursor, CCMF on ALDH, GST and cell viability in liver, the target tissue for its metabolism and toxicity. A known toxin, HNE, which is also a substrate for ALDH and GST, was used for comparison. Interspecies difference in metabolism of FBM is well documented, therefore, human tissue was deemed most relevant and used for these studies. ATPAL inhibited ALDH and GST activities and led to a loss of hepatocyte viability. Several fold greater concentrations of CCMF were necessary to demonstrate a similar degree of ALDH inhibition or cytotoxicity as observed with ATPAL. This is consistent with CCMF requiring prior conversion to the more proximate toxin, ATPAL. GSH was shown to protect against ALDH inhibition by ATPAL. In this context, ALDH and GST are detoxifying pathways and their inhibition would lead to an accumulation of reactive species from FBM metabolism and/or metabolism of other endogenous or exogenous compounds and predisposing to or causing toxicity. Therefore, mechanisms of reactive aldehydes toxicity could include direct interaction with critical cellular macromolecules or indirect interference with cellular detoxification mechanisms.

PMID:12399159 Kapetanovic I et al; Chem Biol Interact 142 (1-2): 119-34 (2002)


5.7 Biological Half-Life

20-23 hours


Elimination /half-life is/ 13 to 23 hours.

Thomson/Micromedex. Drug Information for the Health Care Professional. Volume 1, Greenwood Village, CO. 2007.


5.8 Mechanism of Action

The mechanism by which felbamate exerts its anticonvulsant activity is unknown, but in animal test systems designed to detect anticonvulsant activity, felbamate has properties in common with other marketed anticonvulsants. In vitro receptor binding studies suggest that felbamate may be an antagonist at the strychnine-insensitive glycine-recognition site of the N-methyl-D-aspartate (NMDA) receptor-ionophore complex. Antagonism of the NMDA receptor glycine binding site may block the effects of the excitatory amino acids and suppress seizure activity. Animal studies indicate that felbamate may increase the seizure threshold and may decrease seizure spread. It is also indicated that felbamate has weak inhibitory effects on GABA-receptor binding, benzodiazepine receptor binding.


The exact mechanism of action of felbamate is not known, but available data suggest that the drug increases seizure threshold and reduces seizure spread. A predominant effect on any particular cell process has not been demonstrated to date, but felbamate appears to exhibit a spectrum of anticonvulsant activity that is pharmacologically distinct from other currently available agents. In animals, felbamate protects against seizures induced by electrical stimulation, suggesting that it would be effective in the management of tonic-clonic (grand mal) seizures and partial seizures. In animals, felbamate also protects against seizures induced by pentylenetetrazol, indicating that it may be effective in the management of absence (petit mal) seizures. Felbamate also protects against seizures in animals induced by picrotoxin, glutamate, or N-methyl-d, l-aspartic acid; it does not protect against seizures induced by bicuculline or strychnine.

McEvoy, G.K. (ed.). American Hospital Formulary Service. AHFS Drug Information. American Society of Health-System Pharmacists, Bethesda, MD. 2007., p. 2229


In vitro studies indicate that felbamate has weak inhibitory effects on binding at gamma-aminobutyric acid (GABA) receptors and benzodiazepine receptors. The monocarbamate, p-hydroxy, and 2-hydroxy metabolites of felbamate appear to contribute little, if any, to the anticonvulsant action of the drug.

McEvoy, G.K. (ed.). American Hospital Formulary Service. AHFS Drug Information. American Society of Health-System Pharmacists, Bethesda, MD. 2007., p. 2229


In vitro receptor binding studies suggest that felbamate may be an antagonist at the strychnine-insensitive glycine-recognition site of the N-methyl-D-aspartate (NMDA) receptor-ionophore complex. Antagonism of the NMDA receptor glycine binding site may block the effects of the excitatory amino acids and suppress seizure activity. Animal studies indicate that felbamate may increase the seizure threshold and may decrease seizure spread.

Thomson/Micromedex. Drug Information for the Health Care Professional. Volume 1, Greenwood Village, CO. 2007.


Felbamate is an anticonvulsant used in the treatment of seizures associated with Lennox-Gastaut syndrome and complex partial seizures that are refractory to other medications. Its unique clinical profile is thought to be due to an interaction with N-methyl-D-aspartate (NMDA) receptors, resulting in decreased excitatory amino acid neurotransmission. To further characterize the interaction between felbamate and NMDA receptors, recombinant receptors expressed in Xenopus oocytes were used to investigate the subtype specificity and mechanism of action. Felbamate reduced NMDA- and glycine-induced currents most effectively at NMDA receptors composed of NR1 and NR2B subunits (IC50 = 0.93 mM), followed by NR1-2C (2.02 mM) and NR1-2A (8.56 mM) receptors. The NR1-2B-selective interaction was noncompetitive with respect to the coagonists NMDA and glycine and was not dependent on voltage. Felbamate enhanced the affinity of the NR1-2B receptor for the agonist NMDA by 3.5-fold, suggesting a similarity in mechanism to other noncompetitive antagonists such as ifenprodil. However, a point mutation at position 201 (E201R) of the epsilon2 (mouse NR2B) subunit that affects receptor sensitivity to ifenprodil, haloperidol, and protons reduced the affinity of NR1-epsilon2 receptors for felbamate by only 2-fold. Furthermore, pH had no effect on the affinity of NR1-2B receptors for felbamate. /Investigators/ suggest that felbamate interacts with a unique site on the NR2B subunit (or one formed by NR1 plus NR2B) that interacts allosterically with the NMDA/glutamate binding site. These results suggest that the unique clinical profile of felbamate is due in part to an interaction with the NR1-2B subtype of NMDA receptor.

PMID:10215667 Kleckner N et al; J Pharmacol Exp Ther 289 (2): 886-94 (1999)


The effect of the antiepileptic drug felbamate (FBM) on high-voltage-activated Ca++ currents was studied in cortical and neostriatal neurons acutely isolated from adult rats. Patch-clamp recordings in the whole-cell configuration were performed. Ba++ ions as the charge carrier for Ca++ channels were used. In pyramidal cortical cells, FBM dose-dependently reduced high-voltage-activated Ca++ currents in all the tested neurons. At concentrations of 30 to 100 nM, FBM already produced a significant inhibition of high-voltage-activated Ca++ currents (-6/-15%). At saturating concentrations (1-3 microM), FBM-mediated inhibition averaged 44%. The responses were fully reversible. The dose-response curves revealed IC50 of 504 nM. In striatal neurons, FBM decreased the same conductances by about 28%; the threshold dose was 1 to 2 microM, with an IC50 of 18.7 microM. In both structures, the observed inhibitions were unaffected by omega-conotoxin GVIA and omega-agatoxin IVA, suggesting that N-like channels and P-Like channels were not involved in the FBM-mediated responses. In addition, when omega-conotoxin GVIA and omega-agatoxin IVA (100 nM) were coapplied, the FBM-mediated inhibition on the remaining Ca++ currents averaged 87%. The FBM responses were occluded by micromolar concentrations of nifedipine, supporting a direct interference with dihydropyridine-sensitive channels. It is concluded that the described effect of FBM might represent an efficacious mechanism for either controlling spike discharge from epileptic foci or protecting neurons from excessive Ca++ loading.

PMID:8613908 Stefani A et al; J Pharmacol Exp Ther 277 (1): 121-7 (1996)