Pharmacist Tips - Anti-epileptic drugs

Epilepsy is a complex disease with diverse symptoms. Most patients develop the disease in childhood, which has a serious impact on the growth, development and quality of life of children. Anti-epileptic drug treatment is the most important and basic treatment, and it is also the preferred treatment for most children with epilepsy. Once anti-epileptic drugs are started, long-term treatment is generally required. Except for hospitalization in the acute phase or for concomitant diseases, most of the time the family members of the children are responsible for managing the children's medication outside the hospital. Therefore, the children and their families should have certain knowledge about drugs. So what are the key points to master?

Improve compliance

Anti-epileptic drugs must be taken as prescribed by the doctor, on time and in the correct dosage. Do not reduce, increase or stop taking the drugs at will.

For most anti-epileptic drugs, whether a satisfactory therapeutic effect can be achieved is closely related to a stable and effective blood drug concentration, so regular and quantitative medication is required. Adding medication without permission will increase the risk of adverse reactions, while arbitrary reduction or sudden discontinuation of medication may cause a rebound in the blood drug concentration in the body, leading to severe epileptic seizures or even status epilepticus. You must never stop taking medication without permission just because your symptoms are under control. You must reduce or stop taking medication under the guidance of a doctor.

What should I do if I miss a dose?

If you miss a dose or miss the medication time, you should take it as soon as you remember; if it has been several hours or it is close to the next medication time, there is no need to make up for it, take the next dose at the original time; never take two doses at one time.

Commonly used anti-seizure drugs

——Sodium valproate

It can be taken on an empty stomach or with food. If stomach discomfort occurs, please take it with food. Domestic manufacturers recommend that syrups be taken immediately after meals to reduce the irritation of the drug to the stomach. Please do not dilute the oral solution when taking it.

Sodium valproate may inhibit blood clotting and make your child more likely to bleed. Avoid getting hurt while taking this medicine, such as using a soft-bristled toothbrush. Check your blood routine if spontaneous bruising or bleeding occurs.

-- Carbamazepine

Food will not affect the absorption of carbamazepine. You can take the drug during, after, or between meals. Taking the drug after meals can reduce gastrointestinal reactions. If you have stomach discomfort, you can take the drug after meals.

Avoid eating grapefruit and its products during medication to prevent the increase of blood concentration of carbamazepine and cause toxic side effects;

After taking the medicine, the child may become more sensitive to sunlight. Even a short exposure to sunlight may cause symptoms such as rash, itching, redness, or even sunburn. During the medication period, it is recommended that children take sun protection measures, such as wearing sun-protective clothing and applying sunscreen.

- Topiramate

Food does not affect the absorption and utilization of topiramate. It can be taken on an empty stomach or with food. Please drink plenty of water during medication;

If you are taking tablets, swallow them whole without breaking or crushing them;

If the capsule is taken, it can be swallowed whole, or the entire contents can be carefully opened and sprinkled on a small amount (teaspoon) of soft food, such as applesauce, jelly, ice cream, oatmeal, pudding, or yogurt. Do not chew, and drink water immediately to ensure that the child swallows the mixture. The medicine should be swallowed immediately after mixing with food, and should not be left for later use.

Topiramate may cause decreased sweating and increased body temperature, especially in children, so please observe carefully during medication, especially in hot weather.

- Oxcarbazepine

Food does not affect the absorption of oxcarbazepine, and it can be taken on an empty stomach or with food;

Please shake oxcarbazepine oral suspension well before taking it. You can take it directly or mix it with a small amount of water and take it immediately;

Oxcarbazepine oral suspension contains sorbitol and should not be used by people with genetic fructose intolerance;

Once the oral suspension is opened, it can be used for up to 7 weeks.

——Levetiracetam

Food does not affect the efficacy of the drug, but the drug must be taken at the same time every day;

Levetiracetam oral solution can be diluted with water for administration;

Levetiracetam oral solution contains maltitol and should not be used by children with hereditary fructose intolerance;

- Lamotrigine

Food does not affect the absorption of lamotrigine, and it can be taken with or without food;

Lamotrigine may need to be used for several weeks to fully take effect, so please strictly follow your doctor's instructions;

If you develop a rash, fever, or lymphadenopathy after taking this medicine, see a doctor immediately.

- Perampanel

Take the medicine before bedtime, on an empty stomach or with food. Swallow the medicine whole without chewing, crushing or breaking it.

Perampanel has a long half-life. If you miss a dose, do not make up for it and wait until the next dose. If you miss multiple doses and the duration exceeds 3 weeks (1 week when taking drugs that induce the metabolism of this drug at the same time, such drugs include carbamazepine, phenytoin, oxcarbazepine, etc.), it is recommended to readjust the dose from the initial dose.

——Lacosamide

Food does not affect the absorption of lacosamide. It can be taken on an empty stomach or with food. When taking twice a day, please take the medicine in the morning and evening respectively.

If you are taking tablets, please swallow them whole and do not cut them; please shake the oral solution well before taking it;

Lacosamide oral solution contains sorbitol, which may cause gastrointestinal discomfort and has a mild laxative effect and should not be used by people with genetic fructose intolerance;

Dizziness may occur after taking the medicine, which increases the risk of accidental injury or falling. Parents are requested to remind their children to stand up slowly after sitting or lying down, and to be careful when going up and down stairs.

Please store in a sealed container at a temperature not exceeding 30°C. The oral solution cannot be refrigerated.

Epilepsy requires long-term treatment. Every family of a child with epilepsy has a common responsibility and mission to care for the child and give the child the courage and motivation to overcome the disease. While building confidence in overcoming the disease, the child must actively cooperate with the treatment, follow the doctor's orders, check and take medicine on time, maintain a stable and optimistic mood, combine work and rest, pay attention to dietary taboos, and try to avoid or control the intake of spicy and irritating foods, as well as alcohol, coffee, carbonated drinks, strong tea, functional drinks, chocolate, etc., so as not to induce epilepsy. In particular, alcohol (or alcoholic beverages) should be avoided while taking anti-epileptic drugs.

References:

[1] Drug instructions

[2] MICROMEDEX database

[3] Chinese Anti-Epilepsy Association. Clinical Diagnosis and Treatment Guidelines - Epilepsy Volume (2023 Revised Edition) [M]. Beijing: People's Medical Publishing House, 2023.

[4] Chen Guohong. Diagnosis and treatment of pediatric neurological seizure disorders[M]. Henan Science and Technology Press, 2018, 12.

Source: Department of Pharmacy, Tianjin Children's Hospital

Author: Liu Qian, Chief Pharmacist

Reviewer: Li Rongrong, Chief Pharmacist