Special concerns on taking Anti-epileptic Drugs

• 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 malformations, 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 classification in pregnacy
• 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.
• Other 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 dental anesthetics.
• Anticoagulants (blood thinner)
• Tricyclic 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 frequently.
• 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 medicine:
  • 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 unwanted effects.

Top

When to stop taking AED?

When 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.

According to evidence in literature, experts support recommendation to consider AED withdrawal in the following patients (includes both adult and children):

• Seizure-free for 2-5 years on AEDs (mean 3.5 years)
• Single type of partial seizure (simple partial or complex or secondary generalized tonic-clonic seizure) or single type of generalized tonic-clonic seizure
• Normal I.Q. /neurologic examination
• EEG normalized with treatment 

Discontinue 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.

Factors which increased the risk of seizure recurrence in drug withdrawal group:

1. Age 16 and over
2. Taking more than one AED
3. History of seizures after starting treatment
4. History of tonic-clonic seizures (primary or secondary)
5. History of myoclonic seizures
6. History of neonatal seizures
7. Duration of treatment for ten or more years
8. An abnormal EEG in the previous year.

Top

Drug therapy, Surgery, Alternative methods

Back                                                                                                                      

  Next