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.
  
  
• 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.