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!