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How long does it take for drugs to work?
Side effects
Interactions with other drugs
Common epilepsy drugs used in Ireland
While there is no cure for epilepsy, it can be controlled with a range of different medicines to allow people to get on with a full and active life. Anti-epileptic drugs (known as AEDs), prevent seizures by acting on the brain. Although it is not fully understood how they do this, they have been proven to be very effective.
There are many different AEDs. The key to good control of epilepsy is that medicines are tailored to each individual. A hospital specialist or GP is the person who will decide the most appropriate drug, while an epilepsy nurse may also be involved in follow-up advice. The usual approach is that your health professional will start with a low dose of a selected AED and gradually increase the dosage if necessary to achieve the best results in your particular case.
Different AEDs work in different ways. If one drug doesn’t work, then the doctor will try different dosages and perhaps try another drug. If controlling seizures proves difficult, then a doctor may decide to try a combination of drugs. Epilepsy medicines come in different dosages and strengths. They also come in different forms like tablets, capsules, liquid or crushable.
How long does it take for drugs to work?
The time it takes to get seizures under control varies from person to person. Some people may find that as soon as they start their AED, their seizures stop. In other cases, different drugs or combinations of drugs and different dosages may need to be tried before good results are achieved. People taking exactly the same amount of a particular drug, may find that their reactions greatly differ.
When changing from one drug to another, there is a risk that seizures may occur. Therefore, it is usual that a new drug is introduced prior to the existing one being stopped.
The aim with AEDs is to have the required level of medicine in the blood system to control seizures. It important that the instructions on the prescription are carefully followed and people look after their care, with regular visits to a health professional to discuss progress. People who are seizure free for a number of years may feel that they would like to stop using their AED. It is very important not to stop taking an epilepsy drug unless this has been discussed with a doctor and it has been recommended. This could trigger a seizure.
Epilepsy treatment is kept under review. So if you feel that a drug is not working as well as it used to, it is important to discuss this with the doctor.
Side effects
Patient information leaflets, which are supplied with your prescription, set out the possible side effects associated with that particular drug. In reality few people will experience side effects and in those who do, they are likely to be mild. Any side effects should be reported to your health professional. The most common ones include drowsiness or dizziness, particularly in the early days of taking a drug. If these effects are persistent, medical advice should be sought.
Interactions with other drugs
AEDs can affect each other as well as other medicines. This will be taken into account when drugs are prescribed. For example some AEDs interact with the contraceptive pill. (See article on Contraception and epilepsy). Some medicines can interact with the epilepsy itself, which can make seizures more likely. Medicines of this nature include anti-depressants, anti-histamines and certain anti-malaria drugs.
The overall picture regarding various aspects of health should be discussed with your doctor to see what medicines you need to be taking and what side effects or interactions might be expected.
Another issue to discuss with your doctor or pharmacist is the question of routine remedies that are bought in a pharmacy and whether there might be possible interactions. Read the instructions with the packet very carefully. Also check with your doctor/pharmacist about herbal and other remedies, which are not regulated and may not have any information leaflets.
Common epilepsy drugs used in Ireland
Carbamazepine (Tegretol, Tegretol Retard)
Used for generalised tonic-clonic and partial seizures
Possible side effects: Skin rash, double vision, unsteadiness and nausea may occur initially or if the dose is too high.
Clobazam (Frisium)
Used for generalised tonic-clonic and partial seizures, but tolerance frequently develops.
Possible side effects: Drowsiness may occur but this drug is much less sedating than clonazepam or diazepam.
Clonazepam (Rivotril)
Used for partial seizures, absences and myoclonic jerks.
Possible side effects: Drowsiness and sedation are quite common, but these may wear off and tolerance tends to develop.
Ethosuximide (Zarontin, Emeside)
Used for absence seizures only.
Possible side effects: Nausea and drowsiness may occur.
Gabapentin (Neurontin)
Used for partial seizures where previous treatment has been ineffective.
Possible side effects: Drowsiness, dizziness, headache and fatigue.
Lamotrigine (Lamictal)
Used for partial seizures and generalised seizures where previous treatment has been ineffective
Possible side effects: Skin rash, drowsiness, double vision, dizziness and headache.
Levetivacetam (Keppra)
Used for partial seizures.
Possible side effects: Drowsiness, headache, memory problems, tiredness, dizziness.
Oxcarbazepine (Trileptal)
Used for partial seizures.
Possible side effects: Drowsiness, dizziness, headache, nausea, double vision.
Phenobarbitone
Used for generalised tonic-clonic and partial seizures.
Possible side effects: Nausea, unsteadiness and drowsiness may occur initially but sedation and slowing of mental performance may persist.
Phenytoin (Epanutin)
Used for generalised tonic-clonic and partial seizures.
Serum level monitoring essential.
Possible side effects: Skin rash, drowsiness, unsteadiness and slurred speech.
Coarsening of facial features, overgrowth of gums and acne may be a problem with prolonged therapy.
Pregabalin (Lyrica)
Used for partial seizures, with or without secondary generalisation.
Possible side effects: Dizziness and drowsiness.
Primidone (Mysoline)
As Phenobarbitone
(Primidone is partly metabolised to phenobarbitone in the body)
Sodium Valproate (Epilim)
Used for generalised tonic-clonic and partial seizures and absences.
Drowsiness and tremor are infrequent side-effects. Hair loss occurs in some people and on occasions excessive weight gain may occur. However, these effects are usually reversible if the dose is reduced.
Tiagabine (Gabitril)
Used in partial seizures where previous treatment has been ineffective.
Possible side effects: Dizziness, fatigue, anxiety, tremors, concentration difficulties, depression of mood, jerkiness of limbs.
Topiramate (Topamax)
Used in partial seizures where previous treatment has been ineffective.
Headache, slowing of mental performance, drowsiness, dizziness, pins and needles in hands and feet, loss of weight, kidney stones.
Vigabatrin (Sabril)
Used for partial and secondary generalised seizures where previous treatment has been ineffective.
Possible side effects: Drowsiness, nausea, behaviour and mood changes. Psychotic reactions have been reported
NB: People taking Vigabatrin should have a regular eye sight check up, particularly to monitor visual field problems.
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