The information provided here is meant to give you a general idea about each of the medicines listed below. Only the most general side effects are included, so ask your doctor if you need to take any special precautions. Use each of these medicines as recommended by your doctor, or according to the instructions provided. If you have further questions about usage or side effects, contact your doctor.
Medicines are the first line of treatment for epilepsy. Anti-epileptic medicines should only be used if the diagnosis is established. The goal of medicine is to prevent epileptic seizures and to decrease the frequency and severity of seizures. The type and dosage of medicine given must be tailored to the type of epilepsy you have. Dosage is very important. It must balance prevention of seizures with the side effects that epileptic drugs can cause.
Often, one type of medicine is tried at a time until the most effective one is found. Changes in medicine are often made gradually because these changes can increase the likelihood of seizures. Taking just one type of medicine is preferred to reduce side effects and increase compliance. Good control is achieved in 50%-75% of people.
In some cases, however, anti-epileptic medicines may be used in combination. In approximately 80% of people, epileptic medicine is fully or partially successful in preventing seizures. Regularity in routine is the key. Be sure to take the medicine at time the same time of day.
Carbamazepine
Ethosuximide
Gabapentin
Lamotrigine
Oxcarbazepine
Phenytoin
Primidone
Valproic acid
Diazepam Rectal Gel
Vigabatrin
Phenobarbital
Topiramate
Levetiracetam
Lacosamide
Common brand names include:
Carbamazepine
prevents seizures by reducing the excitability of nerve fibers in the brain. This medicine is taken as a tablet (regular or chewable) 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 (nystagmus)
- Dizziness
- 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
More serious, but less common side effects include:
- Bone marrow suppression
- 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, 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
- Dizziness
- 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 bone marrow suppression.
Gabapentin
Common brand name: Neurontin
The mechanism by which
gabapentin
prevents convulsive seizures is uncertain. 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
- Dizziness
- Fatigue
- Lack of coordination (ataxia)
- Weight gain
- Rapid back and forth eyeball movements (nystagmus)
- Increased risk of suicidal thinking and behavior
Lamotrigine
Common brand name: Lamictal
The mechanism by which
lamotrigine
prevents convulsive seizures is uncertain. But, it may work by stabilizing nerve membranes. The medicine is taken in tablet (regular or chewable) 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
- Dizziness
- 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 thereby 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
- Dizziness
- 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 (regular or chewable) or liquid form. It is best taken with liquid and at the same time each day.
Possible side effects include:
- Bleeding
- Swollen gums
- Fever
- Rash
- Dizziness
- Drowsiness
- Rapid back and forth eyeball movement (nystagmus)
- 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 inhibiting the repetitious 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
- Dizziness
- 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—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 administered rectally by trained parents or other caregivers in a non-hospital setting. In the two-year study leading to its approval by the FDA, none of the patients taking Diastat had to go to the emergency room for treatment of seizure clusters.
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 old. This type of infantile seizure is dangerous because it can happen frequently throughout the day.
Vigabatrin
can also be used in adults who have a particular kind of seizure (called 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:
- Feeling lightheaded or dizzy
- Sleepiness
- Weight gain
- Shakiness
- Depression
- Diarrhea
- Nausea or vomiting
- 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 intravenously (a needle that goes into your arm).
Possible side effects include:
- Depression
- Sleepiness
- Dizziness
- 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 barbituate, 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:
- Feeling lightheaded
- Sleepiness
- Blurred vision
- Difficulty in thinking clearly
- Dizziness
- 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.
- Increased risk of suicidal thinking and behavior
More serious, but less common side effects include:
- 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 (when the muscles contract rapidly). The medicine is often prescribed in combination with other anti-epileptic medicine. To prevent stomach upset, take levetiracetam with food.
Possible side effects include:
- Feeling lightheaded
- Sleepiness
- Blurred vision
- Difficulty in thinking clearly
- Changes in mood
- Nausea or vomiting
- Headache
- Cough, runny nose, sore throat
- Risk of infection
- 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:
- Feeling lightheaded
- Sleepiness
- Blurred vision
- Difficulty in thinking clearly
- Headache
- Dizziness
- Nausea or vomiting
- Increased risk of suicidal thinking and behavior
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
- 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.
- Know what the results and side effects. 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.
