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Drug Treatment of Epilepsy in Adults
THESE ARE GUIDELINES ONLY
First line drugs
Available as
Average total dose
Treatment
Possible side effects include the following list
(generic name)
(brand name)
in a day for adults
(any severe reactions should be reported to your GP or neurologist)
Carbamazepine
Carbamazepine: Tablets 100mg, 200mg,
Effective against generalised tonic clonic and partial Skin rash, if allergic to carbamazepine. Diplopia (double vision), ataxia (unsteadiness) and nausea may occur initially or if the dose is too Tegretol: Tablets 100mg, 200mg,
Suppositories 125mg, 250mg.
Tegretol Retard: Tablets 200mg, 400mg.
Ethosuximide
Ethosuximide: Capsules 250mg. Emeside:
Nausea and drowsiness may occur initially or if the dose is too high. Anorexia (weight loss).
Zarontin: Syrup 250mg/5ml
Lamotrigine
Lamictal: Tablets 25mg, 50mg, 100mg,
Effective against partial seizures and generalised tonic Drowsiness, diplopia (double vision), dizziness, headache, insomnia, tremor and flu-like Dispersible tablets 2mg, 5mg, 25mg, 100mg.
Lamotrigine: Tablets 25mg, 50mg, 100mg,
Dispersible tablets 5mg, 25mg, 100mg.
Levetiracetam
Keppra: Tablets 250mg. 500mg, 750mg,
Effective against partial seizures with or without Dizziness, drowsiness, irritability, behavioural problems, insomnia, ataxia (unsteadiness), tremor, secondary generalisation, and adjunctive therapy for headache, nausea may occur in high dosages or when doses are increased, but will usually myoclonic seizures and Juvenile Myoclonic Epilepsy.
Oxcarbazepine
Oxcarbazepine: Tablets 150mg, 300mg, 600mg. 1200 - 2400mg divided
Effective against partial seizures and secondarily Skin rash, if allergic to oxcarbazepine. Trileptal: Tablets 150mg, 300mg, 600mg. Oral
Diplopia (double vision), ataxia (unsteadiness), headache, nausea, confusion and vomiting.
Sodium Valproate: Tablets 200mg, 500mg.
Effective against generalised tonic clonic seizures, Drowsiness and tremor are infrequent side effects. Hair loss occurs in some people but is not Valproate
usually severe and is usually reversible if the dose is reduced. Weight gain may occur. Liver Epilim: Tablets 200mg, 500mg. Crushable
damage is rare. Sodium valproate has been associated with increased incidence of Polycystic tablets 100mg. Liquid (sugarfree) 200mg/5mL.
Ovary Syndrome and menstrual irregularities. Any menstrual problems should be reported to the GP and neurologist. Sodium valproate is associated with a higher risk of foetal malformations Epilim Chrono (slow release):
than other AEDs, if taken in pregnancy.
Tablets 200mg, 300mg, 500mg.
Epilim Chronosphere: Sachets 50mg, 100mg,
250mg, 500mg, 750mg.
Episenta (slow release): Tablets 100mg,
300mg. Granules 500mg, 1000mg.
Second Line Drugs
Available as
Average total dose
Treatment
Possible side effects include the following list
(generic name)
(brand name)
in a day for adults
(any severe reactions should be reported to your GP or neurologist)
Acetazolamide
Diamox: Tablets 250mg.
Effective against generalised tonic clonic seizures, partial Loss of appetite, drowsiness, depression, paraesthesia (pins and needles in hands and feet), joint seizures and atypical absences. Also used for menstrual pain, polyuria (increased urine output), thirst, headache, dizziness, fatigue (tiredness) and related seizures, certain episodic disorders and to irritability. Tolerance may develop.
enhance other anti-epileptic drugs (e.g. carbamazepine).
Clobazam
Frisium: Tablets 10mg.
Effective against generalised tonic clonic seizures and Drowsiness may occur but this drug is less sedating than clonazepam or diazepam. Tolerance Clonazepam
Clonazepam: Tablets 0.5mg, 2mg.
Effective against generalised tonic clonic seizures, partial Drowsiness and sedation are quite common but these may wear off. Tolerance tends to develop.
Rivotril: Tablets 0.5mg, 2mg.
seizures, absences and myoclonic seizures.
Gabapentin
Neurontin: Tablets 600mg, 800mg.
Recommended in partial seizures where previous Gabapentin: Tablets 600mg, 800mg.
May make myoclonic seizures and/or absences worse.
Lacosamide
Vimpat: Tablets 50mg, 100mg, 150mg,
Add on therapy for partial seizures.
Nausea, vomiting, dizziness, headache, drowsiness, depression, diplopia (double vision), impaired memory, impaired coordination, tremor, fatigue (tiredness), asthenia (muscleweakness), pruritus (itching).
Phenobarbital
Phenobarbital: Tablets 15mg, 30mg, 60mg.
Effective against generalised tonic clonic seizures and Drowsiness may occur initially. Lethargy, sedation and slowing of mental performance may Phenytoin
Phenytoin: Tablets 100mg.
Effective against generalised tonic clonic seizures and Epanutin: Capsules 25mg, 50mg, 100mg,
partial seizures. Ineffective against absences.
Drowsiness, ataxia (unsteadiness) and slurred speech may occur if the dose is too high.
Blood tests are essential to guide dosing.
Coarsening of facial features, overgrowth of gums, excess hair growth and acne may occur with prolonged therapy, as can some anaemias. Piracetam
Nootropil: Tablets 800mg, 1200mg. Oral
Recommended in myoclonic seizures where previous Very rare, but may include weight gain, diarrhoea, insomnia, drowsiness, nervousness, depression Pregabalin
Lyrica: Capsules 25mg, 50mg, 75mg,
Effective against partial seizures, with or without Dizziness, fatigue (tiredness), changes in mood, attention difficulties, changes in appetite, weight gain, blurred or double vision, oedema, drowsiness, speech disorder, memory impairment,confusion, paraesthesia (pins and needles). Very rarely rhabdomyolysis (damaged muscle tissue).
Primidone
Mysoline: Tablets 250mg.
Effective against generalised tonic clonic siezures and Nausea, unsteadiness, dizziness and drowsiness may occur initially. Sedation and slowing of partial seizures. May be ineffective against absences.
Rufinamide
Inovelon Tablets 100mg, 200mg, 400mg
Add on therapy for Lennox-Gastaut syndrome.
Nausea, vomiting, constipation, diarrhoea, dyspepsia (heartburn), abdominal pain, weight loss, This drug has a restricted licence (orphan drug).
rhinitis (runny nose), dizziness, headache, drowsiness, insomnia, anxiety, fatigue (tiredness).
Hypersensitivity syndrome (possibly including rash and fever) also reported - if concerned seek Stiripentol
Diacomit Capsules 250mg, 500mg
Add on therapy for tonic clonic seizures in Severe Nausea, vomiting, loss of appetite, weight loss (especially when used with sodium valproate), Myoclonic Epilepsy in Infancy (SMEI).
anorexia, insomnia, drowsiness, ataxia (loss of muscle coordination), hypotonia (low muscle This drug has a restricted licence (orphan drug).
tone), dystonia (muscle contractions), aggressiveness, irritability, neutropenia (reduced immunity).
Tiagabine
Gabitril: Tablets 5mg, 10mg, 15mg.
Recommended in partial seizures where previous Dizziness, fatigue (tiredness), nervousness, tremor, concentration difficulties, depression of Topiramate
Topamax: Tablets 25mg, 50mg, 100mg,
Recommended in partial seizures where previous Headache, drowsiness, dizziness, paraesthesia (pins and needles in hands and feet), loss of treatment has been ineffective. Topiramate has a licence weight and kidney stones. Speech disorder, impaired memory and concentration may occur for monotherapy but is not widely used as a first line when dose is increased but will usually disappear after a few days. Rare reported cases of acute visual impairment usually occuring within a month of starting treatment.
Vigabatrin
Sabril: Tablets 500mg.
Effective against partial seizures and secondarily Drowsiness, behaviour and mood changes. Psychotic reactions have been reported. Visual field generalised seizures where all previous treatment has defects have been reported in one in three people taking vigabatrin in the long term. Anybody who has concerns about this should talk with their GP and neurologist. Visual field tests should May worsen absences and myoclonic seizures.
be done every six months if taking vigabatrin.
Zonisamide
Zonegran: 25mg, 50mg 100mg.
Effective against partial seizures with or without Drowsiness, dizziness, weight loss, kidney stones, confusion, cognitive slowing, agitation,irritability, depression, speech disorder, very rarely some idiosyncratic (unusual or individual)reactions.
The side effects listed in this table are some of the possible side effects for each AED. For more details on each drug, and a complete list of their side effects log on to www.medguides.medicines.org.uk

Source: http://open.jorum.ac.uk/xmlui/bitstream/handle/10949/11754/Unit2/downloads/AED%20table.pdf?sequence=76

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