Seizure Medications

Types and differences of seizure medications

There are numerous types of seizure medications, each of which may be used to treat different seizure conditions.

People with epilepsy may initially be prescribed a first-line medication. These are medications that are the first choice of physicians to treat seizures. In some cases, people may be required to take other medications in addition to these first-line drugs. These additional medications are called add-ons or second-line therapy. Other medications may also be used on a temporary basis. Some medications are available in extended release (XR) formulations, which help to maintain a steady level of the medication in a patient’s body.

Some of the most common seizure medications and their brand names include:

Generic substitution of seizure medications can be problematic and may result in breakthrough seizures. Patients should not make a generic substitution without first consulting their physician.

Conditions treated with seizure medications

Seizure medications are prescribed for a variety of conditions, including:

Conditions of concern

Patients are advised to consult their physician about whether seizure medications are appropriate for them if they have been diagnosed with any of the following conditions:

• Diabetes
• High blood pressure
• Heart disease
• Kidney disease
• Anemia
• Allergies to components of seizure medications

Potential side effects of seizure medications

Common side effects of seizure medications may include:

• Dizziness
• Nausea
• Vomiting
• Diarrhea
• Headache
• Irritability
• Clumsiness
• Drowsiness
• Fatigue

The following seizure medications may have additional side effects, including:

Drug or other interactions

Patients should consult their physician before taking any additional prescriptions, over-the-counter medications, nutritional supplements or herbal remedies. Of particular concern to individuals taking seizure medications are:

• Other seizure medications. Most seizure medications interact with other seizure medications. This may decrease the effectiveness of either (or both) medications or produce severe side effects. For people undergoing polytherapy (treating epilepsy with more than one seizure medication) it is important that any side effects or increase in number of seizures are reported to a physician.
• Alcohol. Drinking alcohol is not recommended for people who are taking seizure medications to control seizures. Alcohol can increase the likelihood of experiencing certain side effects such as dizziness and drowsiness. Alcohol can also decrease the effectiveness of many seizure medications, and increase the risk of having a seizure.
• Oral contraceptives. Many seizure medications adversely interact with oral contraceptives and may reduce the effectiveness of both. Women who are taking oral contraceptives are advised to discuss alternative contraceptive methods with their physician.
• Antidepressants. People who take antidepressants should consult with their physician about which seizure medications to take. Some antidepressants can reduce the effectiveness of certain seizure medications (e.g., carbamazepine, phenytoin, phenobarbital).
• Grapefruit juice. Grapefruit juice interferes with the liver’s ability to rid the body of some substances. This could cause seizure medications to build up to toxic levels in the body. While the buildup is less likely if the juice is ingested four or more hours prior to the medication, patients taking seizure medications are advised to refrain from drinking grapefruit juice at all. There is no indication that eating grapefruit (as opposed to drinking juice) presents any risk of adverse effects to patients.

The seizure medication carbamazepine interacts with certain antibiotics (e.g., erythromycin) by raising the levels of carbamazepine in the blood. The seizure medication phenytoin is known to interact with a wide variety of medications including antibiotics, ibuprofen, lithium and corticosteroids.

Additionally, some seizure medications can interact with certain vitamins and herbal medications, decreasing the effectiveness of the seizure medication. Patients are advised to consult their physician regarding supplements and interactions with their seizure medication.

Livestyle considerations with seizure medications

Taking seizure medications as prescribed is one of the most important lifestyle considerations for patients with epilepsy. It is believed that 15 percent of patients with epilepsy do not take their medications as instructed, according to the Epilepsy Foundation. This can significantly increase the risk of more severe and unmanageable seizures.

Using memory aids such as a pill reminder box or calendar can help patients comply with their medication schedule. Watch alarms and other reminder devices may also help.

Pregnancy use issues with seizure medications

The safety of most seizure medications during pregnancy has not been established and it is important that women who are taking seizure medications consult with their physician before they attempt to get pregnant.

Women with epilepsy have a slightly higher risk (4 to 6 percent) of having a child with a birth defect than women without epilepsy (2 to 3 percent), according to the Epilepsy Foundation. This risk increases when pregnant women take certain seizure medications. The most common birth defects associated with seizure medications are spina bifida and cleft palate formation. The American Academy of Neurology recommends that women with epilepsy of childbearing age should take no less than 0.4 milligrams per day of folic acid and continue this during pregnancy.

A physician may recommend that women modify their dosage level or taper off their medications before they become pregnant to reduce the risk of birth defects. If seizure medication withdrawal is planned, it should be done at least six months before conception. If medication withdrawal is not possible, therapy should be optimized before conception. During pregnancy, it is not recommended to switch to another anti-seizure medication for the sole purpose of avoiding birth defects. Women with epilepsy are advised to follow up regularly with their neurologist during pregnancy.

Some seizure medications may be passed to infants through breast milk. Women who are taking seizure medications may be advised by their physician to refrain from nursing or to wait several hours after taking their medications before nursing. It is important to discuss medication management with a physician before, during and after pregnancy.

Child use issues

Because of the tendency of children to experience seizures as a result of a high fever, seizure medications are not usually recommended for children who have an isolated seizure. However, children who have epilepsy will usually be prescribed seizure medications.

There are differences in the way children and adults are prescribed seizure medications. For example, children may be prescribed larger doses of seizure medications than adults because of the way children’s bodies process the drugs. Also, dosage levels for children are changed regularly because of the rapid growth their bodies undergo as they mature. This may require regular consultations with the child's physician to assess the effectiveness of the current seizure medications.

It is important that children learn to take responsibility for their seizure medications. Although parents or guardians should monitor the child’s compliance, children who understand when and why they must take their medications are less likely to stop taking their seizure medications.

Some parents worry that children may become addicted to their seizure medication, although there is no evidence that this occurs. Also, nothing indicates that children who take seizure medications are more likely to abuse medications or take illegal drugs.

Elderly use issues

Seizure medications may not pass as quickly (metabolize) through the bodies of elderly patients as they do in younger patients. As a result, elderly people may be especially likely to experience certain side effects associated with seizure medications, including confusion, unsteadiness or fatigue.

Additionally, elderly people are more likely to be taking other medications that may adversely interact with seizure medications or they may have medical conditions that can affect the way seizure medications are absorbed. This is especially true in the case of diabetes, heart failure or kidney failure.