Anti epileptic drugs are serious medications. They can be vital in preventing fits for people with epilepsy, thereby greatly enhancing quality of life. However, if used incorrectly, these drugs can present significant risks. Using anti epileptic drugs wisely is your responsibility as well as your doctor's. It is important to know as much as possible about the drugs you are taking.

Commencing medication

The choice of anti epileptic drugs is based primarily on the type of fit or epilepsy that the person experiences. The dose is usually built up slowly over a period of days or weeks. Anti epileptic medication must be taken as prescribed and changes should only be made in consultation with your doctor. It is important that the correct amount of medication is taken at the same time each day.

Side effects

Hopefully, you will not have any problem with side effects. However, each of the anti epileptic drugs has different side effects, and these can vary from one person to another. The risk of side effects is increased as the number of different drugs in use increases.

The aim of anti epileptic drug therapy is simple: no fits and no side effects. In some people these aims can be achieved easily, but in others the balance between fit control and adverse effects is delicate. Open discussion with the doctor about what to expect, and the impact of any side effects and fits on quality of life is the best way to manage drug therapy.

Missing a dose

Missing a dose can trigger a fit in some people. However, if a dose is missed it can usually be taken with the next dose (double dosing), or as soon as realised. This can sometimes cause adverse side effects for a short time, particularly with tegretol and dilantin. If the daily dose is only taken once a day, double dosing to make up for a lost dose is a problem. If, on the other hand, the drug is given as two to three doses per day the aim should be to replace the missed doses as soon as possible.

If you have been missing doses and there are more fits as a result, be honest with the doctor about the reason. Otherwise the doctor may increase the dose unnecessarily.

To avoid missing does, place all the tablets required for a day or a week in a special container called a dosette box. These are available through epilepsy associations and some pharmacies. A glance at the dispenser will reassure you that no dose has been missed.

Do not allow yourself to run out of medication. Always keep a spare prescription at home or with your chemist.

Blood level monitoring

There are big differences between people in how fast anti epileptic medication is broken down by the liver. As a result, If the same dose is given to several people, a very different drug concentration in the blood can result. Hence, you cannot compare the dose for one person with that of another person.

In recent years, doctors have been monitoring blood levels of anti epileptic drugs less often than previously and it is no longer recommended as a routine procedure. However, where there are signs of toxicity the blood level should be monitored, particularly in the case of dilantin.

Interactions with other drugs

Do not use any other medication without asking the doctor. Other medications may interact with the anti epileptic drugs causing increased side effects or more fits. It is safe to use paracetamol for headache or fever and most antibiotics (except erythromycin if you are using tegretol) for infections.

Other people's drugs

Never use other people's drugs. Even if a friend says they get better control with a different drug, seek the doctor's advice. Anti epileptic drugs have been prescribed with your particular needs in mind.

Storage

Keep anti epileptic medication in a cool dry place out of the reach of children. Throw away drugs you are no long using. (Never give them to someone else).

What to take with the drugs

Anti epileptic drugs should be taken with fluids and with food because of occasional heartburn or indigestion. Dilantin should not be taken with milk.

Vomiting and diarrhoea

Vomiting and diarrhoea can result in insufficient amounts of the drug getting into the body and thus into the brain. If vomiting occurs within minutes of taking medication, another dose should be taken. If vomiting continues the doctor should be consulted. If there is diarrhoea, the drug may be excreted and so not absorbed and more may be needed. Seek medical advice.

Addiction

Doctors will say that the majority of anti epileptic drugs are not addictive. The only commonly used anti epileptic drugs with addictive potential are the benzodiazepines (anti epileptic forms are diazepam, stesolid, valium etc). However, almost all anti epileptic drugs are addictive, in that withdrawing the drug suddenly will cause withdrawal symptoms, both normal withdrawal symptoms (cold turkey) and possible increases in fit levels. Anti epileptic drugs should never be stopped suddenly and never without the doctor's advice. Only if serious side effects appear such as an allergic skin rash or acute liver damage must treatment be stopped more quickly. It is likely that another anti epileptic drug would then be introduced immediately.

(not available)   Weaning from drugs

The strategy for weaning from drugs is complex, and needs to be planned in detail with the doctor. The process of weaning is particularly important in relationship to the ketogenic diet. Some anti epileptic drugs interact with the diet and should be withdrawn before the start of the diet; the effect of others may be amplified by the use of the diet, so that the levels need to be cut, and there is the overall strategy for reducing or eliminating drugs as the diet becomes effective.

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