Epilepsy Talk

Combined Meds — What They Are Doing to Your Body | April 9, 2021

For many of us, monotherapy just doesn’t work.

However adjunct therapy has its dangers.

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 drowsiness.

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!

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  1. Reblogged this on Ken's Devotions.


    Comment by Kenneth — April 9, 2021 @ 11:19 AM

  2. It’s hard enough battling with epilepsy and the meds don’t make it any easier.

    Liked by 1 person

    Comment by Ed Lugge — April 9, 2021 @ 12:09 PM

  3. For refractory epilepsy, (not well controlled by an AED), the ketogenic diet is MORE successful than adding a second medication.
    This is not the opinion of some whackadoodle website. This is medically proven fact.
    Are cookies and cakes really worth risking all those drug interactions and increased side effects, not to mention not really having your seizures improve much if at all on multiple meds?
    People are willing to have their heads cut open or keep double and triple poisoning themselves with meds, all so they can keep eating pasta. I just don’t get it.

    Liked by 1 person

    Comment by paleobird — April 9, 2021 @ 2:07 PM

  4. My only question is: would the keto diet supplement the primary AED? (Not replace it?)


    Comment by Phylis Feiner Johnson — April 9, 2021 @ 2:10 PM

    • It can do either depending on your particular case. I used keto as an adjunct treatment for years before I worked up the nerve to titrate off the meds.

      Liked by 1 person

      Comment by paleobird — April 9, 2021 @ 2:17 PM

      • Thanks lots for the explanation. Makes sense to me. (But I don’t know if I’d have the discipline, to be honest.)


        Comment by Phylis Feiner Johnson — April 9, 2021 @ 3:01 PM

  5. How does eating bacon and eggs for breakfast and steak for dinner require discipline?
    Side effects for me were losing 60 pounds, no more aching knees, and no more migraines. Plus a whole bunch of little stuff like no dry skin, hair and nails strong and healthy, great sleep, etc. It’s an overall upgrade in quality of life, not just a diet.

    Liked by 1 person

    Comment by paleobird — April 9, 2021 @ 3:43 PM

  6. I hear you. You’re singing to the choir.

    Unfortunately, I can only eat fish and chicken, because I am allergic to all mammals.

    If it has four legs, no. It’s only fins and feathers for me. (Some missing protein which they discovered 43 years ago, after 23 years of being sick.)

    So, I can go to town with dairy, etc. but I sure do miss that meat. (I still dream about it!!!)


    Comment by Phylis Feiner Johnson — April 9, 2021 @ 5:31 PM

    • Interesting. But there are still a lot of edible critters that aren’t mammals. Chicken, duck, goose, ostrich, emu, plus all the wonderful seafoods and alligator is yummy. Are you OK with eggs? Poultry eggs plus fish roe. I wonder if marsupials count as mammals for your allergy. Kangaroo is delicious.

      Liked by 1 person

      Comment by paleobird — April 9, 2021 @ 10:41 PM

      • p.s. There are also great keto foods from the plant kingdom such as avocados and coconuts.
        Have you ever tried cricket flour? I make fabulous waffles with it. No mammals involved.

        Liked by 1 person

        Comment by paleobird — April 9, 2021 @ 10:45 PM

      • I love game. Ostrich, emu duck, goose, all of the above.

        I roast a yummy chicken weekly and Arthur makes killer omelettes. (Sometimes with avocado.)

        So, I’m not exactly starving. And yes, I get your point! 🙂


        Comment by Phylis Feiner Johnson — April 10, 2021 @ 9:17 AM

  7. as they’ve never found a reason for my epilepsy, even saying it’s PINES, I’ve been on every drug around, and neuros don’t like to hear me complaining so I’ve always done my own research if I suddenly get bad symptoms with a new drug to see how it works, works with others, it’s is alarming how they can react on each other

    Liked by 1 person

    Comment by Gail Barry — April 10, 2021 @ 4:56 AM

  8. yes, had issues with certain seizure meds , dilantin {evil evil just evil } took that with phenobarb, mysoline .. did fine on , even while pregnant , my ob , was in touch with neuro told him drop the phenobarb,{ becuz mysolne had it in there .. } ,& drop the dilantin .. after my last baby , dr put me back on it even after the first born , put me on HCTZ for HBP { High blood pressure } .. even made toxic levels , then no levels , even with HTCZ , tend to make go higher / lower, read on drugs dot com ,worst drugs to mix, making levels either toxic , or worst.. then went to book store to buy a PDR , really helped too started reading up even told the pharmacist , even my dr , they both said nah , no way , then told them check drugs website & the PDR , They both agreed i was right .. had a great teacher when i worked as a pharmacist tect ..

    Liked by 1 person

    Comment by Cathy Flowers — April 10, 2021 @ 10:01 AM

  9. The serum concentration of Lamictal is increased by 211%, causing possible toxicity.Can you give me a link about this please? Great article!

    Liked by 1 person

    Comment by Marianna Zacharatou — April 10, 2021 @ 3:45 PM

  10. With all the seizure meds out there i told my neuro that we need to go thru all the meds one by one, before i start on 2 at a time. It’s hard enough to know how one works let alone 2 and together. UGH And some symptoms won’t show up for months.

    Liked by 1 person

    Comment by Zolt — April 11, 2021 @ 10:41 PM

  11. That’s an intelligent but difficult trail. You might be at it for eons!!!!


    Comment by Phylis Feiner Johnson — April 12, 2021 @ 10:07 AM

  12. My husband JUST “Refreshed My Memory.” Needless to say, he remembers a lot of events. This is one of them:
    Some years back, I had gone to a doctor for an eye problem. He gave me a *Pain Pill to help with the situation. He couldn’t Rx Hydrocodone because at the time everyone was so paranoid about giving this stuff out. A weekend was coming up, and the best he could do was Rx *Darvocet. Which, unknown to us, *ups Dilantin levels. Over several days, my Dilantin went toxic and one morning I came downstairs and then just fell over, flat on my face, in the kitchen. Had to get rushed to a hospital, where some wise intern decided to get levels on my meds. Even after insurance, because a doc couldn’t Rx $5 worth of pain pills, my life was put in jeopardy and we were $3,000 poorer. Nuts.

    As of NOW, I am still taking what used to be *Mysoline, now called, *Primidone (250Mgs. twice a day), *Zonisamide, ( 50Mgs., down from *400Mgs. a day) and
    *150Mgs. of *XCOPRI at bedtime. I wait until getting upstairs or just before when taking this pill! So there’s a Different Time when taking the other anti-seizure med Much Earlier. *XCOPRI Is A POWERFUL Drug! When first given, I would walk “Zig-Zag.” And when TRYING to go up the steps, I would PULL myself up *14 steps with help of the hand rail. Joe would carry my water, cell phone and Daily Journal upstairs ahead of me. I was started on just 50Mgs. at bedtime and gradually increased. “The Limit” is 200Mgs. I’m NOT going any further than 150Mgs. It has even made my vision more blurry, at times.

    Liked by 1 person

    Comment by Effie Erhardt — September 30, 2021 @ 12:14 AM

    • Wow. You have a horrible and daunting road to follow.

      I remember going toxic on Dilantin and it was a day at the beach compared to you.

      And that’s just one cross for you to bear. I’m so very sorry, Effie.

      Liked by 1 person

      Comment by Phylis Feiner Johnson — September 30, 2021 @ 8:36 AM

  13. I’ve had so MANY of AED’s since 1961, and to tell all side effects from them all would tale more words that the A to Z WORLD BOOK ENCYCLOPEDIA has in that, but Who uses that today? EVERY AED made has never had any positive effects of the brain chemicals of GABA & GLUTAMATE ”THAT I KNOW ABOUT” where brain chemistry can be calmed & relaxed more than having a brain chemistry which is UNSTABLE, ALWAYS ACTIVE & NEVER CALM to have a normal life of clear THINKING 365 days a year, before a seizure is on the march ready to attack the brain chemistry. All to say THINK BACK of the past 4 months. TOMATOES were in season which they have a NATURAL GLUTAMATE in their natural grown sources of how a tomato is grown, People ate MORE tomatoes & even some made tomato juice for later in the cold months to drink or make soups with using it or to have spaghetti. Who would think seizures could happen from that ? BUT a rise of GLUTAMATE in the BBB Blood Brain Barrier CAN make a seizure happen shortly after any meal where GLUTAMATE from a natural food OR MSG’s in other toxic foods will do the same. Yet,, when you use SUGAR mixed in your spaghetti or anything else that tomatoes are in the food meal, you may help that brain chemistry have more of a BALANCE between the levels of GLUCOSE & GLUTAMATE where those 2 chemicals are so important to have a balance that the brain needs to stay CALM & RELAXED so seizures NEVER happen after any meal, which I try hard myself to WATCH & KNOW everything that has the EXCITOTOXINS & those foods like a TOMATO knowing that frying them with ADDED SUGAR ion the top of them with BUTTER BREAD is 1 of the SAFEST MEALS I CAN EAT knowing no seizure is going to be the result, plus you can’t eat a fried tomato WITHOUT sugar on it, not in WV, VA, MD or PA anyway. NEVER use ASPARTAME’s or any other sugar substitutes you can easily find anywhere. STEVIA though is to be ”the safest to use”, even as it will have with most brands ADDED aspartame in it. As always learn & read all food substitute labels and all other labels even in all drugs & every OTC drugs & NON drug items, especially all DENTAL items. That’s right, at least 95% of anything we can buy to digest that goes to the stomach by chewing or just drinking, CAN cause abnormal & unstable brain chemistry, & WE DON’T KNOW THAT until a seizure activity starts happening & we ask WHY ? & WHAT is causing this again to happen ? So SUGAR is not as bad as everyone says it is. ASPARTAME is the BRAIN CELL & NEURON DESTROYER as is MSG, NITRATES & NITRITES, and there is NO AED to help the GABA levels increase to help keep brain chemistry calmer & relaxed more by keeping more INHIBITORY nerve endings more stable. Instead it seems as if most to almost all AED’s make the EXCITITORY nerve endings if the brain, which effects GLUTAMATE actions, to be more active, that causes more seizure activity AND seizures for everyone, even if they have never had a diagnosis of epilepsy. So WHY are we on drugs to begin with if they will never help stop seizures ? remember harvest time is over, and Will LESS seizures be a result because tomatoes are not around much now ? until MAY of 2022. NEUROLOGISTS will never tell you this. But they WILL say YOU NEED A RNS, VNS, or more drugs, or brain surgery. That is MONEY for them.

    Liked by 1 person

    Comment by James D — September 30, 2021 @ 9:14 AM

  14. When reading the last letter of information, I was chewing on *half a stick of “EXTRA” Peppermint chewing gum. Had to get my LARGE Magnifying Glass and flashlight to Read The Ingredients. “Contains *less than 2% ASPARTAME. As if this is not much. Most of the time, I use *STEVIA IN THE RAW. Have some here on my table. There have been times when I didn’t feel like looking for that small, zip-loc bag, when in a restaurant. I will know to take the extra time, now.
    What do you think I usually eat at a restaurant? *SPAGHETTI! And I plan on making this, tomorrow–*WITH Sugar in the Tomato Sauce.
    I checked the two iced teas in fridge. They have sugar, only.

    I SO Agree as to “WHY” take AED’s when they do not control seizures. Medical Marijuana seems to REALLY Work for some people. I know someone on FB who *Vapes it. I’m not a smoker and will not do this. He might use the drops, also. Mike is very brilliant in this. He knows the Chemistry of the plant. Anyway, Mike is now Seizure Free and NOT taking any AED’S. Something I wish that ALL of us could achieve.

    Liked by 1 person

    Comment by Effie Erhardt — September 30, 2021 @ 9:54 PM

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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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