Special concerns on taking
- Tell the doctor if one
have ever had any unusual or allergic reaction to the medication or
any drug related to one's medication and any allergies to any other
substances, such as foods, preservatives, or dyes.
- Breastfeeding should be
avoided in use of barbiturates (e.g. phenobarbital) and ethosuximide.
Carbamaezepine, phenytoin, clonazepam, clobazam, oxcarbazepine,
lamotrigine, felbamate, primidone and acetazolamide can pass into breast milk and
the baby may be affected.
- During pregnancy, total
plasma concentration may fall (particularly phenytoin) and increases the
risk of seizure. Increase risk of tetratogenicity (birth defects in foetus)
with AED can be reduced via limiting the treatment to use of one single
drug. The most significant abnormalities reported have been spinal
cleft lip/palate and heart and hand malformations. This is particularly true in women taking carbamazepine,
phenytoin, phenobarbital and valproate and are best avoided in pregnancy. Folic acid (naturally
occuring vitamin that has been shown to reduce the risk of miscarriage and
fetal abnormality, particulary spinal malformation) 5mg daily is recommended
for all women of child bearing age. Check out AED
- Risk of bleeding within
one month after birth in baby and mother (associated with use of
carbamazepine, phenytoin and valproate) can be prevented by vitamin K1 given
before delievery to the mother and to the baby after birth.
- Behavior changes are
more likely to occur in children taking AED.
- Old people are
usually more sensitive than younger adults to the adverse effects of AED.
- Although certain
medicines should not be used together at all, in other cases two different
medicines may be used together even if an interaction might occur. Let the
doctor know all medicines taking currently especially if they are:
- Other AED : A
change in the pattern of seizures/increase side effects/toxivity may occur;
close monitoring of blood levels of both medications is recommended. Can
increase risk of birth defects in pregnancy.
- Monoamine oxidase
(MAO) inhibitors (furazolidone [e.g., Furoxone], isocarboxazid [e.g.,
Marplan], phenelzine [e.g., Nardil], procarbazine [e.g., Matulane],
selegiline [e.g., Eldepryl], tranylcypromine [e.g., Parnate])--Taking AED
while you are taking or within 2 weeks of taking monoamine oxidase (MAO)
inhibitors may cause sudden high body temperature, extremely high blood
pressure, and severe convulsions; at least 14 days should be allowed between
stopping treatment with one medicine and starting treatment with the other.
- Oral contraceptives
(birth control pills) containing estrogen. AED may decrease the
effectiveness of these oral contraceptives, and you may need to use of a
nonhormonal method of birth control or an oral contraceptive
containing only a progestin may be necessary. Read your concern here.
CNS depressants (medicines that cause drowsiness). Examples:
antihistamines or medicine for hay fever, allergies or colds; sedatives,
tranquilizers, or sleeping medicine; prescription pain medicine or
narcotics; barbiturates; muscle relaxants; or anesthetics, including some
antidepressants (amitriptyline [e.g., Elavil], amoxapine [e.g., Asendin],
clomipramine [e.g., Anafranil], desipramine [e.g., Pertofrane], doxepin
[e.g., Sinequan], imipramine [e.g., Tofranil], nortriptyline [e.g., Aventyl],
protriptyline [e.g., Vivactil], trimipramine [e.g., Surmontil])--Central
nervous system depressant effects of AED may be increased while the
anticonvulsant effective of AED may be decreased; seizures may occur more
- Other medical
problems may affect the use of AED especially: Liver diseases and kidney
disease; it is important to let the doctor knows.
- Vomiting and diarrhea
can affect the amounts of medication that are absorbed from the gut into the
blood stream. This can result in low circulating levels of antiepileptic
medication and triggering factor for seizures. If vomiting occurs within
minutes of taking the medication, another dose can be administered. Seek
medical advice if vomiting and diarrhea persist.
- It is very important to
take this medicine exactly as directed by the doctor to obtain the
best results and lessen the chance of serious side effects. Do not take more
of it, do not take it more often, and do not take it for a longer time than
what the doctor has ordered. Best to take it at the same time each day. It
may take several weeks for the most dose to be achieved.
- The dose prescribed is
different in different patients and maybe different from that on the information
label which only gives the average dose required. Do not change the dose
unless as directed by the doctor.
- If you miss a dose,
take it as soon as possible. However, if it is almost time for your next
dose, skip the missed dose and go back to your regular dosing schedule. Do
not double doses as it might be toxic. However, if you miss more than one
dose a day, check with the doctor. It is good practice to keep a record of
the doses missed. Taking medication with
meals or using a medication dosette may help. Maintaining supplies and
current scripts can avoid the situation of running out of medication at the
last minute, particularly if on holidays.
- To store this
- Keep out of the
reach of children.
- Store away from
heat and direct light.
- Do not store the
tablet forms of carbamazepine in the bathroom, near the kitchen sink, or
in other damp places. Heat or moisture may cause the medicine to break
down and become less effective .
- Keep the liquid
form of this medicine from freezing.
- Do not keep
outdated medicine or medicine no longer needed. Be sure that any
discarded medicine is out of the reach of children.
- Regular visits
allow the doctor to check progress since AED often need frequent adjustment
to its doses before the optimum desire amount is determined.
- Sudden withdrawal of
AED can provoke seizure especially after taking regularly for several
weeks. Gradually reduction is inevitable before stopping completely.
- Drinking alcohol
while taking AED can increase drowsiness and the likelihood of seizures.
- AED may cause some
people to become drowsy, dizzy, lightheaded, or less alert than they are
normally, especially when they are starting treatment or increasing the dose,
if affected by
drowsiness one should not drive or operate machinery
- Before having any
medical tests, tell the medical doctor in charge that you are taking
this medicine. The results of some pregnancy tests may be affected by AED.
- Before having any
kind of surgery, dental treatment, or emergency treatment, tell the
medical doctor or dentist in charge that you are taking this medicine .
Taking AED together with medicines that are used during surgery or dental or
emergency treatments may increase the CNS depressant effects and cause other
to stop taking AED?
a person on AED has no more seizure attack for 2 or more years, withdrawal of
AED can be considered although the danger of recurrence is always present. Risk
of relapse within 2 years of starting to withdraw treatment is two or three
times greater than that in continued treatment (10% per annum). The risk of
seizure recurrence decreases as the length of the seizure free period increases
e.g. 5 years or more.
Considering these points, the benefits of stopping AED should outweigh the
consequences of seizure recurrence such as in the cases of young women
contemplating pregnancy. The decision of stopping AED lies in the person taking
it because social factors such as the possession of a driving license and the
need to work are often
of greater importance. The person's attitude to prolonged therapy as well as
fear of seizure recurrence should also be taken into account by the physician.
For a polytherapy, only one drug should be withdrawn at a time.
experts support recommendation to consider AED withdrawal in the following
patients (includes both adult and children):
for 2-5 years on AEDs (mean 3.5 years)
type of partial seizure (simple partial or complex or secondary generalized
tonic-clonic seizure) or single type of generalized tonic-clonic seizure
I.Q. /neurologic examination
normalized with treatment
may be appropriate in people not meeting the above criteria although the risk of
recurrence maybe higher than 31.2% in children and 39% in adults.
which increased the risk of seizure recurrence in drug withdrawal group:
16 and over
more than one AED
of seizures after starting treatment
of tonic-clonic seizures (primary or secondary)
of myoclonic seizures
of neonatal seizures
of treatment for ten or more years
- An abnormal
EEG in the previous year.