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by Alan R

Medications for Epilepsy

The information provided here is meant to give you a general idea about each of the medications listed below. Only the most general side effects are included. Ask your doctor if you need to take any special precautions. Use each of these medications as recommended by your doctor, or according to the instructions provided. If you have further questions about usage or side effects, contact your doctor.
Medications are the first line of treatment for epilepsy . Anti-epileptic medications should only be used if the diagnosis is established. The goal of medication is to prevent epileptic seizures and to decrease the frequency and severity of seizures. The type and dosage of medication given must match the type of epilepsy you have. Dosage is important. It must balance prevention of seizures with the side effects that epileptic drugs can cause.
Often, but not always, one type of medication is tried at a time until the most effective one is found. Changes in medication are often made gradually because these changes can increase the likelihood of seizures. Good control is achieved in the majority of people.
In some cases, however, anti-epileptic medications may be used in combination. In approximately 80% of people, epileptic medication is fully or partially successful in preventing seizures. Be sure to take the medication on a regular schedule.

Prescription Medications

Carbamazepine
  • Tegretol
  • Carbatrol
Ethosuximide
  • Zarontin
Gabapentin
  • Neurontin
Lamotrigine
  • Lamictal
Oxcarbazepine
  • Trileptal
Phenytoin
  • Dilantin
Primidone
  • Mysoline
Valproic acid
  • Depakene
Diazepam Rectal Gel
  • Diastat
Vigabatrin
  • Sabril
Phenobarbital
  • Luminal
Topiramate
  • Topamax
Levetiracetam
  • Keppra
Lacosamide
  • Vimpat
Zonisamide
  • Zonegran
Rufinamide
  • Banzel
Tiagabine
  • Gabitril
Clobazam
  • Onfi
Ezogabine
  • Potiga

Carbamazepine

Common brand names include:
  • Tegretol
  • Carbatrol
Carbamazepine prevents seizures by reducing the excitability of nerve fibers in the brain. This medicine is taken as a tablet or liquid. It is best taken at the same time or times each day. Taking carbamazepine with food or drink can help prevent stomach upset.
Possible side effects include:
  • Blurred vision
  • Rapid back and forth eyeball movements
  • Lightheadedness
  • Drowsiness
  • Possible reduced effectiveness of birth control pills—Your doctor will recommend that you use another form of birth control.
  • Interaction with birth control pills—Your doctor may need to adjust your medicine dose.
  • Increased risk of suicidal thinking and behavior
More serious, but less common side effects include:
  • Suppressed bone marrow
  • Rashes
  • Low blood sodium levels
  • Heart failure
According to the Food and Drug Administration (FDA), people of Asian ancestry who have a certain gene, called HLA-B*1502, and take carbamazepine are at risk for dangerous or even fatal skin reactions. If you are of Asian descent, the FDA recommends that you get tested for this gene before taking carbamazepine. If you have been taking this medicine for a few months with no skin reactions, then you are at low risk of developing these reactions. Talk to your doctor before stopping this medicine.

Ethosuximide

Common brand name: Zarontin
Ethosuximide controls seizures by depressing nerve transmissions in the motor cortex, which is the part of the brain that controls muscles. The medicine is taken in liquid or capsule form. It is best taken at the same time or times each day. Taking it with food or drink can help prevent stomach upset.
Possible side effects include:
  • Nausea
  • Appetite loss
  • Vomiting
  • Fatigue
  • Lightheadedness
  • Drowsiness
  • Headache
  • Muscle pain
  • Rash
  • Change in urine color
  • Increased risk of suicidal thinking and behavior
Persistent fever or sore throat should be reported to your doctor. These symptoms may indicate a low white blood cell count due to suppressed bone marrow.

Gabapentin

Common brand name: Neurontin
It is not known how gabapentin prevents convulsive seizures. But, it may work by altering the transport of amino acids in the brain. This medicine is taken in capsule form. Maintenance dosage varies. It is best taken with food or liquid to prevent stomach upset.
Possible side effects include:
  • Sleepiness
  • Lightheadedness
  • Fatigue
  • Lack of coordination
  • Weight gain
  • Rapid back and forth eyeball movements
  • Increased risk of suicidal thinking and behavior

Lamotrigine

Common brand name: Lamictal
It is not known how lamotrigine prevents convulsive seizures. But, it may work by stabilizing nerve membranes. The medicine is taken in tablet form. Maintenance dosage varies. It is best taken with liquid to prevent stomach upset.
When you are taking lamotrigine, call your doctor right away if you have the following symptoms:
  • Rash—can be extremely serious and life-threatening
  • Fever
  • Flu-like symptoms
  • Swollen glands
  • An increase in your seizures
Possible side effects include:
  • Double or blurred vision
  • Clumsiness
  • Lightheadedness
  • Headache
  • Nausea or vomiting
  • Drowsiness
  • Reduced effectiveness of birth control pills—Your doctor will recommend that you use another form of birth control.
  • Increased risk of suicidal thinking and behavior
  • Aseptic meningitis—inflammation of the layers of tissue that surround the brain

Oxcarbazepine

Common brand name: Trileptal
Oxcarbazepine is believed to prevent convulsive seizures by altering the transport of amino acids in the brain and stabilizing the nerve membranes. This medicine is taken in tablet or liquid form. Maintenance dosage varies. It is best taken with liquid.
Possible side effects include:
  • Vision changes
  • Lightheadedness
  • Nausea or vomiting
  • Sleepiness
  • Headache
  • Fatigue
  • Reduced effectiveness of birth control pills—Your doctor will recommend that you use another form of birth control.
  • Increased risk of suicidal thinking and behavior

Phenytoin

Common brand name: Dilantin
Phenytoin prevents seizures by promoting sodium loss in nerve fibers. This inhibits nerve excitability and the spread of nerve impulses. This medicine is taken in tablet or liquid form. It is best taken with liquid at the same time each day.
Possible side effects include:
  • Bleeding
  • Swollen gums
  • Fever
  • Rash
  • Lightheadedness
  • Drowsiness
  • Rapid back and forth eyeball movement
  • Reduced effectiveness of birth control pills—Your doctor will recommend that you use another form of birth control.
  • Increased risk of suicidal thinking and behavior

Primidone

Common brand name: Mysoline
Primidone is believed to prevent seizures by stopping the spread of nerve impulses.
This medicine is taken in tablet or liquid form. It is best taken at the same time each day. It is also best taken with food or drink.
Possible side effects include:
  • Rash
  • Confusion
  • Rapid back and forth eyeball movement
  • Clumsiness
  • Lightheadedness
  • Drowsiness
  • Reduced effectiveness of birth control pills—Your doctor will recommend that you use another form of birth control.
  • Increased risk of suicidal thinking and behavior

Valproic Acid

Common brand name: Depakene
Valproic acid may prevent seizures by increasing concentrations of gamma aminobutyric acid. This inhibits nerve transmissions in parts of the brain. This medicine is taken in capsule or syrup form. It is best taken once a day, at the same time each day. Taking it with food or drink can help prevent stomach upset.
Possible side effects include:
  • Loss of appetite
  • Weight gain
  • Indigestion
  • Nausea or vomiting
  • Diarrhea
  • Tremors
  • Headache
  • Menstrual changes in young women
  • Pancreatitis
  • Liver injury
  • Increased risk of suicidal thinking and behavior

Diazepam Rectal Gel

Common brand name: Diastat
Diazepam is approved for the treatment of people with epilepsy who are affected by seizure clusters. Seizure clusters are multiple seizures that are different from the person's usual pattern. These episodes can last minutes to hours and may require emergency treatment.
Diastat can be given rectally by trained parents or other caregivers in a non-hospital setting.
Possible side effects include:
  • Drowsiness
  • Difficulty breathing
  • Headaches
  • Chemical dependence
  • Increased risk of suicidal thinking and behavior

Vigabatrin

Common brand name: Sabril
Vigabatrin is used to treat seizures in infants aged 1 month to 2 years. This type of infantile seizure is dangerous because it can happen frequently throughout the day. Vigabatrin can also be used in adults who have refractory complex partial seizures in combination with other anti-seizure medicines.
The medicine can cause serious side effects, including vision loss. Other side effects include:
  • In infants:
    • Sleepiness
    • Weight gain
    • Diarrhea
    • Nausea or vomiting
    • Excitement or agitation
  • In adults:
    • Lightheadedness
    • Sleepiness
    • Weight gain
    • Shakiness
    • Diarrhea
    • Nausea or vomiting
    • Depression
    • Increased risk of suicidal thinking and behavior

Phenobarbital

Common brand name: Luminal
Phenobarbital is used with other anti-epileptic medicines in people who have partial seizures or generalized convulsive seizures. But, the medicine can be prescribed to treat all types of seizures. Phenobarbital is also used for other conditions, such as tremor, insomnia , and drug withdrawal . The medicine has a very long half-life. This means that it stays in your system for a long time. It is available as a pill or given by IV.
Possible side effects include:
  • Depression
  • Sleepiness
  • Lightheadedness
  • Blurred vision
  • Difficulty in thinking clearly
  • Reduced effectiveness of birth control pills—Your doctor will recommend that you use another form of birth control.
  • Increased risk of suicidal thinking and behavior
Phenobarbital is a barbiturate, a type of medicine that can be addictive. To avoid withdrawal symptoms, you doctor will slowly reduce the dose when it is time for you to stop taking phenobarbital.

Topiramate

Common brand name: Topamax
Topiramate may be prescribed with other anti-epileptic medicines or alone. The medicine is used to treat all types of seizures. To prevent stomach upset, take topiramate with food.
Possible side effects include:
  • Sleepiness
  • Blurred vision
  • Difficulty thinking clearly
  • Lightheadedness
  • Changes in mood
  • Nausea or vomiting
  • Numbness or tingling in hands or feet
  • Loss of appetite, weight loss
  • Reduced effectiveness of birth control pills—Your doctor will recommend that you use another form of birth control.
  • Depression
More serious, but less common side effects include:
  • Increased risk of suicidal thinking and behavior
  • Glaucoma
  • Kidney stones
  • Acidosis—high acidity in the blood
  • Not sweating enough in hot weather—This causes body temperature to rise.

Levetiracetam

Common brand name: Keppra
Levetiracetam is used to treat partial, generalized convulsive, and myoclonic seizures. The medicine is often prescribed in combination with other anti-epileptic medicine. To prevent stomach upset, take levetiracetam with food.
Possible side effects include:
  • Lightheadedness
  • Sleepiness
  • Blurred vision
  • Difficulty in thinking clearly
  • Changes in mood
  • Nausea or vomiting
  • Headache
  • Cough , runny nose, sore throat
  • Risk of infection
  • Depression
  • Increased risk of suicidal thinking and behavior

Lacosamide

Common brand name: Vimpat
By affecting the central nervous system, this medicine reduces how many seizures a person has and how severe the seizures are. Given as a pill or an injection, lacosamide is usually prescribed with other anti-epileptic medicine.
Possible side effects include:
  • Lightheadedness
  • Sleepiness
  • Blurred vision
  • Difficulty thinking clearly
  • Headache
  • Nausea or vomiting
  • Increased risk of suicidal thinking and behavior

Zonisamide

Common brand name: Zonegran
This medication is a mood stabilizer that works by calming the brain. It is used to prevent or control seizures. It may also be used as a treatment for manic depression .
Possible side effects include:
  • Lightheadedness
  • Sleepiness
  • Blurry vision
  • Unable to think clearly
  • Feeling nervous and excitable
  • Headache
  • Nausea
  • Vomiting
  • Not feeling hungry
  • Serious skin reactions, rarely

Rufinamide

Common brand name: Banzel
This medication is used to treat seizures. It is also especially useful in the treatment of Lennox-Gastaut syndrome.
Possible side effects include:
  • Lightheadedness
  • Sleepiness
  • Blurry vision
  • Unable to think clearly
  • Feeling dizzy
  • Headache
  • Nausea
  • Vomiting

Tiagabine

Common brand name: Gabitril
This medication is used to prevent or control seizures. It is also useful as an add-on treatment for partial seizures.
Possible side effects include:
  • Increased appetite
  • Diarrhea
  • Shakiness
  • Feeling nervous and excitable
  • Lightheadedness
  • Sleepiness
  • Blurry vision
  • Unable to think clearly
  • Feeling dizzy
  • Difficulty moving around
  • Dry mouth
  • Nausea
  • Vomiting
This medicine may rarely cause seizures in patients who do not have them.

Clobazam

Common brand name: Onfi
This medicine is used to control seizures in people with Lennox-Gastaut syndrome, a rare condition that causes severe seizures in childhood.
Possible side effects include:
  • Feeling tired or sleepy
  • Fever
  • Drooling
  • Constipation
  • Cough
  • Urinary tract infection
  • Insomnia
  • Aggression
  • Respiratory infection
  • Irritability
  • Vomiting
  • Problems swallowing
  • Problems with coordination
  • Suicidal thoughts or changes in mood

Ezogabine

Common brand name: Potiga
This medication is used to control seizures in adults with epilepsy. The medicine is often prescribed in combination with other anti-epileptic medicine.
Possible side effects include:
  • Lightheadedness
  • Tiredness or confusion
  • Vertigo —sensation of spinning
  • Tremor
  • Problems with coordination
  • Double vision
  • Attention and memory problems
  • Lack of strength
  • Hallucinations or psychosis
  • Suicidal thoughts or changes in mood
  • Urinary problems

Special Considerations

Before taking any of these medicines, consult with your doctor if you:
  • Have high blood pressure
  • Have heart disease
  • Have glaucoma
  • Have emotional or mental problems
  • Have liver or kidney disease
  • Have a history of blood disorders
  • Have asthma or any other lung disorder
  • Have a blood disorder
  • Have a sodium disorder
  • Will be having any surgery within two months
  • Are taking any other medicines
  • Are or plan to become pregnant
  • Drink more than two alcoholic drinks per day
  • Have any known allergies
If you are taking medicines, follow these general guidelines:
  • Take your medicine as directed. Do not change the amount or the schedule.
  • Do not stop taking them without talking to your doctor.
  • Do not share them.
  • Use a measuring spoon, cup, or syringe to give the right dose. Make sure it has the same measurements as the medicine. For example, if the medicine is given in milligrams (mg), the device should also say mg.
  • Ask what the results and side effects are. Report them to your doctor.
  • Some drugs can be dangerous when mixed. Talk to a doctor or pharmacist if you are taking more than one drug. This includes over-the-counter medicine and herb or dietary supplements.
  • Plan ahead for refills so you do not run out.

When to Contact Your Doctor

Contact your doctor if you:
  • Have any unusual, rare, or severe symptoms or side effects
  • Suffer any repeat seizures

References

Antiepileptic drugs for seizure disorders. EBSCO DynaMed website. Available at: http://www.ebscohost.com. Updated February 15, 2013. Accessed February 22, 2013.
Dreifuss FE, Rosman NP, et al. A comparison of rectal diazepam gel and placebo for acute repetitive seizures. N Engl J Med. 1998;338:1869-1875
FDA approves Onfi to treat severe types of seizures. US Food and Drug Administration website. Available at: http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm276932.htm. Accessed February 22, 2013.
Lacosamide. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. January 18, 2013. Accessed February 22, 2013.
Lamotrigine. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated February 15, 2013. Accessed February 22, 2013.
Lennox-Gastaut syndrome . EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated August 2, 2012. Accessed February 22, 2013.
Levetiracetam. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated February 15, 2013. Accessed February 22, 2013.
Myoclonic seizures. Epilepsy Foundation website. Available at: http://www.epilepsyfoundation.org/aboutepilepsy/seizures/genconvulsive/myoclonicseizures.cfm. Accessed February 22, 2013.
Phenobarbital. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated January 18, 2013. Accessed February 22, 2013.
Rufinamide. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated January 18, 2013. Accessed February 22, 2013.
Tiagabine. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated January 18, 2013. Accessed February 22, 2013.
Topiramate. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated January 18, 2013. Accessed February 22, 2013. .
Vigabatrin. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated January 18, 2013. Accessed February 22, 2013.
Zonisamide. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated January 18, 2013. Accessed February 22, 2013.
12/20/2007 DynaMed's Systematic Literature Surveillance. http://www.ebscohost.com/dynamed: 2007 safety alerts for drugs, biologics, medical devices, and dietary supplements: Carbamazepine (marketed as Carbatrol, Equetro, Tegretol and generics). Medwatch. US Food and Drug Administration website. Available at: http://www.fda.gov/medwatch/safety/2007/safety07.htm#carbamazepine.
11/10/2009 DynaMed's Systematic Literature Surveillance. http://www.ebscohost.com/dynamed: Sabril approved by FDA to treat spasms in infants and epileptic seizures. US Food and Drug Administration website. Available at: http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm179855.htm. Updated August 21, 2009. Accessed October 8, 2009.
5/14/2010 DynaMed's Systematic Literature Surveillance. http://www.ebscohost.com/dynamed: Patorno E, Bohn RL, et al. Anticonvulsant medications and the risk of suicide, attempted suicide, or violent death. JAMA. 2010;303(14):1401-1409.
8/23/2010 DynaMed's Systematic Literature Surveillance. http://www.ebscohost.com/dynamed: US Food and Drug Administration. Aseptic meningitis risk with use of seizure drug lamictal. US Food and Drug Administration website. Available at: http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm222212.htm. Published August 12, 2010. Accessed August 21, 2010.
12/17/2010 DynaMed's Systematic Literature Surveillance. http://www.ebscohost.com/dynamed: Andersohn F, Schade R, et al Use of antiepileptic drugs in epilepsy and the risk of self-harm or suicidal behavior. Neurology. 2010;75(4):335-340.
6/10/2014 DynaMed's Systematic Literature Surveillance. http://www.ebscohost.com/dynamed: Veiby G, Engelsen BA, et al. Early child development and exposure to antiepileptic drugs prenatally and through breastfeeding: a prospective cohort study on children of women with epilepsy. JAMA Neurol. 2013;70(11):1367-1374.

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