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Medications for Epilepsy

This sheet gives you facts on each of the medicines below. Only basic side effects are listed. Ask your doctor if you need to take any special steps. Use each of these medicines the way your care team has taught you. Call your doctor if you have any questions.

Medicines are the first thing used to treat epilepsy. Anti-epileptic medicines should only be used if the doctor is certain you have epilepsy. It is used to prevent seizures and reduce how often you get them and how bad they are. The type and dose you are given must match the type of epilepsy you have. The dose must balance preventing seizures with the side effects that the drugs can cause.

You may need to try more than one medicine before finding the one that works best for you. Medicine changes are done slowly. These changes can raise the chances of having seizures. Most people are able to control their seizures with medicine. Some people may need to take more than one.

Be sure to take your medicine at the right times.

Brivaracetam

Brivaracetam prevents seizures by joining with a protein that is involved with the release of certain neurotransmitters in the brain. It is not known why this helps treats seizures.

Problems you may have are:

  • Nausea and vomiting
  • Lightheadedness
  • Tiredness
  • Problems with balance
  • Problems breathing
  • Suicidal thinking and behavior

Cannabidiol Oral Solution

Cannabidiol is an active ingredient from the cannabis plant. The way that it works to control seizures is not known. It is thought to slow down the way messages are sent in the brain.

Problems you may have are:

  • Rash
  • Lack of hunger
  • Diarrhea
  • Infections
  • Problems sleeping
  • Tiredness

Carbamazepine

Carbamazepine prevents seizures by reducing the excitability of nerve fibers in the brain.

Problems you may have are:

  • Blurred eyesight
  • Rapid back and forth eye movements
  • Lightheadedness
  • Tiredness
  • Possible reduced birth control effectiveness
  • Interaction with birth control pills—Your doctor may need to change your dose.
  • Suicidal thinking and behavior

More serious, but less common side effects may be:

  • Bone marrow problems
  • Rashes
  • Low sodium levels in the blood
  • Heart failure

People of Asian descent who have a certain gene and take this medicine are at risk for harmful or even deadly skin reactions. People of Asian descent should be tested for this gene before taking this.

Clobazam

Clobazam is used to control seizures in people with Lennox-Gastaut syndrome. This is a rare health problem that causes severe seizures in children.

Problems may be:

  • Tiredness
  • Fever
  • Drooling
  • Constipation
  • Cough
  • Urinary tract infection
  • Problems sleeping
  • Aggression
  • Respiratory infection
  • Irritability
  • Vomiting
  • Problems swallowing
  • Problems with coordination
  • Suicidal thoughts or changes in mood

Diazepam Rectal Gel

Diazepam is in people with epilepsy who have seizure clusters. These are many seizures that are not like the person's typical pattern. They can last minutes to hours and may need urgent care.

It can be given rectally by trained parents or caregivers.

Problems may be:

  • Tiredness
  • Problems breathing
  • Headaches
  • Drug dependence
  • Suicidal thinking and behavior

Eslicarbazepine

Eslicarbazepine is used to treat focal or partial seizures. It may be used by itself or with other anti-epileptic medicine. It is started out at a lower dose, then your doctor may have you slowly take more.

Problems you may have are:

  • Headache
  • Lightheadedness
  • A feeling of spinning
  • Sleepiness
  • Blurred eyesight
  • Nausea or vomiting
  • Tremor

More serious, but less common side effects may be:

  • Rashes
  • Severe allergic reaction
  • Lasting flu-like symptoms, with or without a fever
  • Low sodium levels in the blood
  • Liver damage
  • Suicidal thinking and behavior

Ethosuximide

Ethosuximide controls seizures by depressing nerve transmissions in the part of the brain that controls muscles.

Problems you may have are:

  • Nausea and vomiting
  • Lack of hunger
  • Tiredness
  • Lightheadedness
  • Headache
  • Muscle pain
  • Rash
  • Change in urine color
  • Suicidal thinking and behavior

Tell your doctor if you have a lasting fever or sore throat. It could be a sign of a low white blood cell count due to suppressed bone marrow.

Ezogabine

Ezogabine is used to control seizures in adults with epilepsy. It is often given with other anti-epileptic medicine.

Problems you may have are:

  • Lightheadedness
  • Tiredness
  • A feeling of spinning
  • Tremor
  • Problems with coordination
  • Double vision
  • Attention and memory problems
  • Lack of strength
  • Sensing things that are not really there
  • Changes in thinking
  • Suicidal thoughts or changes in mood
  • Urinary problems

Felbamate

Felbamate is often tried in people who have severe seizures that are not helped by other medicines. It may be used by itself or with another medicine. Felbatol helps stop brain cells from working quickly during a seizure. It can stop seizures when they start.

Problems you may have are:

  • Lack of hunger
  • Weight loss
  • Nausea and vomiting
  • Problems sleeping
  • Headache
  • Lightheadedness

Felbamate is rarely used. It can cause rare but deadly side effects. Your body may stop making new blood cells. Liver failure may also happen.

Gabapentin

It is not known how gabapentin prevents seizures. It may work alter the transport of amino acids in the brain.

Problems you may have are:

  • Tiredness
  • Lightheadedness
  • Lack of coordination
  • Weight gain
  • Rapid back and forth eye movements
  • Suicidal thinking and behavior

Lacosamide

Lacosamide affects the central nervous system. It can lower how many seizures you have and how bad they are. It is often given with other anti-epileptic medicine.

Problems you may have are:

  • Lightheadedness
  • Tiredness
  • Blurred eyesight
  • Problems thinking
  • Headache
  • Nausea or vomiting
  • Suicidal thinking and behavior

Lamotrigine

It is not known how lamotrigine prevents seizures. It may work by stabilizing nerve membranes.

Call your doctor right away if you are taking lamotrigine and have:

  • Rash—can be deadly
  • Fever
  • Flu-like symptoms
  • Swollen glands
  • More seizures

Problems you may have are:

  • Double or blurred eyesight
  • Clumsiness
  • Lightheadedness
  • Headache
  • Nausea or vomiting
  • Tiredness
  • Possible reduced birth control effectiveness
  • Suicidal thinking and behavior
  • Swelling of the layers of tissue around the brain

Levetiracetam

Levetiracetam is used to treat partial, generalized, and myoclonic seizures. It is often given with other anti-epileptic medicine.

Problems you may have are:

  • Lightheadedness
  • Tiredness
  • Blurred eyesight
  • Problems thinking
  • Changes in mood
  • Nausea or vomiting
  • Headache
  • Cough, runny nose, sore throat
  • Risk of infection
  • Depression
  • Suicidal thinking and behavior

Oxcarbazepine

Oxcarbazepine is thought to prevent seizures by changing the transport of amino acids in the brain and stabilizing the nerve membranes.

Problems you may have are:

  • Eyesight changes
  • Lightheadedness
  • Nausea or vomiting
  • Tiredness
  • Headache
  • Possible reduced birth control effectiveness
  • Suicidal thinking and behavior

Perampanel

The way that perampanel stops seizures is not known. It is thought to work by blocking a substance (glutamate) that excites nerve cells in the brain.

Problems you may have are:

  • Lightheadedness
  • Headache
  • Loss of balance
  • Problems walking
  • Problems sleeping
  • Irritability
  • Mood problems
  • Aggression
  • Suicidal thinking and behavior

Phenobarbital

Phenobarbital is used with other anti-epileptic medicine in people who have partial seizures or generalized seizures. It can be used to treat all types of seizures. It stays in the body for a long time.

Problems you may have are:

  • Depression
  • Tiredness
  • Lightheadedness
  • Blurred eyesight
  • Problems thinking
  • Possible reduced birth control effectiveness
  • Suicidal thinking and behavior

Phenobarbital can be addictive. Your doctor will slowly lower the dose when it is time for you to stop taking it.

Phenytoin

Phenytoin prevents seizures by promoting sodium loss in nerve fibers. This curbs nerve excitability and the spread of nerve impulses.

Problems you may have are:

  • Bleeding
  • Swollen gums
  • Fever
  • Rash
  • Lightheadedness
  • Tiredness
  • Rapid back and forth eye movement
  • Possible reduced birth control effectiveness
  • Suicidal thinking and behavior

Primidone

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

Problems you may have are:

  • Rash
  • Problems thinking
  • Rapid back and forth eye movement
  • Clumsiness
  • Lightheadedness
  • Drowsiness
  • Possible reduced birth control effectiveness
  • Suicidal thinking and behavior

Rufinamide

This medicine is useful in treating Lennox-Gastaut syndrome.

Problems may be:

  • Lightheadedness
  • Tiredness
  • Blurry eyesight
  • Problems thinking
  • Lighheadedness
  • Headache
  • Nausea and vomiting

Tiagabine

Tiagabine is useful as an add-on treatment for partial seizures.

Problems you may have are:

  • Feeling hungry
  • Diarrhea
  • Shakiness
  • Feeling nervous and excitable
  • Lightheadedness
  • Tiredness
  • Blurry eyesight
  • Problems thinking
  • Lightheadedness
  • Problems moving around
  • Dry mouth
  • Nausea and vomiting

Topiramate

Topiramate may be given with other anti-epileptic medicine or by itself. It is used to treat all types of seizures.

Problems you may have are:

  • Tiredness
  • Blurred eyesight
  • Problems thinking
  • Lightheadedness
  • Changes in mood
  • Nausea or vomiting
  • Numbness or tingling in hands or feet
  • Lack of hunger, weight loss
  • Possible reduced birth control effectiveness
  • Depression

More serious, but less common side effects may be:

  • Suicidal thinking and behavior
  • Glaucoma
  • Kidney stones
  • High acidity in the blood
  • Not sweating enough in hot weather

Valproic Acid

Valproic acid may prevent seizures by increasing gamma aminobutyric acid. This slows nerve transmissions in parts of the brain.

Problems you may have are:

  • Lack of hunger
  • Weight gain
  • Stomach upset
  • Nausea or vomiting
  • Diarrhea
  • Tremors
  • Headache
  • Menstrual changes in young women
  • Pancreatitis
  • Liver injury
  • Suicidal thinking and behavior

Vigabatrin

Vigabatrin is used to treat seizures in infants aged 1 month to 2 years. This type of seizure is harmful because it can happen many times a day. It can also be used in adults who have refractory complex partial seizures. They can take it with other anti-epileptic medicine.

Vigabatrin can cause serious side effects, such as loss of eyesight. Other problems may be:

  • In infants:
    • Tiredness
    • Weight gain
    • Diarrhea
    • Nausea or vomiting
    • Excitement or agitation
  • In adults:
    • Lightheadedness
    • Tiredness
    • Weight gain
    • Shakiness
    • Diarrhea
    • Nausea or vomiting
    • Depression
    • Suicidal thinking and behavior

Zonisamide

This is a mood stabilizer that works by calming the brain. It is used to prevent or control seizures.

Problems you may have are:

  • Lightheadedness
  • Tiredness
  • Blurry eyesight
  • Problems thinking
  • Feeling nervous and excitable
  • Headache
  • Nausea and vomiting
  • Lack of hunger
  • Serious skin reactions (rare)

Special Considerations

Before taking any of these medicines, talk with your doctor if you:

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

If you are taking medicine:

  • Take your medicine as advised. Don't change the amount or schedule.
  • Ask what side effects could happen. Tell your doctor if you have any.
  • Talk to your doctor before you stop taking any prescription medicine.
  • Don't share your prescription medicine.
  • Medicines can be harmful when mixed. Talk to your doctor or pharmacist if you are taking more than one, including over the counter products and supplements.
  • Plan ahead for refills.

If your are giving your child medicine:

  • Give your child the medicine as advised. Don't change the amount or schedule.
  • Use the measuring device that came with the medicine. 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 medicine is given in milliliters (mL), the device should have mL on it.
  • Ask what side effects could happen. Tell the doctor if your child has any.
  • Talk to your child's doctor before stopping any prescription medicine.
  • Don't share your child's prescription medicine.
  • Medicine can be harmful when mixed. Talk to your child's doctor or pharmacist if your child is taking more than one, including over the counter products and supplements.
  • Plan ahead for refills.

When to Contact Your Doctor

Contact your doctor if you:

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

Antiepileptic drugs (AEDs) for seizure disorders in adults. EBSCO DynaMed Plus website. Available at:https://www.dynamed.com/topics/dmp~AN~T114575. Updated September 13, 2018. Accessed March 27, 2019.

Epilepsy in adults. EBSCO DynaMed Plus website. Available at:http://www.dynamed.com/topics/dmp~AN~T115086/Epilepsy-in-adults. Updated November 9, 2018. Accessed March 27, 2019.

Epilepsy in children. EBSCO DynaMed Plus website. Available at:http://www.dynamed.com/topics/dmp~AN~T900174/Epilepsy-in-children. Updated March 22, 2018. Accessed March 27, 2019.

Lennox-Gastaut syndrome . EBSCO DynaMed Plus website. Available at:http://www.dynamed.com/topics/dmp~AN~T115316/Lennox-Gastaut-syndrome. Updated November 19, 2018. Accessed March 27, 2019.

Myoclonic seizures. Epilepsy Foundation website. Available at: http://www.epilepsy.com/learn/types-seizures/myoclonic-seizures. Updated July 2013. Accessed March 27, 2019.

National Institute for Health and Clinical Excellence (NICE). The epilepsies: the diagnosis and management of the epilepsies in adults and children in primary and secondary care. NICE 2012 Jan:CG137.

Treating seizures and epilepsy. Epilepsy Foundation website. Available at: http://www.epilepsy.com/learn/treating-seizures-and-epilepsy. Updated July 2013. Accessed March 27, 2019.

Last reviewed March 2019 by EBSCO Medical Review Board Rimas Lukas, MD  Last Updated: 3/26/2019