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Drugs for Epilepsy

EPILIM Sodium valproate, Reckitt & Colman Pharmaceuticals

This is another extremely useful drug with a wide range of anti-epileptic activity. It is thought to act by increasing the brain's levels of the inhibitory neurotransmitter, GABA.

Epilim is presented as lilac colored tablets of 200 mg and 500 mg strength. These should be swallowed whole. It is also available as crushable tablets of 100 mg strength, and as syrup of 200 mg/5ml strength, and sugar free liquid of similar strength.

It is usual to give Epilim twice a day, with meals, with roughly 12 hours between doses. Since blood levels of Epilim are unreliable as a guide, adjustment of the dosage is made according to the patient's body weight, and the adequacy of seizure control. The usual dose range is 20 to 30 mg/kg body weight/24 hours.

Mild side effects, especially nausea and diarrhea in the first few days, are common. A fine tremor of the hands is often noticed in patients taking Epilim over the long term. Weight gain and loss of hair (usually reversible) can also occur.

Very rarely, Epilim may produce acute liver disease, and there have been instances of acute liver failure, some fatal. Small children and infants with serious underlying medical conditions are most at risk. The question of the safety of Epilim has received careful study by Australian health authorities, and its continued use has been endorsed, for it is in practice a widely used, effective, and well tolerated medication.

It is suggested that Epilim be avoided in patients with a history of liver disease, and that blood tests to check liver function and the level of platelets in the blood (sometimes reduced by Epilim) be carried out before starting treatment, and repeated after one month's treatment, and thereafter at intervals of not more than 6 months. Minor abnormalities of liver function are common in patients taking most anti-epileptic drugs, but evidence of increasing abnormality would require substitution of Epilim.

Symptoms of this rare complication of liver failure include severe nausea persistent abnormal pain, jaundice (yellowish discoloration of the skin), severe nausea, weakness and tiredness, and swelling of the face. Any of these symptoms should be reported to the treating doctor.

ZARONTIN Ethisyxunudem Parke 

This drug is effective in controlling one form of epilepsy only, namely absence seizures (formerly known as "petit mal"). As this form of epilepsy begins in childhood, Zarontin is made available as a red syrup (250 mg/5 ml) and as capsules (250 mg). The dose required will vary according to blood levels and body weight, the average dose for a child aged 6 years being one capsule, 2 or 3 times a day.

Side effects are not common, but include nausea and digestive upset, drowsiness and sleep disturbance.

DILANTIN Phenytoin sodium, Warner-Lambert

This is the oldest of the effective major anti-epileptic drugs. It is still one of the most potent in preventing major seizures of tonic-clonic and other types, but its troublesome side effects have meant that the other, newer drugs such as Tegretol and Epilim are usually selected instead. Dilantin has a powerful action in controlling seizures, and is very useful as an additional drug where seizures cannot be controlled by one drug alone, or when it is not intended to continue treatment over a very long period (for example, when anti-epileptic drugs are given routinely for a year or two after brain surgery).

Dilantin is presented in capsule form (100mg, orange and white capsules, 30mg, all white capsules), in liquid form (30 mg/5ml strength for children, 100 mg/5ml. "Dilantin Forte Suspension" for adults), and as chewable tablets for children (50 mg, "Infatabs")

The drug is slowly released, so that theoretically it would be possible to take the medication as a dingle daily dose; however, people's memories being what they are, it is recommended that the medication be taken twice a day (e.g. after breakfast, and after the evening meal as a routine). The usual dose for an adult of average size is 3 to 4 capsules of 100 mg strength per 24 hours.

Dilantin overdose produces symptoms similar to drunkenness, with drowsiness, unsteadiness on the feet, etc. Blood levels of Dilantin will indicate the true picture.

Short term side effects of Dilantin are not usually a problem, but side effects developing gradually over a period of years do present serious objections to its long term use, especially as other effective anti-epileptic drugs which do not have these problems are now available. These long-term side effects of Dilantin are the growth of hair on the face, arms and legs, especially in female patients of dark complexion, unhealthy overgrowth of the gums, with a tendency for them to bleed, and mental sluggishness and loss of memory.

If Dilantin is to be taken over a long period, special attention should be paid to brushing the teeth and generally maintaining good oral hygiene. An uncommon complication of Dilantin therapy is the development of an allergic measles like rash, which requires substitution of the drug with another.

TEGRETOL Carbamazepine, 

This is a powerful anti-epileptic drug with a wide range of activity. It is available as white tablets of two strengths (100 mg and 200 mg), and is usually given twice a day (say after breakfast, and then after the evening meal, around 12 hours later). An average sized adult usually requires between one and two tablets (200 mg size, twice a day).

If the dose is too high, the patient may appear to be "drunk", with drowsiness, lack of co-ordination in walking, etc. Reduction of the dose, based on blood levels, is all that is required.

Side effects (unwanted symptoms occurring in someone whose levels are correct) are common in the first few days or week or two, especially giddiness and light headedness, mild nausea, and dryness of the mouth. These usually disappear within a few days. They are less likely to occur if Tegretol is introduced in a gradual way. A measles-like rash sometimes occurs during Tegretol treatment, and in this event, Tegretol must be replaced by another anti-epileptic drug. Serious side effects are fortunately rare. They include jaundice due to liver involvement, and lowering of the white cell count of the blood, resulting in persistent ulceration of the throat and mouth.

The manufacturers recommend that blood tests (full blood count, tests of liver and kidney function) be carried out before starting Tegretol, and that the full blood count be repeated weekly for the first month of treatment, then monthly for the first year.

In practice, Tegretol side effects are usually mild, and disappear within the first week or two. It is arguably the most powerful and useful anti-epileptic drug currently available.


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