Medications for Epilepsy

Prescription Medications

• Brivaracetam
• Cannabidiol oral solution
• Carbamazepine
• Cenobamate
• Clobazam
• Diazepam—rectal gel
• Eslicarbazepine
• Ethosuximide
• Ezogabine
• Felbamate
• Fenfluramine
• Gabapentin
• Lacosamide
• Lamotrigine
• Levetiracetam
• Oxcarbazepine
• Perampanel
• Phenobarbital
• Phenytoin
• Primidone
• Rufinamide
• Tiagabine
• Topiramate
• Valproic acid
• Vigabatrin
• Zonisamide

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 treat seizures.

Possible problems 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.

Possible problems are:

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

Carbamazepine

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

Possible problems are:

• Blurred eyesight
• Rapid back and forth eye movements
• Lightheadedness
• Tiredness
• Possible reduced birth control effectiveness
• Interaction with birth control pills—the dose may need to be changed
• 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.

Cenobamate

Cenobamate is used to control partial onset seizures in adults. It binds to proteins in the brain to slow the neurons down. Why this helps seizures is not known. People with some heart or liver problems may not want to take this medicine.

Possible problems are:

There are a few more serious and less common side effects. Call the doctor or get medical help right away if a person has:

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 or problems sleeping
• Fever
• Drooling or problems swallowing
• Constipation
• Cough or respiratory infection
• Urinary tract infection
• Irritability or aggression
• Vomiting
• 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,. The doctor may slowly raise the dose over time.

Possible problems 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.

Possible problems are:

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

Call the doctor if a person taking ethosuximide has a fever or sore throat that does not go away. 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.

Possible problems are:

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

Possible problems 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. A person's body may stop making new blood cells. Liver failure may also happen.

Fenfluramide

Fenfluramine is used to treat Dravet Syndrome, a rare and severe seizure disorder that can affect children. Echocardiograms need to be done while a person takes this medicine to make sure the heart does not get damaged.

Possible problems are:

Gabapentin

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

Possible problems 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 a person has and how bad they are. It is often given with other anti-epileptic medicine.

Possible problems 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 the doctor right away if a person is taking lamotrigine and has:

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

Other possible problems are:

• Double or blurred eyesight
• Clumsiness
• Lightheadedness
• Headache
• Nausea or vomiting
• Tiredness
• 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.

Possible problems 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.

Possible problems are:

• Eyesight changes
• Lightheadedness
• Nausea or vomiting
• Tiredness
• Headache
• 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.

Possible problems are:

• Lightheadedness
• Headache
• Loss of balance
• Problems walking
• Problems sleeping
• Irritability or aggression
• Mood problems
• 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.

Possible problems are:

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

Phenobarbital can be addictive. The doctor will slowly lower the dose when it is time 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.

Possible problems 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.

Possible problems 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
• Headache
• Nausea and vomiting

Tiagabine

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

Possible problems are:

• Feeling hungry
• Diarrhea
• Shakiness or lightheadedness
• Feeling nervous and excitable, or having trouble thinking
• Tiredness
• Blurry eyesight
• 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.

Possible problems are:

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

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.

Possible problems are:

• Lack of hunger
• Weight gain
• Stomach upset, nausea, or vomiting
• Diarrhea
• Tremors
• Headache
• Menstrual changes in younger people
• Pancreatitis
• Liver injury
• Suicidal thinking and behavior

Vigabatrin

Vigabatrin is used to treat infantile spasms 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.

Possible problems are:

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

Special Considerations

People should talk to their doctor before taking any of these medicines if they:

• 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

When taking medicine:

• Take the medicine as advised. Don't change the amount or schedule.
• Ask what side effects could happen. Tell the doctor if any occur.
• Talk to the doctor before stopping any prescription medicine.
• Do not share prescription medicine.
• Medicines can be harmful when mixed. Talk to the doctor or pharmacist about taking more than one. This includes over the counter products and supplements.
• Plan ahead for refills.

When giving a child medicine:

• Give the medicine as advised. Don't change the amount or schedule.
• Use the measuring device that came with the medicine. If a spoon, cup, or syringe has to be used make sure it has the units that match the 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 any occur.
• Talk to the doctor before stopping any prescription medicine.
• Do not share prescription medicine.
• Medicine can be harmful when mixed. Talk to the doctor or pharmacist about taking more than one. This includes over the counter products and supplements.
• Plan ahead for refills.

When to Contact the Doctor

Call the doctor if there are:

• Any odd, rare, or severe symptoms or side effects
• Repeat seizures