Antiseizure Medications

(Modified January 2024)

The first chart below addresses common questions about antiseizure medications.  The second chart addresses adverse effects and drug interactions.

Antiseizure Medication FAQs

Question

Answer/Pertinent Information

How are antiseizure medications chosen?

Efficacy for seizure type (examples):

  • generalized tonic-clonic or focal seizures in adults:19 carbamazepine, lacosamide, lamotrigine, and valproic acid.c
  • less effective or less evidence:10 eslicarbazepine (focal), gabapentin, levetiracetam, oxcarbazepine, topiramate, and zonisamide.
  • absence seizures:  valproic acidc and ethosuximide (its only indication) are the drugs of choice for new onset absence seizures.10,19  Lamotrigine is probably less effective and is second line if adverse effects are of concern.10
  • See our chart, Pharmacotherapy of Status Epilepticus, for acute use of injectable benzodiazepines, phenobarbital, levetiracetam, etc.

Side effects

  • Phenytoin, phenobarbital, and primidone have fallen out of favor due to poor tolerability.2
  • Felbamate and vigabatrin are last-line due to serious side effects.2
  • See Adverse Effects and Drug Interactions of Common Antiseizure Medications chart, below.

Comorbidities: antiseizure meds may be:2

  • chosen to help treat a comorbidity (e.g., valproic acidc for mood disorders or migraine; pregabalin for neuropathic pain).
  • avoided due to comorbidities (e.g., use zonisamide, topiramate, or levetiracetam cautiously in mood disorders).

Prior response:

  • If a patient does not respond to one antiseizure med, those with a similar mechanism of action (e.g., carbamazepine, eslicarbazepine, oxcarbazepine) are not likely to be effective.2
  • For treatment-resistant seizures (after trials of two appropriately dosed antiseizure meds), newer agents are used as monotherapy or add-ons (examples):19
  • focal seizures in adults:  pregabalin IR (add-on), eslicarbazepine, perampanel, lacosamide, or cenobamate.11,19
  • focal seizures in pediatrics:  levetiracetam (add-on), oxcarbazepine (add-on), or zonisamide (add-on).11
  • generalized tonic-clonic seizures:  lamotrigine (add-on) or levetiracetam (add-on).11

 

What are the adverse effects and drug interactions with antiseizure medications?

See chart below (Adverse Effects and Drug Interactions of Common Antiseizure Medications).

See the FDA drug safety communication about lamotrigine (https://www.fda.gov/safety/medical-product-safety-information/lamictal-lamotrigine-drug-safety-communication-studies-show-increased-risk-heart-rhythm-problems).

Which antiseizure medications require routine laboratory monitoring?

 

See our chart, Lab Monitoring for Common Medications.

What are some considerations for antiseizure medications in kidney or liver impairment?

See our chart, Using Common Medications in Liver Impairment.

  • In severe liver impairment, cenobamate, eslicarbazepine, lacosamide, perampanel, and rufinamide are not recommended.1
  • In patients with a history of liver impairment, felbamate is contraindicated (due to risk of liver failure).9
  • Cenobamate, lacosamide, and perampanel require dose reduction in mild or modearte liver impairment.1

In kidney impairment, a dose reduction is needed for eslicarbazepine, felbamate, gabapentin, lacosamide, levetiracetam, oxcarbazepine, pregabalin, and topiramate.1 Dose cenobamate cautiously, and avoid in ESKD.1

Phenytoin:     free (unbound) phenytoin levels are the best reflection of pharmacologic effect in uremic patients or patients with low albumin levels (e.g., cirrhosis).1,2

 

Which antiseizure medications are problematic in the elderly?

 

See our chart, Potentially Harmful Drugs:  Beers List.

What are some considerations for antiseizure medication use in people who are pregnant or lactating?

 

People who are or may become pregnant should take folic acid 0.4 to 4 mg daily.19,21

If possible, avoid valproic acid,c due to the risk of congenital malformations.19     Lamotrigine and levetiracetam seem to have the lowest risk of congenital malformations.19

Ideally, switch to the lowest dose of monotherapy that provides control before pregnanacy.21,24 Once pregnancy has occurred, switching antiseizure medications might not prevent a bad outcome.24

Monitor antiseizure medication levels preconception (to establish an individualized target level), then monthly during pregnancy.21,25

Breastfeeding is usually safe.22  Monitor the infant for drowsiness, other side effects, adequate weight gain, and developmental milestones, especially in younger, exclusively breastfed infants and when using combinations of with antiseizure medications.23  Check levels if toxicity is suspected.23     For drug-specific information, check LactMed (https://www.ncbi.nlm.nih.gov/books/NBK501922/?report=classic).

What are some tips for safe phenytoin use?

Keep in mind that phenytoin pharmacokinetics are non-linear (e.g., a small dose increase may cause a big increase in plasma concentration).1

When switching dosage forms, keep in mind that different dosage forms contain different amounts of phenytoin:  phenytoin capsules and injection are 92% phenytoin; chewable tablets and suspensions are 100% phenytoin.1

Avoid use of the oral suspension.  It is difficult to resuspend by shaking, possibly leading to dosing errors.2

Intravenous phenytoin may cause rate-related hypotension and cardiac arrhythmias.  It also poses risks of injection site reactions, phlebitis, and tissue necrosis if extravasated.12  Avoid intramuscular phenytoin use (poor absorption, tissue injury).1

Phenytoin’s maximum infusion rate is 50 mg per minute in adults.1

Phenytoin can be diluted in normal saline at a concentration not less than 5 mg/mL.1

  • Use a 0.22 to 0.55 micron in-line filter to prevent infusion of crystals.1

For parenteral use, fosphenytoin (a water-soluble prodrug of phenytoin) is preferred to phenytoin.12  Fosphenytoin has a lower risk of injection site problems, admixture compatibility issues, and perhaps a lower risk of cardiac effects.2

  • Each mL of fosphenytoin contains 50 mg phenytoin equivalents.13
  • Fosphenytoin can be given at a faster rate than phenytoin (150 mg phenytoin equivalents/min [adults]).1
  • Itching (non-allergic) and paresthesias are common; rate-related.2

How are nasal or rectal benzodiazepines used for seizures?

Diazepam

  • Nasal option:     
    • Valtoco (US only) nasal spray 5, 7.5, and 10 mg strengths available.  Dosing based on patient’s age and weight.     Consult product labeling for specifics.  Do not use for more than one episode every five days or more than five episodes per month.31
  • Rectal options:
    • Diastat rectal gel 2.5 mg (5 mg/mL) single-dose syringe.26
    • Diastat AcuDial (US only) single-dose syringe in 10 mg (for doses of 5, 7.5, or 10 mg), or 20 mg (for doses of 12.5, 15, 17.5, or 20mg).  Pharmacists lock the syringe to the prescribed dose before dispensing.26
    • Dosing for Diastat and Diastat AcuDial:  2 to 5 yrs of age:  0.5 mg/kg; 6 to 11 yrs of age:  0.3 mg/kg; 12 years and older:  0.2 mg/kg.     Round up to nearest 2.5 mg.  Reduce dose if elderly or debilitated.26     If needed, repeat in four to 12 hours.26   Can give a 2.5 mg replacement dose if part of the dose is expelled.26     Do not use for more than one episode every five days or more than five episodes per month.26
    • Injectable diazepam solution can also be used rectally.
      • 0.2 to 0.5 mg/kg/dose (max 20 mg).27

Midazolam

  • Nayzilam nasal spray 5 mg/0.1 mL single-dose syringe (US only).
  • Dose:  5 mg (one spray) into one nostril for ages 12 yrs and older.28  If needed, can repeat in the other nostril in ten minutes if the patient is not excessively sedated or having breathing difficulties.28  Do not use for more than one episode every three days or more than five episodes per month.27
  • Generic injectable midazolam 5 mg/mL can be administered intranasally.  It is dispensed with a syringe, vial adapter, and nasal atomization device.  
  • Dose:  children 0.2 mg/kg (max 10 mg);1 adolescents and adults 5 mg (<50 kg) or 10 mg (>50 kg).29

Continue to the next section for a chart of Adverse Effects and Drug Interactions of Common Antiseizure Medications

Adverse Effects and Drug Interactions of Common Antiseizure Medications

This chart provides a brief overview of select pharmacokinetic drug interactions and adverse effects.  Information in the chart may differ from product labeling.  Where US product labeling is referenced, information from Canadian labeling is also included if it differs significantly (e.g., more conservative) than US labeling.  **Information is not comprehensive.  Take care when stopping/starting concomitant medications, with serum concentration monitoring, if applicable.**  Also see our toolbox, Appropriate Use of Oral Benzodiazepines.

Drug

Select Adverse Effects (e.g., common, serious)

Select Pharmacokinetic Drug Interactions

Brivaracetam (Brivlera [Canada only] tablet, oral solution, injection)

Dizziness and dose-dependent sedation and fatigue, are common, especially early in treatment (usually mild to moderate).3

Leukopenia or neutropenia.3

Angioedema.3

DRESS.3,a

CYP4503

May modestly increase phenytoin levels, and carbamazepine epoxide levels via inhibition of epoxide hydrolase.3

 

Carbamazepine (Tegretol tablet, chewable tablet, extended-release tablet, suspension, generics; Carbatrol extended-release capsule, generics [US]; Equetro extended-release capsule [US])

Relatively well-tolerated in regard to sedation and cognitive impairment.2

Sedation, diplopia (may be dose-limiting), nausea common with initiation.  Titrate slowly to minimize.2

  • Extended-release products may be better tolerated due to lower peaks.2

Hyponatremia (risk factors:  elderly, diuretic or SSRI use).2,19

Bone marrow suppression (rarely serious; mild leukopenia more common).2

SJS/TEN (especially patients of Asian heritage with HLA-B* 1502 mutation), DRESS.a,2,4 

Hepatotoxicity (very rare).2

Osteoporosis.19

CYP450

P-glycoprotein

Brivaracetam, felbamate, lamotrigine, and valproic acidc may increase carbamazepine epoxide levels.1,b

Induces its own metabolism; levels may decrease over the first month after initiation or dosage increase.2

Reduces efficacy of estrogen-containing contraceptives, oral progestin-only contraceptives, and possibly the etonogestrel implant.6
 Cenobamate (Xcopri)

Generally well-tolerated.32

Common: dizziness, sedation, headache, fatigue, diplopia32

DRESS32

Euphoria (Schedule V controlled substances [US])33

Dosage reductions for phenytoin (up to 50%), phenobarbital, clobazam, and other CYP2C19 substrates may be needed.1

Dosage increases for lamotrigine, carbamazepine, CYP2B6 substrates (e.g., bupropion). And CYP3A4 substrates may be needed.1

Reduces efficacy of oral contraceptives.1

Eslicarbazepine (Aptiom tablet)

 

 

 

Common:  dizziness, sedation, nausea, headache, diplopia, blurred vision, cognitive impairment.7

Hyponatremia.7

SJS/TEN, DRESS.7,a

Bone marrow suppression (rare).7

Hepatotoxicity.7

Cardiac effects (A-fib or A-flutter, increased heart rate, PR prolongation, heart block).8

CYP450

Lower potential for drug interactions due to enzyme induction than carbamazepine.2

Reduces efficacy of estrogen-containing contraceptives, oral progestin-only contraceptives, and possibly the etonogestrel implant.6,20

 

Ethosuximide (Zarontin capsule, syrup; generics [US])

Divide dose to minimize nausea, vomiting, and sedation.2  These usually resolve with continued use, but temporary dose reduction may be needed.2

Neutropenia (rare; mild, transient leukopenia common).2

 

CYP450

May reduce valproic acidc levels, and valproic acidc may increase ethosuximide levels.1

Felbamate (Felbatol,tablet, suspension; generics)

Due to risk of aplastic anemia or liver failure, use only when all other treatment options exhausted.2

Requires informed consent.9

CYP450

Reduces efficacy of estrogen-containing contraceptives, oral progestin-only contraceptives, and possibly the etonogestrel implant.6,20

Gabapentin (Neurontin tablet, capsule, solution; generics)

Sedation, ataxia, and dizziness are common during initiation.2

Cognitive impairment.1

Respiratory depression.1

Visual disturbances.1

Weight gain and peripheral edema.19

No significant pharmacokinetic drug interactions.

Lacosamide (Vimpat tablet, injection, oral solution [US], generics; Motpoly XR capsule [US])

Common side effects: dizziness, ataxia, blurred vision, diplopia, nystagmus, euphoria, headache, nausea, vomiting, tremor.1  Titrate slowly to minimize.2

Slowed cardiac conduction; monitor PR interval.2,19

DRESS.1,a

 

CYP450

Lamotrigine (Lamictal tablet, orally disintegrating tablet [US], extended-release tablet [US], generics; chewable tablet, generics [US])

Generally well-tolerated.19

Common side effects:  dizziness, ataxia, sedation, diplopia, blurred vision.  Titrate slowly to minimize.2

May cause anxiety, agitation (especially in cognitively impaired patients with autism), or insomnia.1,19

FDA safety communication about arrhythmias.30

Serious rash related to speed of titration.  Valproic acidc use increases risk.2

DRESS.4,a

Requires dose adjustment with valproic acidc and/or enzyme inducers.1

Combination oral contraceptives can reduce lamotrigine levels and may increase seizure activity.6

 

Levetiracetam (Keppra tablet, extended-release tablet [US], oral solution [US], injection [US], generics; Spritam oral suspension [US]; Elepsia extended-release tablet [US])

Usually well-tolerated.2  Common side effects:  weakness, dizziness, vertigo, flu-like symptoms, headache, runny nose, sedation.2

May cause mood or behavioral changes, especially in patients with a history of such problems.2

 

No significant pharmacokinetic drug interactions.2

Oxcarbazepine (Trileptal tablets, generics; oral suspension, generics [US]; Oxtellar XR extended-release tablet [US])

Common side effects:  dizziness, ataxia, sedation, nausea, diplopia.2

Hyponatremia (more common than with carbamazepine; risk factors:  elderly, diuretic or SSRI use).2

Skin reactions, including, SJS/TEN (especially patients of Asian heritage with HLA-B* 1502 mutation).1  25% to 30% chance of cross-sensitivity with carbamazepine; DRESS.1,a

Osteoporosis.19

Reports of bone marrow suppression.1

 

CYP450

No autoinduction (as with carbamazepine).2

Lower potential for drug interactions due to enzyme induction than carbamazepine.2

Reduces efficacy of estrogen-containing contraceptives, oral progestin-only contraceptives, and possibly the etonogestrel implant.6

 

Perampanel (Fycompa tablet, suspension [US])

Common side effects:  dizziness, vertigo, ataxia, sedation, fatigue, headache, nausea, vomiting, weight gain, hostility, irritability.1

Euphoria (Schedule III controlled substance [US]).14

CYP450

Reduces efficacy of levonorgestrel-containing contraceptives when perampanel is dosed at 12 mg/day.1

Phenytoin (Dilantin capsule, chewable tablet, oral suspension, generics; injection [generic only])

 

Fosphenytoin (Cerebyx injection, generics)

Also see “What are some tips for safe of phenytoin?” in the FAQ chart, above.

Common side effects:  nystagmus, ataxia, and sedation may be dose-limiting.2  Gingival hyperplasia and hirsutism common.2

Irreversible neurotoxicity associated with acute or chronically high levels.2

Peripheral neuropathy.2

SJS/TEN (especially patients of Asian heritage with HLA-B* 1502 mutation); DRESS.2,4,a

Osteoporosis.19

CYP450

P-glycoprotein

Reduces efficacy of estrogen-containing contraceptives, oral progestin-only contraceptives, and possibly the etonogestrel implant.6

 

Pregabalin (Lyrica capsule, oral solution [US], generics)

Common side effects:  dose-dependent dizziness, sedation, dry mouth, edema, blurred vision, weight gain, cognitive impairment, mostly within the first 14 days of treatment.2,15

PR prolongation.15

Angioedema.15

Myopathy.15

Decreased platelet count.15

Euphoria (Schedule V controlled substance [US]).15

Significant pharmacokinetic interactions unlikely.15

Rufinamide (Banzel tablet, oral suspension [US])

Common side effects:  headache, dizziness, fatigue, sedation, nausea.16

Shortened QT interval.16

Status epilepticus.16

DRESS.16

Leukopenia.16

 

CYP450

Requires lower starting dose in patient taking valproic acid.16,c

Reduces efficacy of estrogen-containing contraceptives, oral progestin-only contraceptives, and possibly the etonogestrel implant.6,20

Tiagabine (Gabitril tablet, generics [US only])

Common side effects:  dizziness, weakness, sedation, nausea, irritability, tremor, abdominal pain, cognitive impairment.17

 

CYP450

Potential interactions with other highly protein-bound drugs (e.g., valproic acidc).2

Topiramate (Topamax tablet, sprinkle capsule, generics; Eprontia oral solution; Qudexy XR extended-release capsule [US], generics; Trokendi XR extended-release capsule [US])

 

 

 

 

 

 

 

 

 

Common side effects:  metabolic acidosis (often asymptomatic), paresthesias, hyperammonemia, nausea, nystagmus, fatigue, weight loss, bad taste, anorexia, abdominal pain, sedation, dizziness, cognitive impairment, diplopia.1  Titrate slowly to minimize cognitive effects and lethargy.2

May cause/worsen depression, anxiety, or emotional lability.1,19

Hyperammonemia ± encephalopathy (risk increased with higher doses or valproic acidc).1

Hypothermia ±hyperammonemia (risk increased with valproic acidc).1

Kidney stones (due to carbonic anhydrase inhibition; encourage fluids).1

Hypohidrosis/hyperthermia/heat stroke (mainly children).  Risk increased with anticholinergics, hot environment, physical activity, dehydration, zonisamide.1

Elevated intra-ocular pressure ±angle closure glaucoma.1

CYP450

P-glycoprotein

May modestly increase lithium levels.1

May slightly decrease digoxin levels.1

May reduce efficacy of estrogen-containing contraceptives, oral progestin-only contraceptives, and possibly the etonogestrel implant.6

Valproic acid (capsule, oral solution [Depakene, Canada], generics)

Valproate (injection [US])

Divalproex (US:     Depakote delayed-release tablet, sprinkle capsule, generics; Depakote ER extended-release tablet, generics; Canada: Epival delayed-release tablet, generics)

 

Common side effects:  thrombocytopenia, GI side effects, oligomenorrhea, insomnia, hair loss, weight gain/metabolic syndrome.1,2,19     Start low/go slow to minimize nausea, sedation, and cognitive effects.2,19

Solution tastes bad and produces a high peak associated with nausea.2 

Divalproex has lowest risk of GI side effects.

Hepatotoxicity (rare with monotherapy).2

Encephalopathy ± hyperammonemia (risk increased with urea cycle disorder [do not use], topiramate, or phenytoin).1

DRESS.4,a

Dose-related tremor.1

Osteoporosis.19

Hypothermia ± hyperammonemia.1 Risk increased with topiramate.1

CYP450

Inhibits epoxide hydrolase, and glucuronyltransferase.1

  • May cause carbamazepine epoxide accumulation (See footnote b).1

Requires lower lamotrigine and rufinamide starting doses.1

May increase ethosuximide and phenytoin levels.1

Hepatic enzyme inducers 
(e.g., carbamazepine, phenytoin, rifampin) may reduce levels significantly.1

Carbapenem antibiotics and ethosuximide reduce levels.1

Estrogen (e.g., in oral contraceptives) may reduce valproic acidc levels.1

Zonisamide (Zonegran capsules [US], generics)

 

Common side effects:  sedation, anorexia, dizziness, headache, nausea, ataxia.2,11

May cause/worsen confusion, memory impairment, depression, anxiety, irritability, or agitation.1,19

SJS/TEN; DRESS.18,a

Kidney stones (due to metabolic acidosis; encourage fluids).1,2

Elevated intra-ocular pressure ±angle closure glaucoma (usually within the first month).18

Oligohidrosis/hyperthermia/heat stroke (rare; mainly in children).18 Risk may be increased with anticholinergics, hot environment, or topiramte.18

Photophobia (rare).1

CYP450

 

 

Abbreviations:   CYP450 = cytochrome P450; ESKD = end-stage kidney disease; GI = gastrointestinal; IR = immediate-release; SJS = Stevens-Johnson syndrome; SSRI = selective serotonin reuptake inhibitor; TEN = toxic epidermal necrolysis

  1. DRESS (Drug Reaction Eosinophilia and Systemic Symptoms):  often presents as fever and rash.  Other signs and symptoms may include eosinophilia; lymphadenopathy; liver, kidney, and/or heart inflammation.4 Follow labeled instructions for dose initiation and titration.
  2. Carbamazepine epoxide:  active metabolite of carbamazepine.  Can be measured if specifically ordered, but may be a “send out” requiring extra time.   High levels may cause side effects or symptoms of intoxication despite therapeutic carbamazepine levels.5
  3. Includes valproate and divalproex.

 References

  1. Clinical Pharmacology powered by Clinical Key. Tampa, FL:  Elsevier; 2024. http://www.clinicalkey.com. (Accessed January 16, 2024).
  2. McCauley JW, Alldredge BK. Seizure disorders. In: Zeind CS, Carvalho MG, editors. Applied Therapeutics: the Clinical Use of Drugs. 11th ed. Philadelphia, PA: Lippincott Williams & Wilkins, 2018:1273-1300.
  3. Product monograph for Brivlera. UCB Canada. Orakville, ON L6J 5R7. June 2021.
  4. De A, Rajagopalan M, Sarda A, et al. Drug Reaction with Eosinophilia and Systemic Symptoms: An Update and Review of Recent Literature. Indian J Dermatol. 2018 Jan-Feb;63(1):30-40.
  5. Burianová I, Bořecká K. Routine therapeutic monitoring of the active metabolite of carbamazepine: Is it really necessary? Clin Biochem. 2015 Sep;48(13-14):866-9.
  6. Curtis KM, Tepper NK, Jatlaoui TC, et al. U.S. Medical Eligibility Criteria for Contraceptive Use, 2016. MMWR Recomm Rep. 2016 Jul 29;65(3):1-103.
  7. Product information for Aptiom. Sunovion Pharmaceuticals. Marlborough, MA 01752. March 2019.
  8. Product monograph for Aptiom. Sunovion Pharmaceuticals Canada. Mississauga, ON L5N 2V8. July 2019.
  9. Product information for Felbatol. Meda Pharmaceuticals. Somerset, NJ 08873. July 2011.
  10. Kanner AM, Ashman E, Gloss D, et al. Practice guideline update summary: Efficacy and tolerability of the new antiepileptic drugs I: Treatment of new-onset epilepsy: Report of the Guideline Development, Dissemination, and Implementation Subcommittee of the American Academy of Neurology and the American Epilepsy Society. Neurology. 2018 Jul 10;91(2):74-81.
  11. Kanner AM, Ashman E, Gloss D, et al. Practice guideline update summary: Efficacy and tolerability of the new antiepileptic drugs II: Treatment-resistant epilepsy: Report of the Guideline Development, Dissemination, and Implementation Subcommittee of the American Academy of Neurology and the American Epilepsy Society. Neurology. 2018 Jul 10;91(2):82-90.
  12. Falco-Walter JJ, Bleck T. Treatment of Established Status Epilepticus. J Clin Med. 2016 Apr 25;5(5):49. doi: 10.3390/jcm5050049.
  13. Product information for Cerebyx. Pfizer. New York, NY 10017. September 2021.
  14. Product information for Fycompa. Eisai. Nutley, NJ 07110. December 2021.
  15. Product information for Lyrica. Pfizer. New York, NY 100147. June 2020.
  16. Product information for Banzel. Eisai. Nutley, NJ 07110. December 2021.
  17. Product information for Gabitril. Teva Pharmaceuticals.  Parsippany, NJ 07054. September 2021.
  18. Product information for Zonegran. Amdipharm Limited. Dublin, IE. April 2020.
  19. Kanner AM, Bicchi MM. Antiseizure Medications for Adults With Epilepsy: A Review. JAMA. 2022 Apr 5;327(13):1269-1281.
  20. Gynecologic Management of Adolescents and Young Women With Seizure Disorders: ACOG Committee Opinion, Number 806. Obstet Gynecol. 2020 May;135(5):e213-e220. doi: 10.1097/AOG.0000000000003827.
  21. Tomson T, Battino D, Bromley R, et al. Management of epilepsy in pregnancy: a report from the International League Against Epilepsy Task Force on Women and Pregnancy. Epileptic Disord. 2019 Dec 1;21(6):497-517.
  22. National Institute for Health and Care Excellence. Epilepsies in children, young people and adults. April 27, 2022. https://www.nice.org.uk/guidance/ng217. (Accessed June 22, 2022).
  23. National Institutes of Health. United States National Library of Medicine. TOXNET Toxicology Data Network. Drugs and Lactation Database (LactMed). https://www.ncbi.nlm.nih.gov/books/NBK501922/?report=classic. (Accessed June 22, 2022).
  24. Harden CL, Meador KJ, Pennell PB, et al. Practice parameter update: management issues for women with epilepsy--focus on pregnancy (an evidence-based review): teratogenesis and perinatal outcomes: report of the Quality Standards Subcommittee and Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology and American Epilepsy Society. Neurology. 2009 Jul 14;73(2):133-41.
  25. Harden CL, Pennell PB, Koppel BS, Management issues for women with epilepsy--focus on pregnancy (an evidence-based review): III. Vitamin K, folic acid, blood levels, and breast-feeding: Report of the Quality Standards Subcommittee and Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology and the American Epilepsy Society. Epilepsia. 2009 May;50(5):1247-55.
  26. Product information for Diastat. Bausch Health US. Bridgewater, NJ 08807. March 2021.
  27. Glauser T, Shinnar S, Gloss D, et al. Evidence-Based Guideline: Treatment of Convulsive Status Epilepticus in Children and Adults: Report of the Guideline Committee of the American Epilepsy Society. Epilepsy Curr. 2016 Jan-Feb;16(1):48-61.
  28. Product information for Nayzilam. UCB. Smyrna, GA 30080. February 2021.
  29. Scheepers M, Scheepers B, Clarke M, et al. Is intranasal midazolam an effective rescue medication in adolescents and adults with severe epilepsy? Seizure. 2000 Sep;9(6):417-22.
  30. FDA. Lamictal (lamotrigine): drug safety communication – studies show increased risk of heart rhythm problems in patients with heart disease. March 31, 2021. https://www.fda.gov/safety/medical-product-safety-information/lamictal-lamotrigine-drug-safety-communication-studies-show-increased-risk-heart-rhythm-problems. (Accessed June 29, 2022).
  31. Product information for Valtoco. Neurelis. San Diego, CA 92121. February 2022.
  32. Specchio N, Pietrafusa N, Vigevano F. Is Cenobamate the Breakthrough We Have Been Wishing for? Int J Mol Sci. 2021 Aug 28;22(17):9339.
  33. Product information for Xcopri. SK Life Science. Paramus, NJ 07652. June 2022.

Cite this document as follows:  Clinical Resource, Antiseizure Medications.  Pharmacist’s Letter/Prescriber’s Letter.  July 2022. [380724]



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