Epilepsy Talk
Combined Meds — What They Are Doing to Your Body | January 27, 2023
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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Resources:
https://epilepsysociety.org.uk/about-epilepsy/anti-epileptic-drugs/side-effects-and-interactions
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1885026/
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3001218/
https://www.ncbi.nlm.nih.gov/pubmed/19225371
https://www.ncbi.nlm.nih.gov/pubmed/21358975
https://epilepsysociety.org.uk/about-epilepsy/anti-epileptic-drugs/side-effects-and-interactions
https://www.pharmacology2000.com/Central/Epilepsy/Epiobj1.htm
7 Comments »
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About the author
Epilepsy Talk 
I’ve been using two or three AEDs together all my time with epilepsy. My neuros haven’t been helpful, were careless with my meds, just throwing a new drug at me or increasing levels beyond safe levels. I’ve learnt to check out interactions, toxic levels if I have some strange, unexplained symptoms eg vision
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Comment by Miss Gail Barry — January 27, 2023 @ 10:12 AM
As you know, you are your best advocate. Who knows your body better?
Have you considered a new doc?
If so, below is a compilation by website forum members who have had positive personal experiences with docs over the years.
This list is based on recommendations and, of course, is purely subjective. But it might be helpful for anyone looking for a good Neurologist…Epileptologist…Neurosurgeon…or Pediatric Doctor.
NOTE: The National Association of Epilepsy Centers (NAEC) provides a directory of specialized epilepsy centers in the U.S. along with other useful information about epilepsy. https://www.naec-epilepsy.org/about-epilepsy-centers/find-an-epilepsy-center/
2023 Patient Recommendations for TOP Neurologists…Epileptologists…Neurosurgeons…and Pediatric Doctors https://epilepsytalk.com/2023/01/04/2023-patient-recommendations-for-top-neurologistsepileptologistsneurosurgeonsand-pediatric-doctors/
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Comment by Phylis Feiner Johnson — January 27, 2023 @ 10:17 AM
Good combinations happen, too, with you in control. Most meds deplete the body of some vital nutrient. Adding supplements can make a big difference.
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Comment by HoDo — January 27, 2023 @ 10:38 AM
HoDo, you might find this article interesting:
Brain Food For Your Health… https://epilepsytalk.com/2022/03/31/brain-food-for-your-health-2/
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Comment by Phylis Feiner Johnson — January 27, 2023 @ 10:51 AM
I would add choline to that list, just on gut feel. And though doctors rarely recommend supplements, my neurologist put me on Coenzyme Q10, for which I am grateful.
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Comment by HoDo — January 27, 2023 @ 3:44 PM
Depakote and Lamictal at the right dose work well together however, it takes some adjusting to find that sweet spot. Prior to finding the right dosage combination, there were subtle symptoms that led to full toxicity which resulted in several hours in the ER. ER doctor diagnosed Acute Vertigo, and we (the neurologist) later discovered it was toxicity. All this was explained prior to initiating the new med but, the symptoms like visual changes happened so gradually- we missed it. In our case this combination raised medication levels.
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Comment by Patti — January 27, 2023 @ 11:13 AM
Beside being addicted to a drug, what is even more dangers to brain chemistry when you are taking more than 1 controlled substance drugs /CSD’s like EXCPORI & VIMPAT together ? No seizures is great, as I say at any costs BUT when somethings can happen & you are not aware of it, then you wonder if having seizures are not a bad thing.
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Comment by James D — January 27, 2023 @ 1:27 PM