Felbamate is not indicated as a first-line treatment and its use should be reserved for a few patients who respond inadequately to alternative antiepileptic drugs (AEDs) and whose epilepsy is severe enough that the risk of aplastic anaemia and/or liver failure is deemed acceptable by the patient compared with the benefits conferred by its use. Felbamate inhibits seizures induced by maximal electroshock, pentylenetetrazol and picrotoxin, but seizures induced by bicuculline and strychnine are not affected. The drug is protective against epileptiform activity induced by the potassium channel blocker 4-aminopyridine. Animal studies have shown that felbamate distributes rapidly into a number of tissues, including brain, and crosses the placenta. The metabolism of felbamate is accelerated by concomitant treatment with phenytoin or carbamazepine, resulting in an increase in felbamate clearance by about 40-50%. Felbamate should be regarded as a highly efficacious AED in patients refractory to first-line agents.