Fenfluramine: A Review of Pharmacology, Clinical Efficacy, and Safety in Epilepsy

Despite the availability of more than 30 antiseizure medications (ASMs), the proportion of patients who remain refractory to ASMs remains static. Refractory seizures are almost universal in patients with epileptic encephalopathies. Since many of these patients are not candidates for curative surgery, there is always a need for newer ASMs with better efficacy and safety profile. Recently, the anti-obesity medication fenfluramine (FFA) has been successfully repurposed, and various regulatory agencies approved it for seizures associated with Dravet and Lennox-Gastaut syndromes. However, there is a limited in-depth critical review of FFA to facilitate its optimal use in a clinical context. This narrative review discusses and summarizes the antiseizure mechanism of action of FFA, clinical pharmacology, and clinical studies related to epilepsy, focusing on efficacy and adverse effects.

Automated summary

Despite the availability of numerous antiseizure medications, a significant number of patients do not respond to these medications. Refractory seizures are common in patients with epileptic encephalopathies, emphasizing the need for more effective and safer medications. Recently, the repurposing of the anti-obesity medication fenfluramine has shown promising results for seizures associated with specific syndromes. However, a comprehensive review of fenfluramine is needed to optimize its clinical use.