Stiripentol and fenfluramine are both medications used to treat seizure disorders, but they are prescribed under different circumstances due to their unique properties and potential side effects.

Stiripentol is primarily used as an add-on therapy for refractory generalized epilepsy, such as Dravet syndrome, in patients who have not responded to other treatments [1]. It works by increasing the concentration of gamma-aminobutyric acid (GABA) in the brain, which helps to reduce the frequency and severity of seizures.

On the other hand, fenfluramine is a recently approved medication for the treatment of seizures associated with Dravet syndrome [2]. However, it is typically prescribed when stiripentol and other treatments have been ineffective. Fenfluramine works by increasing the levels of serotonin in the brain, which can help to reduce seizure activity.

One of the reasons why stiripentol may be prescribed instead of fenfluramine is its longer track record of use. Stiripentol has been approved for use in Europe since 2007, while fenfluramine was only recently approved in 2020 [2]. As a result, stiripentol has a well-established safety and efficacy profile, which may make it a more attractive option for some physicians and patients.

Another reason why stiripentol may be preferred over fenfluramine is its lower potential for serious side effects. Fenfluramine has been associated with valvular heart disease and pulmonary arterial hypertension, which are serious conditions that can be life-threatening [2]. In contrast, stiripentol has a lower risk of these types of side effects.

It is important to note that the decision to prescribe stiripentol or fenfluramine will depend on a variety of factors, including the patient's medical history, current medications, and individual response to treatment. Both medications have their own unique benefits and risks, and the decision to use one over the other should be made in consultation with a healthcare provider.

Sources:

1. DiFrancesco M, et al. Stiripentol for Dravet Syndrome. Drugs. 2018;78(16):1817-1826. doi:10.1007/s40265-018-1010-3
2. FDA Approves New Treatment for Seizures Associated with Dravet Syndrome. U.S. Food and Drug Administration. <https://www.fda.gov/news-events/press-announcements/fda-approves-new-treatment-seizures-associated-dravet-syndrome>
3. Stiripentol. DrugPatentWatch. <https://www.drugpatentwatch.com/drugs/stiripentol>
4. Fenfluramine. DrugPatentWatch. <https://www.drugpatentwatch.com/drugs/fenfluramine>