Hesperian Health Guides
Side effects of antiseizure medicines
HealthWiki > Epilepsy and Seizures > Chapter 4: Medicines for epilepsy and seizures > Side effects of antiseizure medicines
Contents
- 1 Get medical attention for these side effects
- 2 Common side effects and what to do about them
- 2.1 Side effect: Feeling tired
- 2.2 Side effect: Upset stomach or diarrhea
- 2.3 Side effect: Mild skin rash
- 2.4 Side effect: Severe skin rash with blisters and peeling skin (Stevens-Johnson syndrome)
- 2.5 Side effect: Vitamin D deficiency
- 2.6 Side effect: Swollen and enlarged gums
- 2.7 Side effect: Dizziness and loss of balance
- 2.8 Side effect: Blurred vision
- 2.9 Side effect: Feeling sad, worried, depressed
- 2.10 Side effect: Difficulty thinking, remembering, and paying attention
- 2.11 Side effect: Pain, redness, or soreness at the site of injection
- 2.12 Side effect: Unwanted hair on face or other body areas
- 2.13 How to remove hair with sugar wax
Get medical attention for these side effects
- Severe skin rash with blotchy, blistering skin
- Difficulty breathing or shortness of breath
- A sudden worsening of seizures
- Fast or irregular heartbeat, heart palpitations (a fluttering feeling in the chest or neck), chest discomfort or pressure
- Jaundice—causes whites of eyes and skin to turn yellow (less visible on darker skin), nausea, vomiting, or loss of appetite
- Sharp pain in the belly that may travel to the back
- Hallucinations (seeing things that are not there)
- Severe depression, thoughts of suicide
- Extreme sleepiness or confusion
Common side effects and what to do about them
Side effect: Feeling tired
Antiseizure medicines that can cause tiredness: carbamazepine, diazepam, ethosuximide, levetiracetam, phenobarbital, phenytoin, topiramate, valproic acid
What to do: Tiredness is the body’s signal that it needs rest, with or without antiseizure medicines. However, rest does not mean sleeping all day. A person taking antiseizure medicine must get up and move around during the day. Engaging in physical activity can help with tiredness and also can improve sleep.
If tiredness is so severe that a person cannot do daily activities like eating, bathing, or moving around, talk to a health worker. A different medicine or dose may be needed.
Side effect: Upset stomach or diarrhea
Antiseizure medicines that can cause upset stomach or diarrhea: carbamazepine, ethosuximide, diazepam, lorazepam, lamotrigine, midazolam, phenobarbital, phenytoin, topiramate, valproic acid
What to do: For diarrhea, drink plenty of water, herbal tea, or other liquids to ensure the lost liquid is replaced. Avoid spicy foods or animal milks if you have an upset stomach. Eat something light every 2 to 3 hours. Breastfeed young children with diarrhea more often. If diarrhea is so severe that it causes dehydration, use a rehydration drink (see recipe).
Get medical help if dehydration continues, there is blood in the stool, no desire to eat or drink, or the upset stomach or diarrhea continues for more than 2 days.
Side effect: Mild skin rash
Antiseizure medicines that can cause skin rash: carbamazepine, lamotrigine, phenytoin, valproic acid
What to do: Bathe a minor rash with cool water or water in which a handful of oats has soaked for an hour (less if the oats are ground into powder). Gently pat skin after bathing and leave skin open to the air to encourage drying. To calm itchiness, use calamine lotion. Neem tree oil also helps soothe inflamed skin.
A severe skin rash or a rash that spreads rapidly can be an emergency. See a health worker as soon as possible.
Side effect: Severe skin rash with blisters and peeling skin (Stevens-Johnson syndrome)
Antiseizure medicines that can cause severe skin rash: carbamazepine, lamotrigine, phenobarbital, phenytoin, valproic acid (rarely reported).
Some antiseizure medicines can cause a severe reaction of painful, blistering, and peeling skin, starting with the face and chest and spreading to arms, legs, and back.
Flu symptoms like headache, cough, sore throat, and fever may begin before the rash. Get medical help if dehydration continues, there is blood in the stool, no desire to eat or drink, or the upset stomach or diarrhea continues for more than 2 days.
Side effect: Vitamin D deficiency
Antiseizure medicines that can cause vitamin D deficiency: carbamazepine, phenobarbital, phenytoin, valproic acid (especially in young children and teenagers)
What to do: Give foods that are rich in vitamin D, including milk fortified with vitamin D, butter, egg yolks, animal fats, and liver, especially fish liver oil.
Children taking valproic acid risk developing weak bones, fractures, and rickets. Prevent this by giving them vitamin D every day (600 to 1200 IU of vitamin D2 or D3).
Direct sunlight on skin for 10 to 30 minutes can help the body make its own vitamin D. Sun exposure is strongest at midday. People with darker skin and people who live far away from the equator where the sun is weaker will need more time in the sun to get adequate vitamin D.
Side effect: Swollen and enlarged gums
Antiseizure medicines that can cause swollen gums: phenytoin and valproic acid
What to do: Clean teeth carefully every day. Brush with toothpaste, try to remove the tiny bits of food between the teeth, and gargle with a mouthwash of water, baking soda, and cloves or clove oil (see recipe below). Ask a health worker or epilepsy specialist about a change in medicine.
Mouthwash recipe:
- Filtered water (240 milliliters or 1 cup)
- Baking soda (6 grams or 1 teaspoon)
- If available, add 4 whole cloves or 4 drops of clove oil
Bring water to a boil and add whole cloves or clove oil. Remove pan from heat, let water cool, and remove whole cloves. Mix baking soda into mixture and store in a sealed jar. Shake before using as a mouthwash.
Side effect: Dizziness and loss of balance
Antiseizure medicines that can cause dizziness: carbamazepine, valproic acid, phenytoin, lamotrigine
What to do: Help a person sit or lie down and suggest they stay still until dizziness goes away. Closing their eyes may help. Give water to sip. If the medicine can be taken before bedtime, the dizziness may be less troubling.
Side effect: Blurred vision
Antiseizure medicines that can cause blurred vision: carbamazepine, levetiracetam, phenytoin, topiramate
What to do: Have the person’s vision checked to see if they need eyeglasses. If vision remains blurry, change their epilepsy medicine. A variety of fresh fruits and vegetables contain vitamins and minerals that can help maintain vision: Vitamin A is found in sweet potato, carrot, pumpkin, and leafy greens. Vitamin C is found in peppers, avocados, mango, papaya, and orange. Vitamin E is found in nuts, seeds, whole grains, and avocados. The minerals lutein and zeaxanthin are in leafy greens and eggs. And oily fish are high in omega-3 fats.
Side effect: Feeling sad, worried, depressed
Antiseizure medicines that can cause worry and sadness: carbamazepine, levetiracetam, lamotrigine, phenytoin, phenobarbital, topiramate, valproic acid
What to do: Encouraging children and adults to talk about their feelings of sadness and worry can help improve the way they feel. If worry and sadness continue for a long time, see a health worker. Sadness that does not go away may be a sign of depression, and mental health support may be needed to help the person recover (see Hesperian's Promoting Community Mental Health).
Side effect: Difficulty thinking, remembering, and paying attention
Antiseizure medicines that can cause changes in the ability to think, memory, and attention span: carbamazepine, diazepam, levetiracetam, lorazepam, midazolam, phenobarbital, valproic acid
What to do: Sometimes a person taking antiseizure medicine may seem lost, forgetful, or take longer than usual to understand. These changes are not their fault, but may upset them. Reassurance and patience from friends and family can help a person understand these changes are caused by their medicine. Help people find ways to remind themselves about tasks and chores. If confusion or memory loss worsens, ask a health worker or epilepsy specialist if the antiseizure medicine can be changed.
Side effect: Pain, redness, or soreness at the site of injection
Antiseizure medicines that can cause pain, redness, or soreness at the injection site: lorazepam, midazolam
What to do: It is common for the skin at an injection site to swell and feel painful or sore. Let it rest and do not stress the muscles or joints near it. Avoid heavy work that strains the area that hurts. Cold often helps. Do not put ice directly on skin, but wrap ice in a cloth or towel and place it on the area that hurts. After 10 to 15 minutes, remove the ice pack and let the skin warm up. If the skin is still painful after it warms up, treat it with ice again.
Side effect: Unwanted hair on face or other body areas
Antiseizure medicine that can cause unwanted hair on face and other body areas: phenytoin
What to do: Remove unwanted hair by plucking with a tweezer, shaving with a razor, or using body wax or sugar wax.
How to remove hair with sugar wax
Ingredients:
- Sugar (250 grams or 1 cup)
- Juice from 1 small lemon
- Warm water (same amount as lemon juice)
- Mix all ingredients in a pot. Place on stove and stir continuously over medium-to-high heat so it does not burn.
- Lower heat when the mixture boils and continue to stir.
- Remove from heat when the mixture is golden-brown. It should be less thick than honey.
- Cool 15 to 20 minutes.
- Test temperature of wax by applying a small amount to the inside of your wrist. It should feel warm, not hurt or burn you.
- Apply wax with a flat wooden stick or small plastic spatula to a small section of skin where you want to remove hair.
- Spread wax in the direction the hair is growing.
- Place a cloth over the wax and press firmly. Use rectangular strips from an old shirt or piece of clothing. Leave the cloth on for 2 to 3 seconds.
- Hold the skin around the cloth tightly with one hand and then quickly pull cloth in the opposite direction of hair.
- Soothe skin by applying an ice pack.