Hesperian Health Guides
Common antiseizure medicines
HealthWiki > Epilepsy and Seizures > Chapter 4: Medicines for epilepsy and seizures > Common antiseizure medicines
We describe many of the antiseizure medicines that are widely available, but not all medicines used around the world. Some medicines used in your areaâsuch as gabapentin, lacosamide, or vigabatrinâmay not be included here. To learn about them, talk to a health worker.
| Carbamazepine (Carbatol, Mazetol, Tegretol, Tegrital, Zeptol) |  | |
| Carbamazepine is a common antiseizure medicine and the first choice for several seizure types. Do not use for absence seizures Monitor side effects carefully. | ||
In what forms does this medicine come? Tablet (100 mg, 200 mg, 400 mg) Oral liquid (100 mg in 5 ml) |
Commonly used for these seizures:
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How to use For generalized tonic-clonic or focal seizures: For children 1 month to 11 years, give 5 mg per kg of body weight by mouth 1 time each day, or 2 5 mg per kg 2 times a day Increase this daily dose by 2 5 to 5 mg per kg each week as needed, up to 5 mg per kg 2 to 3 times a day Do not give more than 20 mg per kg total in 1 day. For children 12 years and older, give 100 to 200 mg by mouth 1 time each day, or 50 to 100 mg 2 times a day Increase this daily dose by 100 to 200 mg each week as needed, up to 200 to 400 mg 2 to 3 times a day Do not give more than 1800 mg total in 1 day. For adults,give 100 to 200 mg by mouth 1 time each day, or 50 to 100 mg by mouth 2 times a day Increase this daily dose by 100 to 200 mg each week as needed, up to 400 mg 2 to 3 times a day Do not give more than 2000 mg total in 1 day. |
Important To lessen stomach upset or diarrhea, give medicine with food Even just a piece of fruit or bread can help. If there is skin rash after a few weeks of using medicine, reduce dose Change medicine if rash becomes severe and spreads fast Use carefully if operating heavy machinery or driving Not effective against fever seizures in children. Carbamazepine may have harmful effects in pregnancy It is best not to start this medicine in the first 3 months of pregnancy. If medicine started before pregnancy, do not stop suddenly Lower dose little by little before stopping or changing to another medicine Avoid or use with caution during breastfeeding. | |
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Side effects Feeling tired, dizziness, stomach upset or diarrhea, skin rash, feeling sad and worried, or memory, thinking, and attention problems. | ||
 WARNING Do not drink alcohol while using carbamazepine. | ||
| Clobazam (Frisium, Sympazan) | | |
| Clobazam is a benzodiazepine medicine It is used to treat several types of seizures, by itself and as add-on therapy. | ||
| In what forms does this medicine come? Tablet (10 mg, 20 mg) Oral liquid (2.5 mg in 1 ml) |
Commonly used for these seizures:
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How to use For Lennox-Gastaut syndrome (LGS): For children 2 years or older and 30 kg or under, give 5 mg by mouth 1 time each day at bedtime for 1 week or longer Then increase to 5 mg 2 times a day for 1 week or longer Then increase to 10 mg 2 times a day. For children 2 years or older and over 30 kg, give 5 mg by mouth 2 times a day for 1 week or longer Then increase to 10 mg 2 times a day for 1 week or longer Then increase to 20 mg 2 times a day. For add-on therapy of LGS: For adults, give 5 mg by mouth 2 times a day for 1 week or longer Then increase to 10 mg 2 times a day for 1 week or longer Then increase to 20 mg 2 times a day |
Important Adjust dosages when giving to people with liver problems. How this drug affects a developing pregnancy and newborn babies is not clear Use with caution during pregnancy and breastfeeding. All benzodiazepine medicines such as clobazam can be addictive, may need to be increased over time, and can cause withdrawal seizures if stopped suddenly. Do not use with alcohol. | |
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Side effects Feeling tired, behavior changes, drooling, trouble speaking, constipation. | ||
| Ethosuximide (Zarontin) | | |
| Ethosuximide is used to manage and prevent absence seizures. | ||
| In what forms does this medicine come? Capsule (250 mg) Oral liquid (250 mg in 5 ml) |
Commonly used for these seizures:
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How to use For absence seizures: For children 1 month to 5 years, give 5 mg per kg of body weight by mouth 2 times a day Increase this daily dose by 5 to 10 mg per kg each week as needed, up to 10 to 20 mg per kg 2 times a day Do not give more than 1500 mg total in 1 day For children 6 to 17 years, give 250 mg by mouth 2 times a day Increase this daily dose by 250 mg each week as needed, up to 500 to 750 mg 2 times a day Do not give more than 1500 mg total in 1 day For adults, give 500 mg by mouth 1 time each day, or 250 mg 2 times a day Increase this daily dose by 250 mg each week as needed, up to 1500 mg divided into 2 doses per day Do not give more than 1500 mg total in 1 day |
Important Reduce dose if skin rash develops a week after starting medicine Change to a different medicine if rash becomes severe and spreads fast Always slowly reduce the dose rather than stopping abruptly. | |
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Side effects Feeling tired, weight loss, dizziness, sudden stomach upset, diarrhea, hiccups, headache. | ||
| Lamotrigine (Lamictal, Lamotrix, Lamotrigina) | ||
| Lamotrigine manages different types of seizures, often when used together with another medicine Talk to a health worker when using it as an add-on therapy, as the combination affects dosing Lamotrigine is safe during pregnancy and breastfeeding. | ||
| In what forms does this medicine come? Tablet (25 mg, 50 mg, 100 mg, 150 mg, 200 mg) |
Commonly used for these seizures:
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How to use For focal seizures and Lennox-Gastaut syndrome (LGS): For children 12 to 17 years and adults, give 25 mg by mouth 1 time each day for 2 weeks Then give 50 mg 1 time each day for 2 weeks Then increase this by 50 mg per day every 1 to 2 weeks as needed, up to 100 to 200 mg a day. For add-on therapy of LGS, generalized tonic-clonic seizures, or focal seizures in people taking valproic acid: For children younger than 2 years, give 0 15 mg per kg of body weight by mouth in 1 or 2 doses each day for 2 weeks Then increase the dose to 0 3 mg per kg in 1 or 2 divided doses each day if needed After the fourth week, increase the dose by up to 0 3 mg per kg per day each week up to 1 to 5 mg per kg per day in 3 divided doses Do not give more than 200 mg total in 1 day. For children 2 to 12 years old, round doses down to the nearest whole tablet Give 0 15 mg per kg of body weight by mouth in 1 or 2 doses each day for 2 weeks (For children in this age group who weigh 6 7 to 14 kg, give 2 mg every other day ) After 2 weeks, increase the dose to 0 3 mg per kg of body weight in 1 or 2 divided doses each day if needed After the fourth week, increase the dose by 0 3 mg per kg per day each week up to 1 to 5 mg per kg per day in 1 or 2 divided doses Do not give more than 200 mg total in 1 day. For adults, give 12 5 to 25 mg by mouth 1 time every other day for 2 weeks Then increase the dose to 25 mg 1 time each day for 2 weeks After the fourth week, increase the dose by 25 to 50 mg per day every 1 to 2 weeks as needed up to 100 to 200 mg per day divided in 2 doses.
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For add-on therapy of LGS, generalized tonicclonic seizures, or focal seizures in people taking carbamazepine, phenobarbital, phenytoin, or another medication that decreases lamotrigine in the body * (but not valproic acid):
For children 2 to 12 years old, round doses down to the nearest whole tablet Give 0 6 mg per kg of body weight by mouth divided in 2 doses each day for 2 weeks After 2 weeks, increase the dose to 1 2 mg per kg divided in 2 doses each day After the fourth week, increase the dose by 1 2 mg per kg per day each week up to 5 to 15 mg per kg per day divided in 2 doses Do not give more than 400 mg total in 1 day. For adults, give 50 mg by mouth in 1 or 2 doses each day for 2 weeks Then increase the dose to 100 mg in 1 or 2 doses each day for 2 weeks After the fourth week, increase the dose by 100 mg per day every 1 to 2 weeks as needed up to 300 to 500 mg per day divided in 2 doses. *Other medicines that decrease lamotrigine in the body include rifampin (rifampicin) taken for tuberculosis, and atazanavir (ATV), lopinavir/ritonavir (LPV/r), and ritonavir (RTV) taken for HIV. | |
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Important Read medicine instructions carefully to find out if you can cut tablets for dosing If not, you may have to round doses up or down to the nearest whole tablet See instructions on this above for each seizure type and age group. Raise the dose of this medicine very slowly to avoid skin rash If there is skin rash after a few weeks of using medicine, reduce dose Change to a different medicine if rash becomes severe and spreads fast Always slowly reduce the dose rather than stopping medicine abruptly. Lamotrigine can make your mouth very dry, which can lead to tooth decay Pay attention to dental hygiene. |
Side effects Feeling tired, dizziness, upset stomach and diarrhea, severe skin rash (Stevens-Johnson syndrome), feeling sad and worried. | |
| Levetiracetam (Keppra, Torleva) | | |
| Levetiracetam treats several types of seizures The dosing here is for âimmediate releaseâ levetiracetam, which is most common There is also an âextended releaseâ or âXRâ version of this medicine which is absorbed more slowly by the body, so it lasts longer That dosing is different from the information here | ||
| In what forms does this medicine come? Tablet (250 mg, 500 mg, 750 mg, 1000 mg) Oral liquid (500 mg in 5 ml) |
Commonly used for these seizures:
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How to use For generalized tonic-clonic, focal, or absence seizures: For children 1 to 5 months, give 7 mg per kg of body weight by mouth 1 time each day for 2 weeks Then increase to 7 mg per kg 2 times a day for 2 weeks If seizures continue, increase each dose by 7 mg per kg every 2 weeks, up to 21 mg per kg 2 times a day. For children 6 months to 17 years, give 10 mg per kg of body weight by mouth 1 time each day for 2 weeks Then increase to 10 mg per kg 2 times a day for 2 weeks If seizures continue, increase each dose by 10 mg per kg every 2 weeks, up to 30 mg per kg 2 times a day. For adults, give 250 mg by mouth 2 times a day for 2 to 4 weeks Then increase to 500 mg 2 times a day for 2 to 4 weeks If seizures continue, increase each dose to 1000 mg for 2 to 4 weeks, and then, if needed, increase to 1500 mg 2 times a day. For myoclonic seizures: For adults, give 250 to 500 mg by mouth 2 times a day for 2 weeks Then increase by 1g (1000 mg) a day every 2 weeks as needed, up to 2 g (2000 mg) 2 times a day. For add-on therapy of myoclonic seizures: For children 12 years and over, give 500 mg by mouth 2 times a day for 2 weeks Then increase each dose by 500 mg every 2 weeks, up to 1500 mg 2 times a day. |
Important How this drug affects a developing pregnancy and newborn babies is not clear Use with caution during pregnancy and breastfeeding Sometimes this medicine harms the kidneys Talk to a health worker if you are passing very little urine or have swollen legs, ankles, or feet after starting the medicine. Carefully monitor children with absence seizures who are beginning use of this drug Sometimes it can make these seizures worse. | |
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Side effects Feeling tired, trouble sleeping, headache, dizziness, stomach upset or diarrhea, skin rash, feeling sad and worried, aggressive behavior. For behavioral or mood-related side effects, taking vitamin B6 may help For more information about this, talk to a health worker | ||
WARNING Use with caution if you have heart or kidney problems such as acute kidney injury, frequent urinary tract infections, or kidney stones. | ||
| Phenobarbital (Epitan, Fenirol, Fenobarb, Gardenal, Luminal, Phenobarb, Phenoleptil, Solfoton) |
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| Phenobarbital is a sedative in the barbiturate family of medicines and is one of the oldest medicines used to control seizures. | ||
| In what forms does this medicine come? Tablet (15 mg, 30 mg, 60 mg, 100 mg) Oral liquid (15 mg in 5 ml) |
Commonly used for these seizures:
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Important If used regularly, the dose must be increased over time to keep working. |
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How to use For generalized tonic-clonic or focal seizures: For children 1 month to 11 years, give 2 to 3 mg per kg of body weight by mouth 1 time each day at bedtime or 1 to 1 5 mg per kg 2 times a day for 2 weeks Then increase this daily dose by 1 to 2 mg per kg each week as needed, up to 2 to 6 mg per kg 1 time each day. For children 12 years and older and adults, give 1 mg per kg of body weight by mouth 1 time each day at bedtime for 2 weeks Then increase this daily dose by 15 to 30 mg each week as needed, up to 3 mg per kg per day Do not give more than 180 mg in 1 day |
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Side effects Stomach upset or diarrhea, difficulty breathing, tiredness, sadness and worry, memory or thinking problems, cognitive delay in children. | ||
WARNING Do not use during pregnancy or breastfeeding, or when trying to get pregnant unless there is no other option. Do not use with alcohol. Phenobarbital is habit-forming (addictive) If this medicine is used for a long time, suddenly stopping or lowering the dose can cause severe and possibly life-threatening medical reactions, including seizures To avoid this, work with a health worker to gradually reduce the amount of medicine you take if you change or stop using this medicine. Phenobarbital slows the functioning of several body systems and can make you sleepy Be careful when driving or operating machinery while using this medicine | ||
| Phenytoin (Dilantin, Epanutin, Epsolin, Eptoin, Fenidantoin, Diphantoine) | | |
| Phenytoin is among the oldest antiseizure medicines. | ||
| In what forms does this medicine come? Tablet (50 mg, 100 mg, 300 mg) Capsule (50 mg, 100 mg) |
Commonly used for these seizures:
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How to use For generalized tonic-clonic or focal seizures: For children 1 month to 11 years, give 1 5 to 2 5 mg per kg of body weight by mouth 2 times a day for 2 weeks Then increase this dose by 5 mg per kg per day every 1 to 2 weeks as needed, up to 2 5 to 5 mg per kg 2 times a day Do not give more than 300 mg in 1 day. For children 12 to 17 years, give 75 to 150 mg by mouth 2 times a day for 2 weeks Then increase this dose by 25 mg a day every 1 to 2 weeks as needed, up to 150 to 200 mg 2 times a day Do not give more than 300 mg 2 times a day. For adults, give 150 to 300 mg by mouth in 1 or 2 doses each day for 2 weeks Then increase this dose by 50 mg a day every 1 to 2 weeks as needed, up to 200 to 400 mg 1 time each day or 100 to 250 mg 2 times a day Do not give more than 400 mg 1 time a day or 300 mg 2 times a day. |
Important Some people get painfully swollen and enlarged gums that may bleed If this happens, medicine may need to be changed. | |
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Side effects Feeling tired, dizziness, stomach upset and diarrhea, blurred vision, skin rash, swollen gums, feeling sad or worried, memory and thinking problems, excess hair growth on any area of the body. | ||
WARNING Do not use during pregnancy or breastfeeding, or when trying to get pregnant unless there is no other option. Use carefully with children. | ||
| Topiramate (Topamax) | | |
| Topiramate is used for different seizure types. | ||
| In what forms does this medicine come? Tablet (25 mg, 50 mg, 100 mg, 200 mg) Capsule (15 mg, 25 mg) |
Commonly used for these seizures:
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How to use For generalized tonic-clonic or focal seizures: For children 2 to 10 years, give 25 mg by mouth 1 time each day at bedtime for 1 week Then increase this dose to 25 mg by mouth 2 times a day for 1 week Then increase this dose by 25 to 50 mg a day every week as needed for 5 to 7 weeks, up to 150 to 400 mg in 2 doses per day. For children 10 years or older, give 25 mg by mouth 2 times a day for 1 week Then increase this dose by 50 mg a day every week as needed, up to 100 mg 2 times a day This dose can be increased further by 100 mg a day every week as needed, up to 200 mg 2 times a day. For adults, give 25 mg by mouth 2 times a day for 1 week Then increase this dose by 50 mg a day every week as needed, up to 200 mg in 1 or 2 doses each day This dose can be increased further by 100 mg a day every week as needed, up to 400 mg in 1 or 2 doses per day. For add-on therapy of Lennox-Gastaut syndrome (LGS), generalized tonic-clonic seizures, or focal seizures: For children 2 to 16 years, give 1 to 3 mg per kg of body weight by mouth 1 time each day at bedtime for 1 week Then increase this dose by 1 to 3 mg per kg per day every 1 to 2 weeks, up to 400 mg in 2 doses per day. For adults, give 25 to 50 mg by mouth 1 time each day for 1 week Then increase this dose by 25 to 50 mg a day every 1 to 2 weeks as needed, up to 400 mg in 1 or 2 doses per day. |
Important These tablets taste very bitter, so it is best not to crush, break, or chew them A capsule that can be opened and sprinkled on food may be available. Use with caution during breastfeeding Avoid use during pregnancy or when trying to get pregnant because there is a risk of the baby developing cleft palate. Speak with your health worker to find out if another medicine is available. People with glaucoma or kidney or liver problems should avoid using topiramate or use with careful monitoring. | |
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Side effects Weight loss, feeling very tired, memory and thinking problems, tingling or prickly feeling in arms, hands, legs, or feet, dizziness. | ||
| Valproic acid (Depakote, Depakene) | | |
| Valproic acid is a common treatment for different types of seizures. | ||
| In what forms does this medicine come? Tablet (100 mg, 200 mg, 500 mg) Oral liquid (200 mg in 5 ml) |
Commonly used for these seizures:
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How to use For generalized tonic-clonic, focal, or myoclonic seizures: For children and adults, give 10 to 15 mg per kg of body weight by mouth in 1 to 3 doses per day for 1 week Then increase this dose by 5 to 10 mg per kg per day each week as needed, up to 60 mg per kg per day. For absence seizures: For children and adults, give 15 mg per kg of body weight by mouth in 1 to 3 doses per day for 1 week Then increase this dose by 5 to 10 mg per kg per day each week as needed, up to 60 mg per kg per day. |
Important Some people get painfully swollen and enlarged gums that may bleed If this happens, medicine may need to be changed. | |
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Side effects Dizziness, feeling tired most of the time, diarrhea or upset stomach (reduced if taken after meal), blurred vision, skin rash, vitamin D deficiency especially in young children and teenagers, feeling sad and worried, memory and thinking problems weight gain, hair loss, polycystic ovary syndrome (PCOS). | ||
WARNING Do not use during pregnancy or when trying to get pregnant If pregnant, start replacing with another antiseizure medicine immediately. | ||