| Tegretol
|
|
- Generic Name: Carbamazepine
- This is
 one
of the most effective medications in treating certain seizure disorders.
It has the advantage of having little or no effect on mental abilities
for thinking, learning, and general functioning.
- Side Effects:
The most common side effects of this medication more often occur
when first beginning the medication. These side effects include
nausea, dizziness and unsteadiness. Double vision can also occasionally
occur. These symptoms almost always go away after several days to
several weeks of being on the medication and you should not be alarmed
unless the symptoms persist. To minimize these symptoms Tegretol
should be taken with food.
- Although
there are reports that aplastic anemia is a potential side effect
of Tegretol, this is extremely rare and probably not different from
any other AED. If any effects are seen on the blood count, they
are usually a small reversible gradual reduction in the white blood
cell count from 5,000 to 3,000. Since white blood cells can fight
infection at a level of 1,000, such a decrease is not clinically
significant.
Occasionally, Tegretol can cause a decrease in the serum sodium
level. This is usually only a problem at higher doses and it can
cause break through seizures. The condition can be detected easily
by a blood sample for electrolytes. Usually the decreased sodium
can be corrected by salt tablets, one with each meal or two with
each meal or added salt to meals.
- Other
side effects that occur less commonly with Tegretol may include
headache, diarrhea or constipation, blurred vision, and difficulty
with urination. These symptoms are uncommon and are usually temporary.
- With
all anti-epileptic medications, it is important to maintain an adequate
amount of the drug in your body.
- A
complete blood count (CBC) and liver function (SGOT) must be checked
before Tegretol is started and 3 weeks after. Thereafter levels
should be checked every three months for a year then every 6 months.
-
IF
THE TEGRETOL LEVEL IS TOO LOW, no symptoms are felt,
however, you may experience break-through seizures.
- IF
THE TEGRETOL LEVEL IS TOO HIGH, toxic symptoms may occur.
These usually include dizziness, double vision, nausea, loss of
appetite and unsteadiness (similar to some of the symptoms felt
when first beginning the medication). If these symptoms occur, you
should report them to your doctor immediately.
- If
you are experiencing symptoms that may indicate your level is too
low or too high, your doctor will have you obtain a lab test to
check your Tegretol level. If the level is not therapeutic, he will
likely increase or decrease your medication.
- Since
it is necessary to have a sufficient amount of your anti-epileptic
medication in your blood in order to control seizures, it is important
that you follow your doctor's prescription. Do not adjust your medication
without first consulting your physician.
- Drug-to-Drug interactions:
While taking Tegretol the following medications should be avoided:
Erythromycin, Tagamet (Cimetidine),
Darvon and Calan. These medications can cause a
rise in the Tegretol level since they inhibit its metabolism and
this may result in toxicity. If these medications do need to be
taken, consult your doctor so that appropriate dosage adjustments
of your Tegretol can be made.
- Generic
forms of Tegretol should not be taken without consulting
your physician.
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| Dilantin |
|
- Generic Name: Phenytoin,
Diphenylhydantoin
- This is
a very effective medication in treating many types of seizures.
Dilantin doses have very predictable effects on the blood level
(predictable pharmacokinetics). In blood levels up to 20 Dilantin
has linear pharmacokinetics, that is to say that one extra 100 mg
capsule will produce an increase of 1 in the blood level and that
2 extra capsules will produce an increase of 2 in the blood level.
Above a level of 20 Dilantin pharmacokinetics are nonlinear, that
is to say that one extra 100 mg capsule can make the Dilantin blood
level increase by 2 to 5. When Dilantin levels are high (above 30)
it takes longer than usual for the level to come down to normal.
Dilantin is as safe in pregnancy as Tegretol so a patient can be
on monotherapy (one medication). Dilantin with Folic acid 1 mg daily
can be as safe against birth defects as a patient on Tegretol.
- Side Effects:
The most common long-term side-effect of Dilantin is gum irritation
and enlargement. This occurs in about 15-20% of patients. Good oral
hygiene helps to avoid this problem. We recommend brushing the teeth
immediately after each meal and using dental floss each night. We
also recommend the use of a Water-pik to flush small particles
from below the gumline at bedtime. A new toothbrush known as
Interplak, available at the Price Club or at certain pharmacies)
is also recommended. This costs about $65-$75.
Rarely,
Dilantin can cause swelling of the lymph glands and rash. Since
these side effects are reversible, your doctor will stop the medication
and the problems will go away.
Some side effects of Dilantin make it an undesirable AED in childhood.
Many children who take Dilantin develop coarser facial features.
This is age limited and does not occur in adults.
Some adults who take Dilantin develop excess hair growth. This does
not occur in all patients and usually, if it occurs, is only complained
about by females. Furthermore, it is reversible in adults and therefore
if it occurs the patient's medication can be changed to another.
- Occasionally,
Dilantin can cause inflammation of the liver or a decrease in the
blood count. For this reason your doctor will periodically check
a complete blood count and liver panel. Depending on the individual
case this may need to be checked from one to four times per year.
- With
all anti-epileptic medications, it is important to maintain an adequate
amount of the drug in your body.
Dilantin has several unique aspects which make it a popular AED:
Dilantin can be taken once a day, say at bedtime, and still have
the maximum protective effect against seizures. This is such a convenience,
that many professional people prefer to take Dilantin rather than
other medications.
Dilantin
comes in 100 mg and 30 mg capsules and 50 mg chewable tablets. This
allows very fine titration (adjustment of dosage to obtain best
efficacy - control of seizures - with the least side effects) increasing
the benefit/risk ratio. For instance, Mary's seizures are controlled
with a level of 20 but she is toxic at a level of 25. If she takes
three 100 mg capsules a day (300 mg) her tough level is 16, but
if she takes four 100 mg capsules (400 mg) her level is 30. Mary
could take three 100 mg capsules and one 30 mg capsule and have
a blood level of 22. For another example, John is toxic on 400 mg
daily, but he needs a high blood level to control his seizures.
He requires fine tuning to 370 mg daily (one 100 mg capsule plus
nine 30 mg capsules: 1 x 100 + 9 x 30 = 100 + 270 = 370 ). So by
using the 30 mg capsules in various combinations with the 100 mg
capsules, John can get the optimum dosage per day to control his
seizures without side effects.
- When
all the Dilantin is taken as one dose at night, it is not necessary
to get an AM serum trough level before medications early in the
morning. So Dilantin levels can be taken when convenient after work.
Dilantin is inexpensive.
- IF
THE LEVEL OF DILANTIN IN THE BLOOD IS TOO LOW,
no symptoms will be felt by the patient. However, break-through
seizures may occur.
- IF
THE DILANTIN LEVEL BECOMES TOO HIGH,
you may experience a sense of imbalance as though you are drunk.
Dizziness may also be a symptom of DILANTIN toxicity. If
these symptoms occur you should contact your doctor immediately.
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| Depakote |
|
Generic Name: Divalproex Sodium
- This is a very effective medication for certain seizure types
and has the advantage of being virtually free of any significant
side effects on thinking ability and cognition.
- Side Effects:
When first beginning therapy, patients commonly experience nausea
and may experience dizziness or unsteadiness. These side effects
are usually temporary and rarely require discontinuation of therapy.
A fine tremor of the hand is a common side effect of Depakote and
this may persist as long as the patient is taking the medication.
It is usually seen only at high doses and generally is not disabling.
Weight gain can occur in a small number of patients but this is
generally due to an increased appetite rather than a change in metabolism.
Rarely, changes in thyroid function can occur.
- The
most serious side effects of Depakote are thrombocytopenia (decrease
in blood platelet count), anemia, and inflammation of the liver.
These severe problems rarely occur but your doctor will need to
check a complete blood count and liver panel periodically. This
is checked from two to four times per year in most cases.
Depakote
can cause thinning of the hair but rarely is it permanent. Depakote
can cause problems with liver, however, this is a rare side effect
usually seen in young children who are on many other anticonvulsant
medications.
Depakote
is associated with a 1% to 2% occurrence of spina bifida and meningomyelocele
in the offspring of mothers with epilepsy. Although this is a significant
added risk to the usual 2% occurrence of malformations during any
pregnancy and is a reason why other medications are sought for women
who want to become pregnant, nevertheless, if a mother has seizures
which require the use of Depakote, then, since the seizures are
much more harmful to the unborn baby than the very small risk of
Depakote, Depakote should be used. Situations where we prescribe
Depakote in women of childbearing age are: Juvenile Myoclonic Epilepsy,
Primary Generalized Epilepsy with both Absences (Petit Mals) and
Generalized Tonic-Clonic Seizures (convulsions, grand mal seizures),
and Generalized Tonic-Clonic Seizures not controlled on other medications
usually those with myoclonus or massive jerking in between seizures.
- Drug-to-Drug Interactions:
Usage of any medications containing Phenobarbital or barbiturates
should be avoided while taking Depakote, as Depakote may cause the
Phenobarbital to accumulate to high levels in the bloodstream.
- With
all anti-epileptic medications, it is important to maintain an adequate
amount of the drug in your body. Phenobarbital and Clonazepam (Klonopin)
can interact with Depakote and cause fatigue and tiredness. In some
patients the combination of Depakote and Tegretol increases one
of the breakdown products of Tegretol (the epoxide) which at higher
levels can be toxic. It is important for your doctor to monitor
the ammonia in the blood if you feel tired or sleepy
Levels
of Depakote that control seizures are 70-120. Occasionally higher
levels up to 180 are successful without a major increase in side
effects. As with most of the other medications the therapeutic level
can be higher than the usual therapeutic range of a laboratory.
It typically takes one week for Depakote serum levels to reach a
steady state.
Depakote
Sprinkles are a very useful dosage form. They have a much smoother
rise in the blood level and maintain a more stable blood level than
the regular Depakote tablets. Many patients who cannot tolerate
regular Depakote can easily manage the sprinkles. Furthermore the
capsule containing the sprinkle can be opened and the sprinkles
mixed with applesauce or other food to make it more palatable for
children who can't take pills.
- IF
THE DEPAKOTE LEVEL IS TOO LOW, no symptoms will be felt
by the patient. However, break-through seizures may occur.
- IF
THE DEPAKOTE LEVEL IS TOO HIGH, nausea, vomiting and
dizziness are the most common symptoms.
- Depakote
also increase the ammonia levels in the blood and it is important
for your doctor to monitor this. If you experience unusual lethargy,
feelings of drowsiness or a "drunkenness" feeling, contact
your doctor and have your levels checked immediately. If your level
is too high, the doctor will give you carnitine and/or Lactulose
to lower your level.
- Since
it is necessary to have a sufficient amount of your anti-epileptic
medication in your blood in order to control seizures, it is important
that you follow your doctor's prescription. Do not adjust your medication
without first consulting your physician.
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| Mysoline |
|
- Generic Name: Primidone
- This is anexcellent
medication for complex partial seizures and for some Myoclonic seizures.
Mysoline is an active barbiturate and breaks down to pema and to
phenobarbital. The pema is an active anti-convulsant and therefore
Mysoline has additional effectiveness in controlling seizures beyond
phenobarbital. Therefore it's important to get both Mysoline (Primidone)
and phenobarbital levels for a person on Mysoline. Both must be
requested when getting a blood level. Many patients tolerate Mysoline
better than other barbiturates. In many patients there are no day-to-day
changes in mental function whereas other patients become drowsy.
Each person's reaction to Mysoline can be individual. In many patients
Mysoline is an excellent AED, controlling the seizure without side
effects. Mysoline comes in two tablet strengths - 250 mg and 50
mg. Both are score tablets so that Mysoline can be easily adjusted
in 50 mg increments. Since the usual daily dose is 500 mg to 750
mg the dose can be very finely tuned with the 25 mg increments to
the optimum dose with the best benefit/risk ratio (seizure control/side
effect ratio).
- Side Effects:
The most frequently occurring side effect is a sense of imbalance
and vertigo (sensation of spinning). This tends to disappear with
continued therapy. Occasionally, nausea and loss of appetite, emotional
disturbance, sexual impotency or skin rash may occur.
- IF
THE MYSOLINE LEVEL IS TOO LOW, no side effects will
be felt, however, break-through seizures may occur.
- IF
THE MYSOLINE AND PHENOBARB LEVELS ARE TOO HIGH, drowsiness,
sleepiness, dizziness and unsteadiness of gait may occur. Nausea
and vomiting may also occur. You should report these symptoms to
your physician.
- If
Mysoline is withdrawn, it should be done very slowly to
prevent withdrawal seizures. Feelings of irritability and agitation
may occur during the withdrawal period.
- Drug-to-Drug Interactions:
Mysoline is metabolized to Phenobarb. This is why your
doctor will check both the Mysoline and the Phenobarb level if you
are on Mysoline. Caution should be applied if Depakote is added
to Mysoline. Depakote can make the Phenobarb metabolite of Mysoline
rise into the toxic range.
- Since
it is necessary to have a sufficient amount of your anti-epileptic
medication in your blood in order to control seizures, it is important
that you follow your doctor's prescription. Do not adjust your medication
without first consulting your physician.
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| Klonopin |
|
- Generic Name: Clonazepam
- Thismedication
is given for certain seizure types including myoclonic seizures,
intractable absence seizures and Lennox-Gastaut syndrome.
- Side Effects:
Patients commonly experience drowsiness, lessened muscular coordination.
In many cases these side effects diminish over time. Children frequently
develop behavioral problems which only stop after the drug is tapered
and discontinued. Due to these side effects Klonopin usually is
used as a third line drug for intractable seizures.
- Drug-to-Drug Interactions:
Usage of Klonopin should be avoided while taking Depakote, as Depakote
may cause the Klonopin to accumulate to high levels in the bloodstream
causing sedation and even stupor.
- With
all anti-epileptic medications, it is important to maintain an adequate
amount of the drug in your body.
- IF
THE KLONOPIN LEVEL IS TOO LOW, no symptoms will be felt
by the patient. However, break-through seizures may occur.
- IF
THE KLONOPIN LEVEL IS TOO HIGH, somnolence, confusion,
and diminished reflexes. Klonopin blood levels are less useful than
levels of other AEDs and it is customary to adjust Klonopin dosage
based on clinical response without blood levels.
- Since
it is necessary to have a sufficient amount of your anti-epileptic
medication in your blood in order to control seizures, it is important
that you follow your doctor's prescription. Do not adjust your medication
or abruptly stop taking it without first consulting your physician.
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| Zarontin |
|
- Generic Name: Ethosuximide
- Thismedication
is advantageous in the control of simple absence seizures (petit
mal). Its use is primarily in this seizure type.
- Side Effects:
May impair alertness and nausea. Less common side effects include
dizziness, drowsiness, and irritability.
- Abnormalities in the blood have been reported as well as liver
and renal problems. Therefore periodic blood counts, urinalysis
and liver function tests should be performed.
- Drug-to-Drug Interactions:
Periodic blood levels should be performed when Zarontin is used
together with other anti-epileptic medications since it can effect
the therapeutic levels of other anti-epileptic medications.
- With
all anti-epileptic medications, it is important to maintain an adequate
amount of the drug in your body.
- IF
THE ZARONTIN LEVEL IS TOO LOW, no symptoms will be felt
by the patient. However, break-through seizures may occur.
- IF
THE ZARONTIN LEVEL IS TOO HIGH, patient may feel similar
but more severe side effects such as those listed above.
- Since
it is necessary to have a sufficient amount of your anti-epileptic
medication in your blood in order to control seizures, it is important
that you follow your doctor's prescription. Do not adjust your medication
without first consulting your physician.
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| Felbatol |
|
- Generic Name: Felbamate
- Felbatol isvery
effective for many types of seizures both as add-on therapy with
other medications or as a monotherapy.
It is effective in severe complex partial seizures and in the difficult
to treat Lennox-Gastaut Syndrome (see definitions). Unfortunately,
after a year on the market a number of fatal cases of aplastic anemia
and hepatitis linked to the use of the medication were reported
and most physicians only prescribe it for patients where no other
treatment is effective.
- Side Effects:
The most common side effects of this medication when used alone
are weight loss, insomnia, and headache. The most common side effects
seen in association with other medications are nausea, dizziness,
and somnolence. There are substantially higher rates of side effects
when patients are receiving other antiepileptic medications and
conversion to monotherapy often reduces side effects.
- The
most serious potential side effects from Felbatol includes aplastic
anemia and liver failure. Complete blood count (CBC), reticulocytes,
and liver function blood tests should be performed before Felbatol
therapy every two weeks thereafter for three months, every month
up to one year and every three months thereafter. These tests also
should be checked three months after discontinuation of Felbatol.
- IF
THE FELBATOL LEVEL IS TOO LOW, no symptoms are felt,
however, you may experience break-through seizures.
- IF
THE FELBATOL LEVEL IS TOO HIGH, toxic symptoms may occur.
These usually include persistent insomnia and headache. If these
symptoms occur, you should report them to your doctor immediately.
- If
you are experiencing symptoms that may indicate your level is too
low or too high, your doctor will usually change your Felbatol dose.
Blood levels usually are less useful with Felbatol than with the
standard AEDs.
- Since
it is necessary to have a sufficient amount of your anti-epileptic
medication in your blood in order to control seizures, it is important
that you follow your doctor's prescription. Do not adjust your medication
without first consulting your physician.
- Drug-to-Drug interactions:
Felbatol has significant interactions with Dilantin, Depakote and
Valproate. Felbatol effects the concentrations of these medications
in the blood and your physician will need to make adjustments in
these medications.
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| Lamictal |
|
- Generic Name: Lamotrigine
- Lamictal iseffective
in adults with complex partial seizures and secondarily generalized
seizures. It is most effective when used as an add on therapy with
other anti-epileptic medications.
- Side Effects:
The most common side effects of this medication are dizziness, drowsiness,
blurred or double vision, lack of coordination and headache. A higher
incidence of skin rash has occurred with this drug, especially if
the dosage is rapidly increased when up to 10% of patients develop
a rash. If a rash occurs, we usually stop the medication for two
weeks and re- institute it at a lower dose and increase the dose
more slowly. It is especially important to start Lamictal at a very
low dose with Depakote (valproic acid) and slowly increase the dose.
- With
all anti-epileptic medications, it is important to maintain an adequate
amount of the drug in your body.
- Therapeutic
levels have not been established for Lamictal, however, if you experience
an increase in seizures or continue to experience side effects following
the initial 2-3 three weeks after starting the medication, contact
you physician for an evaluation.
- Since
it is necessary to have a sufficient amount of your anti-epileptic
medication in your blood in order to control seizures, it is important
that you follow your doctor's prescription. Do not adjust your medication
without first consulting your physician.
- Drug-to-Drug interactions:
Lamictal does not appear to affect other antiepileptic drugs.
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| Phenobarbital |
|
- Phenobarbital is an anti-epileptic medication that is used only
after other anti-epileptic medications have been tried.
- Side Effects:
Although phenobarbital is associated with significant behavioral
and subtle cognitive effects, it may cause less toxicity (hematopoietic,
hepatic) than the other drugs. Drowsiness is the most common side
effect although patients usually develop a tolerance to the drug.
It can markedly influence behavior, can provoke irritability in
children, particularly hyperactivity, and exacerbate exiting behavioral
problems in adults.
- This
drug has been known to be habit forming, however, this rarely occurs
when used as an anti-epileptic medication. Abrupt termination of
therapy usually causes withdrawal seizures and it is very important
not to change your dose or discontinue use of the drug without the
care of your physician.
Phenobarbital can be taken once a day, like Dilantin. This convenience
can improve compliance (taking the drug regularly and correctly)
and is an advantage.
It used to be customary practice that when Dilantin failed to control
seizures, phenobarbital was added. This is no longer considered
state of the art therapy. Addition of Neurontin to Dilantin or switching
to monotherapy Tegretol would be considered the next step if Dilantin
in highest tolerated doses does not work.
- With
all anti-epileptic medications, it is important to maintain an adequate
amount of the drug in your body.
- IF
THE PHENOBARBITAL LEVEL IS TOO LOW, no symptoms are
felt, however, you may experience break-through seizures.
- IF
THE PHENOBARBITAL LEVEL IS TOO HIGH, toxic symptoms
may occur. These usually include excessive drowsiness and lethargy.
- If
you are experiencing symptoms that may indicate your level is too
low or too high, your doctor will have you obtain a lab test to
check your phenobarbitol level. If the level is not therapeutic,
he will likely increase or decrease your medication.
- Since
it is necessary to have a sufficient amount of your anti-epileptic
medication in your blood in order to control seizures, it is important
that you follow your doctor's prescription. Do not adjust your medication
without first consulting your physician.
- Drug-to-Drug interactions:
Phenobarbital and Dilantin used together may result in changes of
each drug in the blood stream. When used in conjunction with Dilantin,
blood levels should be checked regularly. Phenobarbital increases
liver metabolism or breakdown and elimination of AEDs and other
drugs. It can decrease the clinical effectiveness of oral anticoagulants,
oral contraceptives, anti-infectives (chloramphenicol, doxycycline,
griseofulvin), lipophilic beta-blockers (eg, Propranolol, metoprolol),
corticosteroids, cyclosporine, tricyclic antidepressants (eg, desipramine,
nortriptyline, haloperidol, phenothiazines, Quinidine, theophylline,
digitoxin, doxorubicin, and Verapamil.
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| Neurontin |
|
- Generic name: Gabapentin
- Neurontin isgenerally
used in adults in conjunction with other anti-epileptic medications
for partial and secondarily generalized seizures. The most celebrated
feature of this drug is its lack of interactions with other drugs
which, with its unique mechanism of action makes it the optimum
add on drug for rational polytherapy.
- Rational polytherapy:
Monotherapy is preferred for treating seizure disorders due to simplicity,
lack of drug-drug interactions and fewer side effects. Recently,
however, rational polytherapy has become increasingly used for several
reasons. First, about 30% of all patients continue to have uncontrolled
seizures despite a trail of all AEDs. Second, the newly available
AEDs have different mechanisms of action than the standard AEDs.
Therefore, their efficacy or effectiveness for control of seizures
can add together with the efficacy of the standard AEDs to improve
control of seizures. Third, the availability of new AEDs with little
side effects and little drug-drug interactions, like Neurontin,
can avoid the usual problem with polytherapy.
- Side effects:
The most common side effects from Gabapentin are mild fatigue and
dizziness. Other side effects have been nystagmus, hypotension,
diarrhea, muscle weakness, dry mouth, sleep disturbances, slurred
speech, decreased alertness, tremor, rash, and nausea.These side
effects can be reduced or eliminated by starting and increasing
the dose slowly.
- With
all anti-epileptic medications, it is important to maintain an adequate
amount of the drug in your body.
- IF
THE NEURONTIN LEVEL IS TOO LOW, no symptoms are felt,
however, you may experience break-through seizures.
- IF
THE NEURONTIN LEVEL IS TOO HIGH OR THE DRUG DOSAGE IS INCREASED
TOO FAST, toxic symptoms may occur. These usually include
dizziness, fatigue and a "drunkenness" feeling. They usually
can be avoided by more gradual changing of dose. Neurontin usually
can be pushed to a higher dose with fewer side effects than most
other AEDs.
- If
you are experiencing symptoms that may indicate your level is too
low or too high, your doctor will adjust your dose. Although Neurontin
levels can be checked, they are less useful than other AED levels
and clinical response usually without levels is the customary indicator
to follow.
- Since
it is necessary to have a sufficient amount of your anti-epileptic
medication in your blood in order to control seizures, it is important
that you follow your doctor's prescription. Do not adjust your medication
without first consulting your physician.
- Drug-to-Drug interactions:
The major feature of Gabapentin is its lack of interaction with
other drugs.
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| Tranxene |
|
- Generic name: Clorazepate
dipotassium
- This medicationis
used as an add on therapy in for partial seizures. This is an add
on medication. It does have have benefits but its effects usually
only last for about six months. We usually use the other AEDs and
use Tranxene in special circumstances.
- Side effects:
The most frequently reported side effect is drowsiness. Other less
common reactions are dizziness, gastrointestinal complaints, nervousness,
blurred vision, dry mouth, headache and mental confusion.
- Drug-to-Drug Interactions:
Careful consideration should be given when combined with other drugs
acting on the central nervous system.
- With
all anti-epileptic medications, it is important to maintain an adequate
amount of the drug in your body.
- IF
THE TRANXENE LEVEL IS TOO LOW, no symptoms will be felt
by the patient. However, break-through seizures may occur.
- IF
THE TRANXENE LEVEL IS TOO HIGH, patient may feel similar
more severe symptoms similar to the side effects.
- Since
it is necessary to have a sufficient amount of your anti-epileptic
medication in your blood in order to control seizures, it is important
that you follow your doctor's prescription. Do not adjust your medication
without first consulting your physician.
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| ACTH |
|
- Generic name: Adrenocorticotropic
Hormone
-
ACTH is used in various types of childhood epilepsy that do not respond to the routine seizure medications. It is a primary drug in the treatment of infantile spasms.
Parents are trained in the administration of the gel which is given intramuscularly once or twice daily .
- Side effects:
Possible side effects of ACTH are irritability, increased appetite and weight gain, high blood pressure, low potassium in the blood, and high blood sugar. These side effects will go away once the ACTH is stopped. Other side effects are rare but more serious. These include infections, changes in mental status because of high blood pressure, renal failure and bleeding from the gastrointestinal system. The impact of these side effects can be lessened if parents are taught the early signs to look for in the child. Blood pressure should be checked often.
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| Ativan |
|
- Generic name: Lorazepam
- Ativan
is an anti-seizure medication which is used for the control of status
epilepticus.
- Side effects:
The most common side effect to Ativan includes drowsiness, weakness
and confusion, depending on the dosage administered. There is a
precaution to those individuals who are sickly, elderly or suffer
from liver and renal disorders. In these cases low dosages are frequently
monitored. There is a limited possibility of psychological dependence
on Ativan. Withdrawal symptoms can occur if the drug is stopped
abruptly. It may also intensify depression and feelings of suicide.
Ativan can not be combined with alcohol as it will increase sedation
on the nervous system.
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| Carbatrol |
|
- Generic name: Carbamazepine
extended release capsules
- Carbatrol
contains carbamazepine, which is a well known and widely used medication
for controlling seizures. It usually is taken twice a day and can
either be sprinkled on food or taken with or without food. Carbatrol
is an anticonvulsant medication used to control partial seizures
with complex symptomatology (psychomotor, temporal lobe) generalized
tonic-clonic seizures (grand mal) and mixed seizure patterns which
include the above or other partial or generalized seizures. Absence
seizures (petit mal) do not appear to be controlled by carbamazepine.
- Side effects:
The most common side effects tend to occur at the beginning of therapy
and they may include dizziness, drowsiness, unsteadiness, nausea
and vomiting. Some people who take carbamazepine develop serious
but rare blood disorders. To check for these, your physician may
order blood tests from time to time. Carbatrol should be used with
caution in patients with a mixed seizure disorder that includes
atypical absence seizures. Patients should report early toxic signs
and symptoms of a potential hematological problem, such as fever,
sore throat, rash, ulcers in the mouth, easy bruising, petechial
or purpuric hemorrhage to their physician. Carbatrol can cause fetal
harm when administered to a pregnant woman.
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| Carnitine |
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- Generic name: N/A
- Carnitine
is a protein found in all tissues and is essential to energy production.
Plasma Carnitine levels are decreased in many people with epilepsy.
It may be a result of nutritional factors, metabolic disorders,
or the effects of specific drug effects and diseases. Many times
it is recommended for patients taking Valproate because of hyperammonemia
is a common occurrence with this drug.
- Side effects:
Transient nausea, vomiting, abdominal cramps, gastrointestinal symptoms
and diarrhea may occur in some patients.
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| Diamox |
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- Generic name: Acetazolamide
- Diamox
is used to control absence seizures, generalized tonic clonic seizures
and as an add on drug in partial seizures. The development of tolerance
to its anticonvulsant effect is why it is not useful as a long term
drug. The most dangerous adverse effect is aplastic anemia.
- Side effects:
Short term use may cause side effects such as loss of appetite,
sensitivity to the sun, fever, rash, thirst, headache, drowsiness
and urinary difficulties. Tolerance to the medication may develop
over the long term which may necessitate a need to increase the
dosage. Monitoring the liver functions for possible negative reactions
is recommended.
- Drug-to-Drug Interactions:
Diamox can interact with salicylates (Aspirin) to produce serious
metabolic acidosis.
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| Diastat |
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- Generic name: Diazepam
rectal gel
- Diastat
is a gel formulation of diazepam intended for rectal administration
in the management of selected, refractory, patients with epilepsy
on stable regimens of AEDs, who require intermittent use of diazepam
to control bouts of increased seizure activity. Diastat should only
be administered by caregivers who in the opinion of the prescribing
physician are able to distinguish the distinct cluster of seizures
(and/or the events presumed to herald their onset) from the patient's
ordinary seizure activity.
- Side effects:
Because Diastat produces central nervous system depression, patients
receiving this drug, who are otherwise capable and qualified to
do so, should be cautioned against engaging in hazardous occupations
requiring mental alertness, such as operating machinery, driving
a motor vehicle or riding a bicycle. Prolonged CENTRAL NERVOUS SYSTEM
depression has been observed in neonates treated with Diazepam.
Therefore, Diastat is not recommended for use in children under
six months of age. No clinical studies have been conducted with
Diastat in pregnant women. Data from several sources raise concerns
about the use of diazepam during pregnancy. Diastat is not recommended
for chronic, daily use as an anticonvulsant because of the potential
for development of tolerance to diazepam.
If
Diastat is to be combined with other psychotropic agents or other
CENTRAL NERVOUS SYSTEM depressants, careful consideration should
be given to the pharmacology of the agents to be employed - particularly
with known compounds which may potentiate the action of diazepam,
such as phenothiazines, narcotics, barbiturates, MAO inhibitors
and other antidepressants.
Valprorate may potentiate the CENTRAL NERVOUS SYSTEM-depressant
effects of Diasepam. There have been no clinical studies or reports
in literature to evaluate the interaction of rectally administered
diazepam with other drugs. As with all drugs, the potential for
interaction by a variety of mechanisms is a possibility.
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| Keppra |
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- Generic name: Levetiracetam
- In
December of 1999, the U.S. Food and Drug Administration (FDA) approved
Keppra (Levetiracetam) as an anti-epileptic medication indicated
as an adjunctive or added therapy to other anti-epileptic medications
for the treatment of partial onset seizures in adults with epilepsy.
- Side effects:
In clinical studies, Keppra was generally well tolerated. In controlled
studies, when Keppra was given with other anti-epileptic medications,
the most frequently reported adverse effects were somnolence, asthenia
(lack or loss of strength), infection and dizziness. Adverse events
were usually mild to moderate in intensity. Patients who have moderate
or severe renal impairment should be followed closely since Keppra
is excreted by the kidneys.
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| Mogadon |
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- Generic name: Nitrazepam
- Mogadon
is used to control myoclonic seizures and may be used in the treatment
of West's syndrome (infantile spasms) and other seizures that occur
in early childhood. It also induces sleep.
- Side effects:
Common reactions to Mogadon include fatigue, dizziness, drowsiness,
confusion and lack of coordination. Withdrawal symptoms including
headaches may be felt if Mogadon is withdrawn abruptly. Patients
who suffer from depression should be watched closely when on Mogadon.
Pregnant women and breast-feeding mothers should avoid taking Mogadon.
Consumption of alcohol must be avoided while taking Mogadon.
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| Paraldehyde |
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- Generic name: N/A
- Paraldehyde
is administered in the hospital through rectal infusion.
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| Tegretol
XR |
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- Generic name: N/A
- In 1996,
Tegretol XR became available as a new extended release formulation
allowing many patients to switch from three or four daily doses
to a more convenient twice-daily regimen. Tegretol XR is indicated
as a first-line monotherapy for the treatment of partial, secondarily
generalized and generalized tonic-clonic seizures.
- Side effects:
The most common side effect, particularly during the initiation
phase of therapy, are dizziness, drowsiness, unsteadiness, nausea
and vomiting. As with all anticonvulsant therapy, periodic hematological,
and blood chemistry evaluations are recommended since low sodium
levels and abnormal blood counts can occur.
If you are experiencing symptoms that may indicate your level is
too high or too low, your physician will require a lab test to check
your level. If the level is not therapeutic, he will likely increase
or decrease your medication.
See Tegretol for drug-to-drug interactions.
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| Gabitril |
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- Generic name: Tiagabine
Hydrochloride
- Gabitril
is used as an add-on medication for adults and adolescent patients
over 12 years of age to control simple partial and complex partial
seizures. Gabitril should be taken with food and should not be stopped
immediately unless advised by a physician.
- Side effects:
Cramps, nausea, vomiting, weight loss, diarrhea, increased appetite,
mouth ulcers, dizziness, drowsiness, general weakness, nervousness,
tremors, difficulty concentrating, depression, hostility, sore throat
and difficulty swallowing, cough and skin rashes may occur in some
patients.
Patients with impaired liver function or liver disease may need
to take a lower dosage. Safety in pregnant women and the effects
on the nursing infant have not been established.
- Drug-to-Drug Interactions:
Gabitril may cause a slight decrease in Valproate levels. There
may also be an additive effect with Gabitril and other central nervous
system depressants. Valproate may significantly increase the Gabitril
level.
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| Topamax
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- Generic name: Topiramate
- In July of 1999,
the U.S. Food and Drug Administration (FDA) approved a new use of
the anti-epileptic drug, Topamax (topiramte) as an add-on treatment
for pediatric patients (ages two to 16) and adults who experience
partial onset seizures. Topamax is also an effective adjunctive
treatment of primary generalized tonic-clonic seizures.
- Side effects:
Clinical trials indicate that Topamax is generally well-tolerated
by patients and has few clinically significant interactions with
traditional anti-epileptic medications. The most common side effects
associated with Topamax in pediatric patients included excessive
drowsiness, loss of appetite, fatigue, nervousness, difficulty with
concentration/attention, weight decrease, aggressive reaction and
difficulty with memory. In adults the most common types of side
effects were somnolence, dizziness, coordination problems, speech
disorders, psychomotor slowing, abnormal vision, difficulty with
memory, sensory distortion and double vision. Most side effects
were mild to moderate in severity and usually disappeared over time.
There was a 1.5 percent incidence of kidney stones, nearly 80% of
patients experiencing stones continued their Topamax therapy.
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| Trileptal
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- Generic name: Oxcarbazepine
- The
new drug Trileptal has been approved by the FDA as a therapy for
the treatment of partial seizures in adults and children.
Trileptal demonstrates fewer drug to drug interactions than other
first-line monotherapy AEDs.
- Side effects:
The most common side effects include headache, somnolence, dizziness,
viral infection and nausea. A less common side effect is low serum
sodium levels.
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| Valium
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- Generic name: Diazepam
- Diazepam
is used to help control status epilepticus, severe recurrent convulsive
seizures.
- Side effects:
Some patients may experience drowsiness, nausea, blurred vision,
headaches, slurred speech, confusion, impaired memory, retention
of urine, constipation and skin rash. Do not take Valium with alcohol.
Pregnant women should talk with their doctor before taking Valium.
New mothers should avoid breast feeding while taking Valium.
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| Zonegran |
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- Generic name: Zonisamide
- Zonegran
is an anti-seizure medication used to treat partial seizures in
adults. It is taken with other seizure medicines to help control
seizures. Zonegran offers rapid absorption. Peak plasma concentrations
occur two to six hours following 200 mg to 49\00 mg dose. Presence
of food delays time to maximum concentration but bioavailability
is unaffected. The precise mechanism by which Zonegran exerts its
anti-seizure effect is unknown.
- Side effects:
Adverse side effects are generally mild to moderate. Many of the
adverse side effects were dose related. Since Zonegran is a sulfonamide,
hypersensitivity or other serious reactions may occur. Consideration
should be given to discontinuing Zonegran in patients who develop
an otherwise unexplained rash. Also, some patients have experienced
somnolence, dizziness, anorexia, headache, nausea and agitation/irritability.
Increases in creatinine and blood urea nitrogen of 8% over baseline
have occurred. Zonegran should not be used in patients with renal
failure. Potentially serious reactions to Sulfonamides have occurred.
- Drug-to-Drug Interactions:
There are few drug interactions. There is no effect on levels of
phenytoin, carbamazepine or valproate. Anti-epileptic medications
that inhibit or induce cytochrome P450 may increase/decrease the
half-life of Zonegran. It does not induce liver enzymes.
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