Epilepsy Talk

Epilepsy Medication Conflicts… | November 22, 2011

Common wisdom is that it’s best to take one anti-seizure medication. But for many of us, monotherapy just doesn’t work. However adjunct therapy has its dangers. And both treatments carry their own interactive risks – even with things as innocent as aspirin.

For example, some seizure medicines can lower or raise the levels of other types of medicines in your blood. Some combinations cause the levels of both medications to fall. Some cause one level to fall and one level to rise. And some cause unpredictable side-effects.

So I hunkered down to discover the unhappy marriages between anti-seizure meds. I’m sure there are many more, but it’s a start. And more than I knew before embarking on this research. Here’s what I discovered…

Depakote (valproic acid) can cause serum Phenobarbital to increase by as much as 40%. A reduction of Phenobarbital by up to 80% may be necessary to avoid side-effects. Aspirin, Persantine, or Warfarin taken together with Depakote can be lessened in efficacy. The serum concentration of Lamictal is increased by 211%, causing possible toxicity.

Dilantin (phenytoin) efficacy will decrease with alcohol intake, increases metabolism of corticosteroids and oral contraceptives, lessening oral contraceptives effectiveness and other anticonvulsants. In addition, Cordarone, Prilosec and Chloromycetin increase Dilantin levels.

Klonopin (clonazepam) increases Dilantin levels. But it’s useful in treating myoclonic seizures in children and absence seizures. It may also be used (sometimes in combination with other drugs) to treat: akinetic seizures, Lennox-Gastaut syndrome, absence seizures, infantile spasms and restless legs. May cause drowsines.

Phenobarbital increases metabolism of oral anticoagulants, steroid hormones, oral contraceptives, anti-epilepticus (other anti-epilepsy drugs), and heart medications, which means they are LESS effective. It is also an immuno-suppressant. Serum Phenobarbital concentrations may increase considerably after adding Depakote.

Tegretol (carbamazepine) increases estrogen metabolism, thus decreasing effectiveness of oral contraception. Serum levels of other anticonvulsants may decrease due to increased metabolic activity. It may also decrease effectiveness of anti-depressant and anti-psychotics, plus it decreases Dilantin, Zarontin, Depakote, Lamictal and Gabitril levels.

Valium (diazepam) by injection can cause shock, coma and acute alcohol intoxication in infants less than 30 days old. By tablet, it can cause glaucoma in children less than 6 months. Safe use in pregnancy is not established.

Zarontin (ethosuximide) levels of Zarontin in the blood is reduced if it is taken along with Tegretol, Dilantin, Mysoline or Phenobarbital.

Why are there so few drugs listed?

Because most of the negative interactions come from the earliest anti-convulsives. Modern AEDs have measurably fewer negative interactions. Which is a GOOD thing!

Now, if they could just get rid of those nasty side-effects!







  1. …………………


    Comment by mkfarnam — November 22, 2011 @ 7:54 PM

      Manageable or not,,, Good to know where, when & how our “remedies” could have potential RISKS & cause UNTENDED difficulties.

      Knowing the SIDE-EFFECTS & consequent hardships ahead of time, can possibly help AVOID far more tragedies, FATAL-deadly family & social conflicts.

      Thanks for a very interesting link & GREAT ARTICLE.

      Liked by 2 people

      Comment by Gerrie — April 26, 2012 @ 7:12 PM

      • I agree. Conflicts can be deadly and often you don’t know about them, until you suffer the consequences and possible toxicity.


        Comment by Phylis Feiner Johnson — October 8, 2015 @ 11:50 AM

  2. Dilantin helps to control my Lamictal level. Once they took me off of Dilantin and my Lamictal level shot up and became toxic.


    Comment by Chris Arceneaux — October 8, 2015 @ 11:28 AM

    • Interesting, because Dilantin made me a zombie and Lamictal itself is working wonderfully for me!


      Comment by Phylis Feiner Johnson — October 8, 2015 @ 11:46 AM

      • I have been on Dilantin for over 16 years and on Lamictal for about 9 years.


        Comment by Chris Arceneaux — October 8, 2015 @ 1:45 PM

  3. So Chris, BOTH work for you together…as long as you take them in sync?


    Comment by Phylis Feiner Johnson — October 8, 2015 @ 4:52 PM

  4. TOPAMAX is it a STEROID?


    Comment by Paula — May 14, 2016 @ 11:02 PM

  5. Topamax is an anti-seizure medicine, also called an anticonvulsant. Topiramate (the generic name) is used to treat seizures in adults and children who are at least 2 years old.

    Topamax is also used to prevent migraine headaches in adults and teenagers who are at least 12 years old. This medicine will only prevent migraine headaches or reduce the number of attacks. It will not treat a headache that has already begun.



    Comment by Phylis Feiner Johnson — May 15, 2016 @ 10:54 AM

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    About the author

    Phylis Feiner Johnson

    Phylis Feiner Johnson

    I've been a professional copywriter for over 35 years. I also had epilepsy for decades. My mission is advocacy; to increase education, awareness and funding for epilepsy research. Together, we can make a huge difference. If not changing the world, at least helping each other, with wisdom, compassion and sharing.

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