Seizure medications
By Mayo Clinic Staff
Seizure medications, also called antiseizure medications, are medicines that prevent or control seizures. You also may hear these medicines called antiepileptic drugs or anticonvulsants.
No single seizure medicine works for every type of seizure. The medicine your care team recommends depends on the type of seizures you have. It also depends on how well the medicine controls them, what the side effects may be and other individual factors.
Some seizure medicines are taken every day to prevent seizures. Others are used only when certain seizures or seizure clusters happen.
Types of seizure medicines
Seizure medicines can be used in different ways. Some are maintenance medicines that you take on a regular schedule to help prevent seizures. Others are rescue medicines that you use only when having certain seizures or seizure clusters.
Daily medicines to prevent seizures
Taking seizure medicine every day to help prevent seizures is called maintenance treatment. Most people start with just one medicine. Over time, the dose is slowly raised. The goal is to find the lowest dose that controls your seizures with the fewest side effects.
The medicine you take depends partly on the type of seizures you have. Some medicines work well for focal seizures, which start in one area of the brain. Others are used for generalized seizures, which involve both sides of the brain. These include tonic-clonic seizures, which cause stiffening and shaking, and absence seizures, which cause brief staring spells.
Rescue medicines
A rescue medicine is a seizure medicine you use only now and then, not every day. It helps stop or shorten certain seizures or seizure clusters while they're happening. Diazepam and midazolam are two examples. Rescue medicines don't take the place of the medicines you take every day to help prevent seizures.
Your care team may prescribe a rescue medicine to use when certain seizures need treatment right away. Your care team will tell you when and how to use the medicine, based on your seizure pattern and seizure action plan. Rescue medicines come in different forms. One type is sprayed into the nose. Another is a gel that is put into the rectum.
A family member or caregiver often gives rescue medicine. Ask your care team to show that person when and how to give the medicine.
Common seizure medicines
Many seizure medicines are available. These examples include medicines used for daily treatment as well as some used for rescue treatment:
- Levetiracetam (Keppra). is a maintenance medicine you take by mouth. It comes as a pill or a liquid. It's used to treat focal seizures. It also may be used for some types of generalized seizures in certain age groups. Common side effects include feeling sleepy, dizzy, weak or tired. Levetiracetam also can cause mood or behavior changes, such as feeling irritable or acting aggressively.
- Divalproex (Depakote). is a maintenance medicine you take by mouth. It's used to treat some focal seizures and absence seizures. It may be taken alone or with other seizure medicines. Side effects can include dizziness, shakiness, weight gain and hair loss. Divalproex can harm an unborn baby if taken during pregnancy. If you are pregnant or could become pregnant, talk with your care team about the risks.
- Lamotrigine (Lamictal). is a maintenance medicine you take by mouth. It's used to treat focal seizures and tonic-clonic seizures. It also may be used for seizures caused by Lennox-Gastaut syndrome, which is a severe type of epilepsy that starts in childhood. Common side effects include dizziness, sleepiness, headache, blurry or double vision, upset stomach, and rash. Rarely, lamotrigine can cause a serious skin rash. To lower this risk, the dose is started low and raised slowly. Tell your care team right away if you get a rash while taking this medicine.
- Phenytoin (Dilantin). is a maintenance medicine you take by mouth. Phenytoin comes as a capsule that releases the medicine slowly over time. It's used to treat tonic-clonic seizures and some focal seizures. Common side effects include sleepiness, trouble with balance and coordination, slurred speech, eye movements you can't control, and confusion. Phenytoin also can cause swollen gums, so regular dental care is important.
- Midazolam (Nayzilam). is a rescue medicine that's sprayed into the nose. It's used to treat seizure clusters in people with epilepsy who are 12 years and older. Common side effects include sleepiness, headache and a runny nose. The spray also may cause discomfort in the nose or throat.
- Diazepam (Valtoco). is a rescue medicine that's sprayed into the nose. It's used to treat seizure clusters in people with epilepsy who are 2 years and older. Common side effects include sleepiness, headache and discomfort in the nose. Diazepam also comes as a gel that is put into the rectum.
Side effects of seizure medicines
Side effects depend on the medicine you take, and they can vary from person to person. Finding the right dose means balancing seizure control with how well your body handles the medicine.
Some side effects happen with many seizure medicines. These include feeling sleepy, dizzy or tired and having trouble with balance. Headache and upset stomach also are common. You may notice these side effects more when you first start a medicine or when your dose changes.
Other side effects depend on the medicine. Some medicines can affect your mood or behavior. Some can cause changes in weight. Others may cause hair loss, a rash or swollen gums.
Tell your care team if side effects bother you. Your care team may be able to change your dose or switch you to a different medicine. Get help right away if you have a severe skin rash, depression that's new or getting worse, or thoughts of harming yourself.
Seizure medicines during pregnancy and breastfeeding
If you take seizure medicine and are pregnant or might become pregnant, talk with your care team as early as you can. Together, you can review your treatment. The goal is to keep your seizures under control while also thinking about how your medicine and dose might affect a pregnancy. Also ask your care team about taking folic acid before and during pregnancy.
Seizure medicines don't all have the same risks during pregnancy. Some are linked with a lower risk of birth defects, so care teams may choose them when they can. Others carry a higher risk to the baby and are best avoided when possible. For example, valproate medicines, which include divalproex (Depakote), carry a higher risk of birth defects and higher risk of issues with learning and development than many other seizure medicines. If possible, it's best to avoid taking valproate medicines during pregnancy. But don't stop taking valproate or any other seizure medicines without talking with your care team first.
No one seizure medicine is the safest one for everyone during pregnancy. The best choice for you depends on your type of epilepsy, how well a medicine controls your seizures, any other health conditions you have and the medicine's known risks during pregnancy.
If you find out you're pregnant, don't stop or switch your seizure medicine on your own. Doing so could lead to more seizures. Seizures during pregnancy, especially tonic-clonic seizures, can be harmful for both you and your baby. Experts recommend caution when changing or replacing a seizure medicine during pregnancy, especially one that works well to control tonic-clonic seizures.
Breastfeeding concerns also differ from medicine to medicine. Many seizure medicines pass into breast milk, some more than others. With some medicines, you may need to watch your baby closely for signs such as being very sleepy, having trouble feeding or not gaining enough weight. Talk with your care team about the benefits and risks of breastfeeding while taking your medicine.
Finding the right seizure medicine
Finding the right medicine and dose for you can take time. Your care team thinks about the type of seizures you have, how well a medicine is likely to control them and the medicine's possible side effects. Your team also looks at any other health conditions you have and whether a seizure medicine could affect other medicines you take.
Sometimes a seizure medicine lowers the number of seizures but doesn't stop them. If you don't have bothersome side effects from the medicine, your care team may add a second medicine while you continue to take the first medicine. If the first medicine doesn't help or it causes side effects that are hard to live with, your care team may switch you to a different medicine instead.
Taking more than one seizure medicine can raise the chance of side effects. It also may be more likely that your medicines will interact with each other. Your care team keeps these risks in mind when adding or changing medicines.
Taking seizure medicines safely
Seizure medicines work best when you take them exactly as prescribed. Taking them on schedule, watching for interactions and making changes only with your care team's help can lower your chance of seizures and side effects.
Missed doses
Missed doses of seizure medicine may lead to more seizures.
- If you miss a dose, follow the directions that came with your medicine. What to do after a missed dose depends on the medicine. For some seizure medicines, you take the missed dose as soon as you remember. If it's almost time for the next dose, you skip the missed dose. Don't take two doses at once unless your care team tells you to. If you aren't sure what to do, ask your pharmacist or care team.
- If you miss many doses in a row, call your care team before you start taking your medicine again. With some medicines, such as lamotrigine, you may need to restart at a lower dose.
Taking too much seizure medicine can be dangerous. Depending on the medicine, signs may include being very sleepy, confused or unsteady. Other signs include having slow or shallow breathing. If you think someone has taken too much seizure medicine, call Poison Help at 800-222-1222 in the United States. If the person is hard to wake up or has trouble breathing, call 911 or your local emergency number.
Use a weekly pill organizer, phone alarm or reminder app to help you remember to take your seizure medicine on time.
Alcohol and other medicines
Alcohol and other medicines can affect seizure medicines. They may make side effects stronger or change how well your seizure medicine works.
Alcohol can make you more sleepy or more dizzy with some seizure medicines. It also can change the amount of some seizure medicines in your body, such as phenytoin. Ask your care team whether it's safe for you to drink alcohol.
Rescue medicines, such as midazolam and diazepam, can slow your breathing. Alcohol, opioid pain medicines or other medicines that make you sleepy can raise this risk.
Tell your care team about all the medicines, vitamins and supplements you take, including those you buy without a prescription, and the doses.
Stopping seizure medicine
Don't stop taking seizure medicine on your own. Stopping some seizure medicines suddenly can cause seizures to happen more often. It also can cause seizures that don't stop, called status epilepticus.
If you have been seizure-free for a long time, your care team may talk with you about whether it makes sense to slowly stop your seizure medicine. For some people, this may be an option after two years or longer without a seizure. But seizures can come back after a medicine is stopped. Your chance of that depends on things such as the type of epilepsy you have and your treatment history. The decision to stop treatment is different for each person.
If you do stop a seizure medicine, the dose usually needs to be lowered slowly over time, not all at once. Work with your care team to decide whether to stop a medicine and how to lower your dose.
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