Anticonvulsant Drugs

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Anticonvulsant Drugs

Definition

Anticonvulsant drugs are medicines used to prevent or treat convulsions (seizures).

Purpose

Anticonvulsant drugs are used to control seizures in people with epilepsy. Epilepsy is not a single disease—it is a set of symptoms that may have different causes in different people. The common thread is an imbalance in the brain's electrical activity. This imbalance causes seizures that may affect part or all of the body and may or may not cause a loss of consciousness. Anticonvulsant drugs act on the brain to reduce the frequency and severity of seizures.

Some cases of epilepsy are brought on by head injuries, brain tumors or infections, or metabolic problems such as low blood sugar. But in some people with epilepsy, the cause is not clear.

Anticonvulsant drugs are an important part of the treatment program for epilepsy. Different kinds of drugs may be prescribed for different types of seizures. In addition to taking medicine, patients with epilepsy should get enough rest, avoid stress, and practice good health habits.

Some physicians believe that giving the drugs to children with epilepsy may prevent the condition from getting worse in later life. However, others say the effects are the same, whether treatment is started early or later in life. Determining when treatment begins depends on the physician and his assessment of the patient's symptoms.

Physicians also prescribe certain anticonvulsant drugs for other conditions, including bipolar disorder and migraine headaches.

Description

Anticonvulsant drugs may be divided into several classes. The hydantoins include pheytoin (Dilantin) and mephenytoin (Mesantoin.) Ther succimides include ethosuximide (Zarontin) and methsuccimide (Celontin.) The benzodiazepines, which are better known for their use as tranquilizers and sedatives, include clonazepam (Klonopin), clorazepate (Tranxene) and diazepam (Valium.) There are also a large number of other drugs which are not related to larger groups. These include carbamazepine (Tegretol), valproic acid (Depakote, Depakene) gabapentin (Neurontin), topiramate (Topamax), felbamate (Felbatol) and several others. Phenobarbital has been used as an anticonvulsant, and is still useful for some patients. The drugs are available only with a physician's prescription and come in tablet, capsule, liquid, and "sprinkle" forms.

Recommended dosage

The recommended dosage depends on the type of anticonvulsant, its strength, and the type of seizures for which it is being taken. Check with the physician who prescribed the drug or the pharmacist who filled the prescription for the correct dosage.

Do not stop taking this medicine suddenly after taking it for several weeks or more. Gradually tapering the dose may reduce the chance of withdrawal effects.

Do not change brands or dosage forms of this medicine without checking with a pharmacist or physician. If a prescription refill does not look like the original medicine, check with the pharmacist who filled the prescription.

Precautions

Patients on anticonvulsant drugs should see a physician regularly while on therapy, especially during the first few months. The physician will check to make sure the medicine is working as it should and will note unwanted side effects. The physician may also need to adjust the dosage during this period.

KEY TERMS

Chronic— A word used to describe a long-lasting condition. Chronic conditions often develop gradually and involve slow changes.

Epilepsy— A brain disorder with symptoms that include seizures.

Glaucoma— A condition in which pressure in the eye is abnormally high. If not treated, glaucoma may lead to blindness.

Porphyria— A disorder in which porphyrins build up in the blood and urine.

Porphyrin— A type of pigment found in living things, such as chlorophyll which makes plants green or hemoglobin which makes blood red.

Seizure— A sudden attack, spasm, or convulsion.

Systemic lupus erythematosus (SLE)— A chronic disease with many symptoms, including weakness, fatigue, joint pain, sores on the skin, and problems with the kidneys, spleen, and other organs.

Withdrawal symptoms— A group of physical or mental symptoms that may occur when a person suddenly stops using a drug to which he or she has become dependent.

Valproic acid can cause serious liver damage, especially in the first 6 months of treatment. Children are particularly at risk, but anyone taking this medicine should see their physician regularly for tests of liver function and should be alert to symptoms of liver damage, such as yellow skin and eyes, facial swelling, loss of appetite, general feeling of illness, loss of appetite, and vomiting. If liver problems are suspected, call a physician immediately.

Felbatol has caused serious liver damage and aplastic anemia, a condition in which the bone marrow stops producing blood cells. Patients taking this drug should have regular blood counts, and should stop taking the drug if there are too few red blood cells.

While taking anticonvulsant drugs, do not start or stop taking any other medicines without checking with a physician. The other medicines may affect the way the anticonvulsant medicine works.

Because anticonvulsant drugs work on the central nervous system, they may add to the effects of alcohol and other drugs that slow down the central nervous system, such as antihistamines, cold medicine, allergy medicine, sleep aids, other medicine for seizures, tranquilizers, some pain relievers, and muscle relaxants. Anyone taking anticonvulsant drugs should check with his or her physician before drinking alcohol or taking any medicines that slow the central nervous system.

Anticonvulsant drugs may interact with medicines used during surgery, dental procedures, or emergency treatment. These interactions could increase the chance of side effects. Anyone who is taking anticonvulsant drugs should be sure to tell the health care professional in charge before having any surgical or dental procedures or receiving emergency treatment.

Some people feel drowsy, dizzy, lightheaded, or less alert when using these drugs, especially when they first begin taking them or when their dosage is increased. Anyone who takes anticonvulsant drugs should not drive, use machines or do anything else that might be dangerous until they have found out how the drugs affect them.

Anticonvulsant drugs may affect the results of certain medical tests. Before having medical tests, people who take anticonvulsant drugs should make sure that the medical professional in charge knows what they are taking.

Children may be more likely to have certain side effects from anticonvulsant drugs, such as behavior changes; tender, bleeding, or swollen gums; enlarged facial features; and excessive hair growth. Problems with the gums may be prevented by regularly brushing and flossing, massaging the gums, and having the teeth cleaned every 3 months whether the patient is a child or an adult.

Children who take high doses of this medicine for a long time may have problems in school.

Older people may be more sensitive to the effects of anticonvulsant drugs. This may increase the chance of side effects and overdoses.

Special conditions

People with certain medical conditions or who are taking certain other medicines can have problems if they take anticonvulsant drugs. Before taking these drugs, be sure to let the physician know about any of these conditions:

ALLERGIES. Anyone who has had unusual reactions to anticonvulsant drugs or to tricyclic antidepressants such as imipramine (Tofranil) or desipramine (Norpramin) in the past should let his or her physician know before taking the drugs again. The physician should also be told about any allergies to foods, dyes, preservatives, or other substances.

PREGNANCY. Some anticonvulsant drugs taken during pregnancy may cause bleeding problems in the mother during delivery and in the baby after delivery. This problem can be avoided by giving vitamin K to the mother during delivery and to the baby after birth.

Pregnancy may affect the way the body absorbs anticonvulsant drugs. Women who are prone to seizures may have more seizures during pregnancy, even though they are taking their medicine regularly. If this happens, they should check with their physicians about whether the dose needs to be increased.

BREASTFEEDING. Some anticonvulsant drugs pass into breast milk and may cause unwanted effects in babies whose mothers take the medicine. Women who are breastfeeding should check with their physicians about the benefits and risks of using anticonvulsant drugs.

DIABETES. Anticonvulsant drugs may affect blood sugar levels. Patients with diabetes who notice changes in the results of their urine or blood tests should check with their physicians.

OTHER MEDICAL CONDITIONS. Before using anticonvulsant drugs, people with any of these medical problems should make sure their physicians are aware of their conditions:

liver disease
kidney disease
thyroid disease
heart or blood vessel disease
blood disease
brain disease
problems with urination
current or past alcohol abuse

behavior problems
diabetes mellitus
glaucoma
porphyria
systemic lupus erythematosus
fever higher than 101 °F (38.3 °C) for more than 24 hours

USE OF CERTAIN MEDICINES. Taking anticonvulsant drugs with certain other drugs may affect the way the drugs work or may increase the chance of side effects.

Side effects

The most common side effects are constipation, mild nausea or vomiting, and mild dizziness, drowsiness, or lightheadedness. These problems usually go away as the body adjusts to the drug and do not require medical treatment. Less common side effects, such as diarrhea, sleep problems, aching joints or muscles, increased sensitivity to sunlight, increased sweating, hair loss, enlargement of facial features, excessive hair growth, muscle twitching, and breast enlargement in males also may occur and do not need medical attention unless they persist or are troublesome.

Other side effects may need medical attention. If any of these side effects occur, check with a physician as soon as possible:

clumsiness or unsteadiness
slurred speech or stuttering
trembling
unusual excitement, irritability, or nervousness
uncontrolled eye movements
blurred or double vision
mood or mental changes
confusion
increase in seizures
bleeding, tender, or swollen gums
skin rash or itching
enlarged glands in neck or armpits
muscle weakness or pain
fever

Other side effects are possible. Anyone who has unusual symptoms after taking anticonvulsant drugs should get in touch with his or her physician.

Interactions

Some anticonvulsant drugs should not be taken within two to three hours of taking antacids or medicine for diarrhea. These medicines may make the anticonvulsant drugs less effective. Ask the pharmacist or physician for more information.

Birth control pills may not work properly when anticonvulsant drugs are being taken. To prevent pregnancy, ask the physician or pharmacist if additional methods of birth control should be used while taking anticonvulsant drugs.

Anticonvulsant drugs may interact with many other medicines. When this happens, the effects of one or both of the drugs may change or the risk of side effects may be greater. Anyone who takes anticonvulsant drugs should let the physician know all other medicines he or she is taking. Among the drugs that may interact with certain anticonvulsant drugs are:

airway opening drugs (bronchodilators ) such as aminophylline, theophylline (Theo-Dur and other brands), and oxtriphylline (Choledyl and other brands)
medicines that contain calcium, such as antacids and calcium supplements
blood thinning drugs
caffeine
antibiotics such as clarithromycin (Biaxin), erythromycins, and sulfonamides (sulfa drugs)
disulfiram (Antabuse), used to treat alcohol abuse
fluoxetine (Prozac)
monoamine oxidase inhibitors (MAO inhibitors) such as phenelzine (Nardil) or tranylcypromine (Parnate), used to treat conditions including depression and Parkinson's disease
tricyclic antidepressants such as imipramine (Tofranil) or desipramine (Norpramin)
corticosteroids
acetaminophen (Tylenol)
aspirin
female hormones (estrogens)
male hormones (androgens)
cimetidine (Tagamet)
central nervous system (CNS) depressants such as medicine for allergies, colds, hay fever, and asthma; sedatives; tranquilizers; prescription pain medicine; muscle relaxants; medicine for seizures; sleep aids; barbiturates; and anesthetics

alcohol
other anticonvulsant drugs

The list above does not include every drug that may interact with anticonvulsant drugs. Be sure to check with a physician or pharmacist before combining anticonvulsant drugs with any other prescription or nonprescription (over-the-counter) medicine.

Resources

PERIODICALS

Reynolds, E.H. "Do Anticonvulsant Drugs Alter the Natural Course of Epilepsy? Treatment Should Be Started as Early as Possible." British Medical Journal 310 (January 21, 1995): 176.