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The information provided here is meant to give you a general idea about each of the medications listed below. Only the most general side effects are included. Ask your doctor if you need to take any special precautions. Use each of these medications as recommended by your doctor, or according to the instructions provided. If you have further questions about usage or side effects, contact your doctor.

Medications are the first line of treatment for epilepsy. Anti-epileptic medications should only be used if the diagnosis is established. The goal of medication is to prevent epileptic seizures and to decrease the frequency and severity of seizures. The type and dosage of medication given must match the type of epilepsy you have. Dosage is important. It must balance prevention of seizures with the side effects that epileptic drugs can cause.

Often, but not always, one type of medication is tried at a time until the most effective one is found. Changes in medication are often made gradually because these changes can increase the likelihood of seizures. Good control is achieved in the majority of people.

In some cases, however, anti-epileptic medications may be used in combination. In approximately 80% of people, epileptic medication is fully or partially successful in preventing seizures. Be sure to take the medication on a regular schedule.

Carbamazepine

Carbamazepine prevents seizures by reducing the excitability of nerve fibers in the brain. This medication is taken as a tablet or liquid. It is best taken at the same time or times each day. Taking carbamazepine with food or drink can help prevent stomach upset.

Possible side effects include:

  • Blurred vision
  • Rapid back and forth eyeball movements
  • Lightheadedness
  • Drowsiness
  • Possible reduced effectiveness of birth control pills—Your doctor will recommend that you use another form of birth control.
  • Interaction with birth control pills—Your doctor may need to adjust your medication dose.
  • Increased risk of suicidal thinking and behavior

More serious, but less common side effects include:

According to the Food and Drug Administration (FDA), people of Asian ancestry who have a certain gene, called HLA-B*1502, and take carbamazepine are at risk for dangerous or even fatal skin reactions. If you are of Asian descent, the FDA recommends that you get tested for this gene before taking carbamazepine. If you have been taking this medication for a few months with no skin reactions, then you are at low risk of developing these reactions. Talk to your doctor before stopping this medication.

Clobazam

This medication is used to control seizures in people with Lennox-Gastaut syndrome, a rare condition that causes severe seizures in childhood.

Possible side effects include:

  • Feeling tired or sleepy
  • Fever
  • Drooling
  • Constipation
  • Cough
  • Urinary tract infection
  • Insomnia
  • Aggression
  • Respiratory infection
  • Irritability
  • Vomiting
  • Problems swallowing
  • Problems with coordination
  • Suicidal thoughts or changes in mood
Diazepam Rectal Gel

Diazepam is approved for the treatment of people with epilepsy who are affected by seizure clusters. Seizure clusters are multiple seizures that are different from the person's usual pattern. These episodes can last minutes to hours and may require emergency treatment.

Diastat can be given rectally by trained parents or other caregivers in a non-hospital setting.

Possible side effects include:

  • Drowsiness
  • Difficulty breathing
  • Headaches
  • Chemical dependence
  • Increased risk of suicidal thinking and behavior
Eslicarbazepine

Eslicarbazepine is an oral medication used to treat focal or partial seizures. It may be used alone or in combination with other anti-epileptic medication. Eslicarbazepine is generally started out at a lower dose, then gradually increased.

Possible side effects include:

  • Fatigue
  • Headache
  • Lightheadedness
  • Vertigo—sensation of spinning when standing still
  • Sleepiness
  • Blurred vision
  • Nausea or vomiting
  • Tremor

More serious, but less common side effects include:

  • Rashes
  • Severe allergic reactiion
  • Persistent flu-like symptoms, with or without a fever
  • Low blood sodium levels
  • Liver damage
  • Increased risk of suicidal thinking and behavior
Ethosuximide

Ethosuximide controls seizures by depressing nerve transmissions in the motor cortex, which is the part of the brain that controls muscles. The medication is taken in liquid or capsule form. It is best taken at the same time or times each day. Taking it with food or drink can help prevent stomach upset.

Possible side effects include:

  • Nausea
  • Appetite loss
  • Vomiting
  • Fatigue
  • Lightheadedness
  • Drowsiness
  • Headache
  • Muscle pain
  • Rash
  • Change in urine color
  • Increased risk of suicidal thinking and behavior

Persistent fever or sore throat should be reported to your doctor. These symptoms may indicate a low white blood cell count due to suppressed bone marrow.

Ezogabine

This medication is used to control seizures in adults with epilepsy. The medication is often prescribed in combination with other anti-epileptic medication.

Possible side effects include:

  • Lightheadedness
  • Tiredness or confusion
  • Vertigo
  • Tremor
  • Problems with coordination
  • Double vision
  • Attention and memory problems
  • Lack of strength
  • Hallucinations or psychosis
  • Suicidal thoughts or changes in mood
  • Urinary problems
Gabapentin

It is not known how gabapentin prevents convulsive seizures. But, it may work by altering the transport of amino acids in the brain. This medication is taken in capsule form. Maintenance dosage varies. It is best taken with food or liquid to prevent stomach upset.

Possible side effects include:

  • Sleepiness
  • Lightheadedness
  • Fatigue
  • Lack of coordination
  • Weight gain
  • Rapid back and forth eyeball movements
  • Increased risk of suicidal thinking and behavior
Lacosamide

By affecting the central nervous system, this medication reduces how many seizures a person has and how severe the seizures are. Given as a pill or an injection, lacosamide is usually prescribed with other anti-epileptic medication.

Possible side effects include:

  • Lightheadedness
  • Sleepiness
  • Blurred vision
  • Difficulty thinking clearly
  • Headache
  • Nausea or vomiting
  • Increased risk of suicidal thinking and behavior
Lamotrigine

It is not known how lamotrigine prevents convulsive seizures. But, it may work by stabilizing nerve membranes. The medication is taken in tablet form. Maintenance dosage varies. It is best taken with liquid to prevent stomach upset.

When you are taking lamotrigine, call your doctor right away if you have the following symptoms:

  • Rash—can be extremely serious and life-threatening
  • Fever
  • Flu-like symptoms
  • Swollen glands
  • An increase in your seizures

Possible side effects include:

  • Double or blurred vision
  • Clumsiness
  • Lightheadedness
  • Headache
  • Nausea or vomiting
  • Drowsiness
  • Reduced effectiveness of birth control pills—Your doctor will recommend that you use another form of birth control.
  • Increased risk of suicidal thinking and behavior
  • Aseptic meningitis—inflammation of the layers of tissue that surround the brain
Levetiracetam

Levetiracetam is used to treat partial, generalized convulsive, and myoclonic seizures. The medication is often prescribed in combination with other anti-epileptic medication. To prevent stomach upset, take levetiracetam with food.

Possible side effects include:

  • Lightheadedness
  • Sleepiness
  • Blurred vision
  • Difficulty in thinking clearly
  • Changes in mood
  • Nausea or vomiting
  • Headache
  • Cough , runny nose, sore throat
  • Risk of infection
  • Depression
  • Increased risk of suicidal thinking and behavior
Oxcarbazepine

Oxcarbazepine is believed to prevent convulsive seizures by altering the transport of amino acids in the brain and stabilizing the nerve membranes. This medication is taken in tablet or liquid form. Maintenance dosage varies. It is best taken with liquid.

Possible side effects include:

  • Vision changes
  • Lightheadedness
  • Nausea or vomiting
  • Sleepiness
  • Headache
  • Fatigue
  • Reduced effectiveness of birth control pills—Your doctor will recommend that you use another form of birth control.
  • Increased risk of suicidal thinking and behavior
Phenobarbital

Phenobarbital is used with other anti-epileptic medications in people who have partial seizures or generalized convulsive seizures. But, the medication can be prescribed to treat all types of seizures. Phenobarbital is also used for other conditions, such as tremor, insomnia , and drug withdrawal . The medication has a very long half-life. This means that it stays in your system for a long time. It is available as a pill or given by IV.

Possible side effects include:

  • Depression
  • Sleepiness
  • Lightheadedness
  • Blurred vision
  • Difficulty in thinking clearly
  • Reduced effectiveness of birth control pills—Your doctor will recommend that you use another form of birth control.
  • Increased risk of suicidal thinking and behavior

Phenobarbital is a barbiturate, a type of medication that can be addictive. To avoid withdrawal symptoms, you doctor will slowly reduce the dose when it is time for you to stop taking phenobarbital.

Phenytoin

Phenytoin prevents seizures by promoting sodium loss in nerve fibers. This inhibits nerve excitability and the spread of nerve impulses. This medication is taken in tablet or liquid form. It is best taken with liquid at the same time each day.

Possible side effects include:

  • Bleeding
  • Swollen gums
  • Fever
  • Rash
  • Lightheadedness
  • Drowsiness
  • Rapid back and forth eyeball movement
  • Reduced effectiveness of birth control pills—Your doctor will recommend that you use another form of birth control.
  • Increased risk of suicidal thinking and behavior
Primidone

Primidone is believed to prevent seizures by stopping the spread of nerve impulses.

This medication is taken in tablet or liquid form. It is best taken at the same time each day. It is also best taken with food or drink.

Possible side effects include:

  • Rash
  • Confusion
  • Rapid back and forth eyeball movement
  • Clumsiness
  • Lightheadedness
  • Drowsiness
  • Reduced effectiveness of birth control pills—Your doctor will recommend that you use another form of birth control.
  • Increased risk of suicidal thinking and behavior
Rufinamide

This medication is used to treat seizures. It is also especially useful in the treatment of Lennox-Gastaut syndrome.

Possible side effects include:

  • Lightheadedness
  • Sleepiness
  • Blurry vision
  • Unable to think clearly
  • Lighheadedness
  • Headache
  • Nausea
  • Vomiting
Tiagabine

This medication is used to prevent or control seizures. It is also useful as an add-on treatment for partial seizures.

Possible side effects include:

  • Increased appetite
  • Diarrhea
  • Shakiness
  • Feeling nervous and excitable
  • Lightheadedness
  • Sleepiness
  • Blurry vision
  • Unable to think clearly
  • Lightheadedness
  • Difficulty moving around
  • Dry mouth
  • Nausea
  • Vomiting

This medication may rarely cause seizures in patients who do not have them.

Topiramate

Topiramate may be prescribed with other anti-epileptic medications or alone. The medication is used to treat all types of seizures. To prevent stomach upset, take topiramate with food.

Possible side effects include:

  • Sleepiness
  • Blurred vision
  • Difficulty thinking clearly
  • Lightheadedness
  • Changes in mood
  • Nausea or vomiting
  • Numbness or tingling in hands or feet
  • Loss of appetite, weight loss
  • Reduced effectiveness of birth control pills—Your doctor will recommend that you use another form of birth control.
  • Depression

More serious, but less common side effects include:

  • Increased risk of suicidal thinking and behavior
  • Glaucoma
  • Kidney stones
  • Acidosis—high acidity in the blood
  • Not sweating enough in hot weather—This causes body temperature to rise.
Valproic Acid

Valproic acid may prevent seizures by increasing concentrations of gamma aminobutyric acid. This inhibits nerve transmissions in parts of the brain. This medication is taken in capsule or syrup form. It is best taken once a day, at the same time each day. Taking it with food or drink can help prevent stomach upset.

Possible side effects include:

  • Loss of appetite
  • Weight gain
  • Indigestion
  • Nausea or vomiting
  • Diarrhea
  • Tremors
  • Headache
  • Menstrual changes in young women
  • Pancreatitis
  • Liver injury
  • Increased risk of suicidal thinking and behavior
Vigabatrin

Vigabatrin is used to treat seizures in infants aged 1 month to 2 years. This type of infantile seizure is dangerous because it can happen frequently throughout the day. Vigabatrin can also be used in adults who have refractory complex partial seizures in combination with other anti-epileptic medication.

The medication can cause serious side effects, including vision loss. Other side effects include:

  • In infants:
    • Sleepiness
    • Weight gain
    • Diarrhea
    • Nausea or vomiting
    • Excitement or agitation
  • In adults:
    • Lightheadedness
    • Sleepiness
    • Weight gain
    • Shakiness
    • Diarrhea
    • Nausea or vomiting
    • Depression
    • Increased risk of suicidal thinking and behavior
Zonisamide

This medication is a mood stabilizer that works by calming the brain. It is used to prevent or control seizures. It may also be used as a treatment for bipolar disorder.

Possible side effects include:

  • Lightheadedness
  • Sleepiness
  • Blurry vision
  • Unable to think clearly
  • Feeling nervous and excitable
  • Headache
  • Nausea
  • Vomiting
  • Not feeling hungry
  • Serious skin reactions, rarely
Special Considerations

Before taking any of these medications, consult with your doctor if you:

  • Have high blood pressure
  • Have heart disease
  • Have glaucoma
  • Have emotional or mental problems
  • Have liver or kidney disease
  • Have a history of blood disorders
  • Have asthma or any other lung disorder
  • Have a blood disorder
  • Have a sodium disorder
  • Will be having any surgery within two months
  • Are taking any other medications
  • Are or plan to become pregnant
  • Drink more than 2 alcoholic drinks per day
  • Have any known allergies

If your child is taking medication, follow these general guidelines:

  • Give your child the medication as directed. Do not change the amount or schedule.
  • Use the measuring device that came with the medication. If you need to use a spoon, cup, or syringe, make sure it has the units that match your child’s prescription. For example, if the medication is given in milliliters (mL), the device should have mL on it.
  • Ask what side effects could occur. Report them to your child’s doctor.
  • Talk to your child’s doctor before stopping any prescription medication.
  • Do not share your child’s prescription medication.
  • Medications can be dangerous when mixed. Talk to your child’s doctor or pharmacist if your child is taking more than one medication, including over-the-counter products and supplements.
  • Plan ahead for refills as your child needs them.
When to Contact Your Doctor

Contact your doctor if you:

  • Have any unusual, rare, or severe symptoms or side effects
  • Suffer any repeat seizures

References:

Antiepileptic drugs (AEDs) for seizure disorders. EBSCO DynaMed Plus website. Available at: http://www.dynamed.com/topics/dmp~AN~T114575/Antiepileptic-drugs-AEDs-for-seizure-disorders. Updated February 7, 2017. Accessed February 7, 2017.

Epilepsy in adults. EBSCO DynaMed Plus website. Available at: http://www.dynamed.com/topics/dmp~AN~T115086/Epilepsy-in-adults. Updated December 8, 2016. Accessed February 7, 2017.

Epilepsy in children. EBSCO DynaMed Plus website. Available at: http://www.dynamed.com/topics/dmp~AN~T900174/Epilepsy-in-children. Updated December 8, 2016. Accessed February 7, 2017.

Lennox-Gastaut syndrome . EBSCO DynaMed Plus website. Available at: http://www.dynamed.com/topics/dmp~AN~T115316/Lennox-Gastaut-syndrome. Updated July 23, 2014. Accessed February 7, 2017.

Myoclonic seizures. Epilepsy Foundation website. Available at: http://www.epilepsy.com/learn/types-seizures/myoclonic-seizures. Accessed February 7, 2017.

Treating seizures and epilepsy. Epilepsy Foundation website. Available at: http://www.epilepsy.com/learn/treating-seizures-and-epilepsy. Accessed February 17, 2014.

5/14/2010 DynaMed Plus Systematic Literature Surveillance. http://www.dynamed.com/topics/dmp~AN~T114575/Antiepileptic-drugs-AEDs-for-seizure-disorders: Patorno E, Bohn RL, Wahl PM, et al. Anticonvulsant medications and the risk of suicide, attempted suicide, or violent death. JAMA. 2010;303(14):1401-1409.

12/17/2010 DynaMed Plus Systematic Literature Surveillance. http://www.dynamed.com/topics/dmp~AN~T114575/Antiepileptic-drugs-AEDs-for-seizure-disorders: Andersohn F, Schade R, Willich SN, Garbe E. Use of antiepileptic drugs in epilepsy and the risk of self-harm or suicidal behavior. Neurology. 2010;75(4):335-340.

6/10/2014 DynaMed Plus Systematic Literature Surveillance. http://www.dynamed.com/topics/dmp~AN~T114575/Antiepileptic-drugs-AEDs-for-seizure-disorders: Veiby G, Engelsen BA, Gilhus NE. Early child development and exposure to antiepileptic drugs prenatally and through breastfeeding: a prospective cohort study on children of women with epilepsy. JAMA Neurol. 2013;70(11):1367-1374.



Last reviewed February 2017 by Rimas Lukas, MD

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.

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