Epilepsy Medications Prescribed
First
Line Drugs
First line describes the principal drugs of first choice.
Phenytoin
(Dilantin) capsules, syrup and tablets
Dosage: Average daily dose range (adults) 200–400mg
in divided doses. Dose needs to be individually adjusted.
Treatment: Effective against generalised tonic–clonic
and partial seizures. Ineffective against absences. Serum
level monitoring essential.
Possible side effects: Blurred vision, double vision, drowsiness,
unsteadiness and slurred speech may occur if the dose is
too high. Coarsening of facial features, overgrowth of gums
and acne may be a problem with prolonged use, as well as
an increase in body hair. May decrease the effectiveness
of the oral contraceptive pill.
Carbamazepine
(Tegretol) tablets and syrup
Dosage: Average daily dose range (adults) 600–1200mg
in divided doses.
Treatment: Effective against generalised tonic-clonic and
partial seizures. Ineffective against absences.
Possible side effects: Blurred vision, double vision, unsteadiness
and nausea may occur initially or if dose is too high. Occasional
rash and drowsiness may occur. May decrease the effectiveness
of the oral contraceptive pill.
-
Sodium
Valproate (Epilim) tablets and syrup
Dosage: Average daily dose range (adults) 600–1500mg
in divided doses.
Treatment: Effective against generalised tonic-clonic, absences
and myoclonus. May be used for partial seizures.
Possible side effects: The most common side effect is gastrointestinal
(diarrhoea, abdominal pain, nausea and vomiting). Weight
gain can also occur. Drowsiness and tremor are infrequent
side effects. Hair loss occurs in some people, but usually
minor and reversible. Liver damage very uncommon. Does not
interfere with the effectiveness of the oral contraceptive
pill.
-
Ethosuximide
(Zarontin) capsules and syrup
Dosage: Dose needs to be individually calculated based on
body weight.
Treatment: Effective against absences only.
Possible side effects: Behavioural disturbances. Nausea
and drowsiness may occur. Hiccups, headaches and rash. Other
possible side effects include a decrease in appetite, abdominal
pain and an unsteady walk. Does not interfere with the effectiveness
of the oral contraceptive pill.
-
Clonazepam
(Rivotril) tablets\syrup
Dosage: Average daily dose range (adults) 2–8 mg in
divided doses.
Treatment: Effective against drop attacks, myoclonic, partial
seizures and absences, but tolerance often develops.
Possible side effects: Behavioural disturbance, including
aggression and depression, are the most significant side
effects. Drowsiness and sedation are quite common but may
wear off. Ataxia (poor co-ordination) and drooling can occur.
Does not interfere with the effectiveness of the oral contraceptive
pill.
-
Clobazam
(Frisium) tablets
Dosage: Average daily dose range (adult) 20–30mg in
divided doses.
Treatment: Effective against drop attacks, generalised tonic-clonic
and partial seizures, but tolerance often develops.
Possible side effects: Drowsiness may occur but this drug
is much less sedating than Clonazepam or Diazepam. Depression
is rare. Weight gain can occur. Does not interfere with
the effectiveness of the oral contraceptive pill.
Second
Line Drugs
Second line refers to drugs used usually in adjunct to the
first line drugs.
Levetiracetam
(Keppra)
– Not PBS listed as at 30th June
2002
Dosage: Average dose range (adults) 1,000–3,000 mg
daily in divided doses. Can be taken with or without food.
The dose should be reduced for people with renal impairment.
Treatment: Effective against partial (focal) seizures with
or without secondary generalisation. Some preliminary evidence
that it may also have efficacy in generalised epilepsy syndromes.
Possible side effects: Generally well tolerated. Some mild
drowsiness, dizziness, agitation and insomnia may occur
when starting, but usually decreases over time. Does not
interfere with the effectiveness of the oral contraceptive
pill.
-
Vigabatrin
(Sabril) tablets and sachets of oral powder.
Dosage: Average daily dose range (adults) 1000–3000mg
in one or two doses before or after meals. Children 3–9
years up to 1000mg daily. 10 years and over 2000mg daily.
Regular blood level testing not essential.
Treatment: For the treatment of partial or focal epilepsies.
Also considered useful in the treatment of infantile spasms.
NB. Can make myoclonic epilepsy worse. Visual Field Defect.
A defect in visual fields has been reported in 1/3 patients,
this should be tested by specialists.
Possible side effects: Drowsiness, sedation, difficulty
concentrating, mood changes may occur. Less frequently double
vision, weight gain, nausea. Side effects tend to decrease
with time. NB. A small percentage of people (especially
those with preexisting psychiatric problems) may experience
psychotic episodes. Visual defects limit the use of this
drug to a limited group of patients, unless other drugs
are ineffective. Does not interfere with the effectiveness
of the oral contraceptive pill.
-
Lamotrigine
(Lamictal) tablets.
Dosage: Average daily dose range 200–400mg in divided
dose if not on Epilim. 100–200mg in divided dose if
also on Epilim. Must be introduced slowly to prevent rash.
Regular blood levels not measured.
Treatment: For the treatment of partial seizures. Recent
worldwide experience suggests it is more effective in the
treatment of refractory generalised epilepsies.
Possible side effects: Rash (more likely if person already
taking Epilim), nausea, dizziness, double vision. Drowsiness
and sleepiness relatively uncommon, but may occur due to
interactions with other drugs. If rash occurs, advise doctor.
Does not interfere with the effectiveness of the oral contraceptive
pill.
-
Gabapentin
(Neurontin) capsules.
Dosage: Average daily dose range 1600 to 4000mg daily in
divided doses with or without food. Regular blood level
testing not required.
Treatment: For adults and children over 12 years for refractory
partial seizures with or without secondary generalisation.
Caution in case of kidney disease.
Possible side effects: Safe drug. In clinical trials, the
most common side effects were sedation, dizziness, fatigue,
unsteadiness. No interaction with other drugs. Does not
interfere with the effectiveness of the oral contraceptive
pill.
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Topiramate
(Topamax) tablets
Dosage: Suggest therapy beings 25–50 mg daily, gradually
increasing to 200–400 mg daily, by slow 1–2
weekly increases of 25 mg per day each week.
Treatment: Add–on therapy in adult patients with partial
epilepsy, also to treat generalised tonic clonic seizures
of generalised epilepsy.
Possible side affects: Initially there may be some tingling,
insomnia, headaches, slurred speech, weight loss, nausea,
or confusion which usually passes. Weight loss is relatively
common. May decrease the effectiveness of oral contraceptives.
If there is a history of kidney stones drink plenty of water.
May decrease the effectiveness of the oral contraceptive
pill.
-
Tiagabine
(Gabitril) tablets
Dosage: Slow introduction and slow increase in dose every
1–2weeks: initially 5–75 mg daily. Maintenance
15–30 mg daily. To be taken with food.
Treatment: Add on therapy for adults and older children
to control partial seizures. Safe and efficacious use in
children under 12 has not yet been established.
Possible Side effects: Reactions may include cramps, nausea,
vomiting, diarrhoea, increased appetite, mouth ulcers, depression.
No serious or life threatening adverse effects reported.
May decrease the effectiveness of the oral contraceptive
pill.
Primidone (Mysoline) tablets
– (No
longer used as a 1st or 2nd line drug)
Dosage: Average daily dose range (adults) 500–1500mg
in divided doses.
Treatment: Primidone is partly metabolised to phenobarbitone
in the body. Effective against generalised tonic-clonic and
partial seizures. Possible side effects: Nausea, unsteadiness
and drowsiness may occur initially but sedation and slowing
of mental performance may persist. May decrease the effectiveness
of the oral contraceptive pill.
New drug under investigation
Remacemide - under investigation.
Studies are continuing for this drug which has not been approved
in Australia as at 30th June 2002.
“Epilepsy
Medications” Epilepsy Australia Ltd
Reviewed June 2002
W
a r n i n g
This document is intended to provide basic information for
the general public about the treatment of epilepsy. It is
not intended to be nor does it constitute medical advice.
Readers are warned against changing medical schedules or life
activities based on the information it contains without first
consulting a doctor.
This
information provided by the Epilepsy Association of South
Australia and Northern Territory Inc on the Internet is designed
to provide basic information about epilepsy. It is not intended,
nor does it constitute medical or other professional advice.
Diagnosis and advice on medical care or other assessments
should be sought from a medical practitioner or suitably qualified
professional.
