Epilepsy Medications

Although epilepsy cannot be cured, there are numerous therapeutic options. Up to 70% of individuals with epilepsy can control their condition with these medications

What is Epilepsy?

Epilepsy, also referred to as a seizure disorder, is a brain disorder that causes chronic (long-term/ reoccurring) seizures. This condition consists of having 2 or more unprovoked seizures that occur more than 24 hours apart. There are various types of seizures, and multiple medications are used to treat them. Seizure medications are called anti-epileptic drugs (AEDs).

To learn more about epilepsy, read Types of Seizures.

When should I start anti-seizure medication therapy?

If you have experienced multiple seizures, a seizure medication is typically started. However, you may start medication therapy if you only experience one seizure but other tests, such as an MRI or EEG (electroencephalogram) indicate the likelihood of future seizure activity.

What’s the difference between acute and chronic seizure management?

Acute seizure management

Most seizures last less than 2 minutes and do not require medical intervention. Seizures that continue longer cause more brain damage and can be fatal.

Status epilepticus (SE) is a seizure lasting beyond 5 minutes because the normal mechanisms that terminate seizures are not working. After 30 minutes, long-term damage can occur. This is a medical emergency, and emergency treatment should begin with any seizure that lasts longer than 5 minutes.

Chronic (long-term) seizure management

Anti-epileptic drugs (AEDs), also referred to as anticonvulsants or anti-seizure medications, are first-line treatment options for epilepsy.

Anticonvulsants are used to manage a variety of medical conditions by stabilizing the level of nerve cell impulses, including:

• Epilepsy
• Seizure disorders
• Nerve pain (neuropathic pain)
• Bipolar disorder

How do AEDs work?

A seizure occurs when excitatory (activating) neurons produce a sudden surge of electrical activity in your brain. The sudden electrical surge is caused by a receptor malfunction or an imbalance of neurotransmitters (NTs).

AEDs reduce abnormal electrical activity by either:

• Increasing GABA (GABA is a chemical messenger in your brain that inhibits excitatory responses)
• Decreasing glutamate (glutamate is the most abundant excitatory neurotransmitter in your brain and central nervous system)
• Blocking calcium (Ca) channels, which slows down or stops the transmission of the electrical signal
• Blocking sodium (Na) channels, which decreases the neuron's firing rate.

AEDs should NOT be stopped abruptly as this can lead to seizures

Adverse effects of AEDs include:

1. Bone loss

• All AEDs can cause bone loss and increase fracture risk. Individuals taking an AED should be supplemented with calcium and vitamin D.
• Bone loss can occur as soon as 2 years after starting an AED.

2. CNS depression

• All AEDs can cause CNS depression (i.e. dizziness, confusion, sleepiness, and coordination difficulties) and increase your risk for impairments, falls, and injuries.

3. Suicidal risk

• All AEDs have a warning for suicidal risk and require monitoring of your mood.
• Call your healthcare provider right away if you experience thoughts of suicide, new or worsening depression or anxiety, panic attack, irritability, or other unusual behavior.

What are the different epilepsy medication options?

Examples of anticonvulsant medications include: Lamotrigine, Levetiracetam, Topiramate, Valproic acid, Divalproex sodium, Carbamazepine, and Oxcarbazepine.

1. Lamotrigine

Brand: Lamictal, lamictal ODT, lamictal starter kit, lamictal XR (extended- release) 25–400 mg daily

• Extended-release (XR) lamotrigine is used in adults and children who are at least 13 years old.
• Lamotrigine is used to treat epileptic seizures in both adults and kids, either on its own or in combination with other drugs.
• In individuals with bipolar disorder (manic depression), lamotrigine is additionally used to prevent and/or delay mood episodes.

Side effects

1. Nausea and/or vomiting
2. Drowsy, dizziness, and/or sleepiness
3. Rash
4. Blurred vision and/or diplopia (double vision/“seeing double”)
5. Tremor
6. Ataxia (poor/weak muscle control)
7. Impaired coordination
8. Alopecia (hair loss)

Individuals taking Lamotrigine should be supplemented with selenium and zinc, especially if experiencing side effects such as alopecia.

Drug Interactions with this medication include oral estrogen-containing contraceptives, higher maintenance doses of lamotrigine may be needed, and valproic acid, lower doses of lamotrigine may be needed.

Black boxed warning (BBW- the strictest warnings for prescriptions): This medication may cause serious skin reactions, including SJS/TEN (Stevens-Johnson syndrome/toxic epidermal necrolysis), particularly in children and in individuals taking a high starting dose, or those also taking valproic acid. SJS/TEN is a life-threatening skin reaction that consists of flu-like symptoms, followed by a painful rash that spreads and blisters.

This skin reaction may occur in the first 2 to 8 weeks of treatment, however, it can happen in individuals who have taken this medication for any period of time.

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2. Levetiracetam

Brand: Keppra, keppra XR, roweepra, roweepra XR 500 mg BID (twice a day), or 1,000 mg daily (XR). Maximum dose is 3,000 mg/day.

• Extended-release (XR) levetiracetam is for adults and children at least 12 years old. Do not chew, break, or crush your XR tablet; instead, swallow it whole.
• Roweepra and Keppra may be used in children as young as 1 month old.
• Levetiracetam is used in combination with other anti-seizure drugs to treat myoclonic seizures in individuals older than 12 years old and tonic-clonic seizures in individuals older than 6 years old.

Side effects

1. Irritability and/or aggressiveness
2. Dizziness
3. Weakness
4. Asthenia (weakness/lack of energy and strength)
5. Vomiting

Warning This medication may cause psychiatric reactions, such as psychotic symptoms, sleepiness, fatigue, suicidal behavior, anaphylaxis (a severe/life-threatening allergic reaction), coordination difficulties, SJS/TEN, hemolytic abnormalities, such as anemia, and loss of seizure control during pregnancy.

There are no significant drug interactions with this mediation

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3. Topiramate

brand: Topamax, topamax sprinkle 25–400 mg (daily or BID)

• Adults and kids who are at least 2 years old can take topiramate to treat specific types of seizures.
• This medication can also be used for migraine prophylaxis in adults and children older than 12 years. Topiramate prevents migraine headaches or lessens the frequency of attacks; it does not treat migraines that have already begun.

Side effects

1. Sleepiness
2. Dizziness
3. Psychomotor slowing (i.e. slow speech with long pauses before answers, slower thinking, and slow body movements)
4. Difficulty with memory, concentration, and attention
5. Weight loss that could potentially lead to anorexia

Warning This medication may increase levels of acid in your blood, also called metabolic acidosis, oligohidrosis (topiramate has the ability to raise your body temperature while reducing sweating, which may result in potentially fatal dehydration), angle-closure glaucoma (an eye disease that can cause vision loss and/or blindness), hyperammonemia (increased levels of ammonia in your blood), and fetal harm.

Pregnancy Taking this medication while pregnant may increase your risk of developing cleft lip and/or palate, a birth defect that can manifest early on even before you are aware that you are pregnant. A seizure during pregnancy, however, has the potential to be harmful to both the mother and the fetus. If you become pregnant, tell your doctor as soon as possible.

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4. Valproic Acid

Brand: Depakene 250 mg daily

• Take with food if this mediation upsets your stomach.
• This medication is not only used to treat various types of seizures but also for treating manic episodes associated with bipolar disorder (manic depression) and reducing migraine headaches.

Side effects

1. Alopecia - Individuals taking this medication are recommended to supplement with selenium and zinc
2. Weight gain
3. Nausea and/or vomiting
4. Headache
5. Anorexia
6. Abdominal pain
7. Dizziness
8. Sleepiness
9. Tremor
10. Blurred vision

Warning This medication may cause hyperammonemia and thrombocytopenia (abnormally low levels of platelets in your blood).

Black boxed warning This medication may cause hepatic failure (loss of liver function), which usually occurs during the first 6 months of therapy, as well as fetal harm, such as neural tube defects and decreased IQ scores.

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5. Divalproex Sodium

Brand: Depakote, Depakote ER (extended-release), Depakote Sprinkle 250 mg daily

• Depakote sprinkle: capsules can be opened and sprinkled on food.
• - This mediation is not only used to treat are used to treat seizures in individuals with epilepsy who are at least 10 years old, but also used for manic episodes associated with bipolar disorder (manic depression) and migraine prophylaxis.

Side effects

1. Alopecia - Individuals taking this medication are recommended to supplement with selenium and zinc
2. Weight gain
3. Nausea and/or vomiting
4. Headache
5. Anorexia
6. Abdominal pain
7. Dizziness
8. Sleepiness
9. Tremor
10. Blurred vision

Warning This medication may cause hyperammonemia and thrombocytopenia (abnormally low levels of platelets in your blood).

Black boxed warning This medication may cause hepatic failure (loss of liver function), which usually occurs during the first 6 months of therapy, as well as fetal harm, such as neural tube defects and decreased IQ scores.

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6. Carbamazepine

Brand: Tegretol, tegretol XR, Carbatrol, Epitol, Equetro (for bipolar disorder) 200–1,600 mg

• This medication is an anticonvulsant that reduces the nerve impulses responsible for conditions like trigeminal neuralgia (TN- a form of neuropathic pain) and diabetic neuropathy (nerve damage that is caused by diabetes) that lead to seizures and nerve pain. Carbamazepine is also used for bipolar disorder.

Side effects

1. Dizziness and/or drowsiness
2. Loss of full control of your body movements (ataxia)
3. Nausea and/or vomiting
4. Dry mouth
5. Photosensitivity (skin is very sensitive to sunlight)—avoid exposure to sunlight and apply sunscreen when outdoors
6. Itching and/or rash
7. Blurred vision
8. Alopecia

Black boxed warning Serious skin reactions, including SJS/TEN, aplastic anemia (serious blood disorder), and agranulocytosis (abnormally low levels of granulocytes (a type of white blood cell) in your blood).

Warning You should not take carbamazepine if you have a history of bone marrow suppression, if you are allergic to it, or if you take an antidepressant such as amitriptyline, desipramine, doxepin, imipramine, or nortriptyline.

Drug interactions Many medications may interact with carbamazepine, and certain medications shouldn't be taken at the same time, such as levothyroxine, warfarin, and hormonal contraceptives. This also includes vitamins, herbs, prescriptions, and over-the- counter medications, as well as grapefruit, which may lead to increased side effects.

7. Oxcarbazepine

Brand: Trileptal, oxtellar XR—300 mg BID Trileptal, 600 mg daily Oxtellar XR

• Oxtellar XR: Should be taken on an empty stomach 1 hour before or 2 hours after meals.
• This medication is an anticonvulsant that functions by reducing the nerve impulses that lead to pain and convulsions.
• Trileptal is the brand of oxcarbazepine and is used in adults and children who are at least 4 years old, and oxtellar XR is another brand of medication used in adults and children 6 years and older.

Side effects

1. Sleepiness
2. Dizziness
3. Nausea and/or vomiting
4. Abdominal pain
5. Visual disturbance
6. Ataxia
7. Tremor
8. Double vision/ “seeing double” (diplopia)

Warning This medication may increase your risk for serious skin reactions, such as SJS/ TEN, and hypersensitive reactions. Oxcarbazepine can also reduce the sodium in your body to very low levels (hyponatremia), which can cause a life-threatening electrolyte imbalance. Call your doctor right away if you have nausea, lack of energy, confusion, feeling tired or irritable, severe weakness, muscle pain, or increased seizures

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Avoid driving while taking an AED due to adverse effects such as dizziness and drowsiness, which could cause falls, accidents, or severe injuries.

Call your doctor immediately if you have signs or symptoms of other serious side effects, such as fever, swollen glands, severe muscle pain, bruising or unusual bleeding, yellowing of your skin or eyes, headache, neck stiffness, vomiting, confusion, or increased sensitivity to light.

Certain AEDs are categorized as “controlled substances,” which are prescription medications that are regulated by the government because they have the ability to cause addiction or may be abused. Given that it’s not permitted to transport controlled substances across state lines, Marley Drug offers these medication in North Carolina. If you live me outside North Carolina, please visit MarleyDrugRx for a coupon.

What should I take with an AED?

All AEDs should be supplemented with calcium and vitamin D. Women of childbearing age should take folate supplementation.

What happens if I miss a dose?

If you forget to take a dose, take it as soon as you remember unless it's almost time for your next dose. In this case, skip the forgotten dose and take the next one at the usual time. Do not take 2 doses together to make up for a missed dose.

Speak With Your Doctor

Anticonvulsant medications are FDA approved to treat seizures and many other medical conditions. No single AED is better than the others to treat or prevent seizures.

Finding the optimal therapeutic strategy that can prevent breakthrough seizures while having the fewest adverse effects is the constant objective of epilepsy treatment. Talk to your healthcare provider today and send your prescription to Marley Drug. Save up to 95% compared to your local pharmacy by using Marley Drug.