Guide to Anti-Epileptic Drugs

Anti-seizure medications, which are also called anticonvulsants or anti-epileptic drugs (AEDs), are medications used to prevent seizures for people who have epilepsy. All AEDs are available only by prescription. 

Epilepsy is a medical condition characterized by a predisposition to recurrent seizures. If you have been diagnosed with epilepsy or a seizure disorder, you might need to take one or more AEDs on a regular schedule to reduce your chances of having a seizure.

AEDs interact with nerve cells in the brain, usually to reduce their activity. There are several mechanisms by which the different AEDs work, so each type of epilepsy responds to some AEDs but not others.

Common Anti-Epileptic Drugs

There are several anticonvulsant drugs that are commonly prescribed. Understanding how your medications work, and their possible side effects, is an important component of your treatment.

Keppra (Levetiracetam)

Keppra (levetiracetam) is approved for adults and for children ages 1 month and older. Keppra is used for prevention of seizures for people who have partial epilepsy, generalized epilepsy, and myoclonic epilepsy. It is among the most commonly used AEDs.

Keppra comes in a regular and extended-release pill, as well as an oral liquid formulation and a formulation that can be taken intravenously (IV). The mechanism of Keppra’s action is not known. 

Side effects may include:

• Headaches
• Tiredness
• Dizziness
• Depression
• Infection
• Weakness
• Agitation
• Aggressive behavior

Dilantin (Phenytoin)

Dilantin (phenytoin) is one of the oldest anticonvulsant medications. It is used for children and adults for prevention of generalized and partial seizures. It is also used for treatment of status epilepticus, a prolonged seizure that requires treatment with AEDs. Dilantin can be used alone or in combination with other AEDs.

Dilantin is available in capsule, chewable pill, oral solution, and IV form. This drug interacts with nerve cell sodium channels. Sodium channels facilitate normal nerve activity, and excessive stimulation may be associated with seizures, while their inhibition may prevent seizures.

Side effects may include:

• Dizziness
• Tiredness
• Difficulty concentrating
• Liver damage

A rare side effect that can occur with Dilantin and several other AEDs, Stevens-Johnson syndrome begins with skin rash and flu-like symptoms. It can rapidly progress, causing severe sloughing of the skin, which may result in a life-threatening infection and/or life-threatening dehydration.

In some instances, Dilantin causes gum overgrowth in the mouth, which can lead to dental problems.

Tegretol, Carbatrol (Carbamazepine)

Tegretol and Carbatrol are both brand names for the drug carbamazepine. Carbamazepine is approved for children and adults and is used for prevention of generalized seizures and partial seizures.

Carbamazepine is also often used for the treatment of pain that is related to conditions such as neuropathy and trigeminal neuralgia.

It comes in a capsule, pill, and oral liquid form. Carbamazepine is believed to prevent seizures by blocking the activity of nerve cells. 

Side effects include:

• Anemia (low red blood cell count)
• Eosinophilia (elevated white blood cell count)
• Dizziness
• Fever
• Bruising
• Skin rash
• Stevens-Johnson syndrome (rare)

Depakote, Depakene (Valproic Acid)

Depakote and Depakene (valproic acid) are used for both children and adults. Valproic acid is used for partial and generalized epilepsy and is often used for the management of seizures associated with childhood developmental conditions such as juvenile myoclonic epilepsy and Lennox-Gastaut syndrome. It is also used for the treatment of bipolar disorder and for migraine prevention.

Valproic acid comes in a tablet, extended-release tablet, and a capsule. It interacts with gamma-aminobutyric acid (GABA), a neurotransmitter that slows down activity in the brain. Valproic acid also has other actions in the brain, which could explain why it has several different uses.

Side effects include:

• Dizziness
• Fatigue
• Stomach upset
• Hair loss
• Menstrual irregularities

Neurontin (Gabapentin)

Neurontin (gabapentin) is approved for adults and for children ages 3 and older. It is approved for the treatment of partial seizures and is often used as an add-on medication for epilepsy.

This drug has other uses as well. It can be used for the prevention of painful conditions, such as trigeminal neuralgia and neuropathy. It is also prescribed for the treatment of restless leg syndrome.

Neurontin comes in three forms that are taken by mouth—pill, capsule, and liquid. The mechanism by which Neurontin prevents seizures is not known

Side effects can include:

• Tiredness
• Dizziness
• Feeling off balance 

Phenobarbital

Phenobarbital is the oldest and most well-understood anticonvulsant. Children and adults can use it. Phenobarbital is used for the treatment of a variety of seizure types, including partial seizures, seizures that occur in Lennox-Gastaut syndrome, and status epilepticus. This medication can be used alone or in combination with other anticonvulsants.

Phenobarbital is available in a tablet, an oral liquid form, and an IV form. It interacts with GABA, and it has a sedative effect that can make you very sleepy. 

Side effects include:

• Dizziness
• Tiredness
• Trouble concentrating
• Slurred speech

Mysoline (Primidone)

Mysoline (primidone) is approved for children and adults and is typically used for seizure control in children. It is used for the prevention of partial seizures as well as partial seizures that generalize (spread to cause decreased consciousness). Mysoline is also used for the treatment of benign essential tremor, a condition characterized by tremors and shaking of the hands, particularly in times of stress.

This medication is available in pill form. It affects GABA. 

Side effects may include:

• Loss of balance or feeling of unsteadiness
• Tiredness
• Nystagmus (jerky eye movements)
• Vomiting

Topamax (Topiramate)

Topamax (topiramate) is approved for adults and for children ages 2 and older. It is used for the treatment of partial and generalized seizures. It is often used in combination with other anticonvulsants. Topamax is also approved for migraine prevention.

Topamax comes in both tablet and capsule form. It affects sodium channels and interacts with GABA.

Adverse effects include:

• Glaucoma
• Kidney stones
• Irritability
• Weight loss
• Fever

Trileptal, Oxtellar, Oxtellar XR (Oxcarbazepine)

Oxcarbazepine is sold under the brands Trileptal, Oxtellar, and Oxtellar XR. It is used for adults, and for children ages 2 and older, to treat partial epilepsy. It can be used alone or in combination with other medications.

Oxcarbazepine is available as a tablet, an extended-release formula, and an oral liquid. It acts on sodium channels in the brain, as well as calcium and potassium channels, which facilitate nerve activity. 

Side effects can include:

• Dizziness
• Drowsiness
• Dry mouth
• Constipation
• Blurred vision
• Skin rash

A prominent and unusual side effect of oxcarbazepine is hyponatremia (low sodium levels), which can become dangerous.

Gabitril (Tiagabine)

Gabitril (tiagabine) is approved for adults and for children ages 12 and older. It is used as an adjunct to other medications for the treatment of partial seizures. Gabitril comes in pill form and is believed to interact with GABA.

Side effects include:

• Itching
• Blistering skin
• Balance problems
• Depression

Lamictal (Lamotrigine)

Lamictal (lamotrigine) is approved for adults and for children ages 2 and older. It is used as a treatment for partial seizures, as well as Lennox-Gastaut syndrome, and refractory epilepsy. Lamictal can also be used for the management of bipolar disorder.

This medication is available in pill form. The mechanism of action of Lamictal is not known.

Side effects can include:

• Itching
• Skin rash
• Sores in the mouth
• Fever
• Depression
• Stevens-Johnson syndrome

Zarontin (Ethosuximide)

Zarontin (ethosuximide) is approved for adults and children and is used for the treatment of absence seizures. Also referred to as petit mal seizures, this type of seizure is characterized by staring into space rather than by involuntary movements of the body.

Zarontin is available in a capsule form and as an oral solution.

Side effects may include:

• Drowsiness
• Headaches
• Dizziness
• Irritability
• Decreased appetite
• Low white blood cell count

Zonegran, Zonisade (Zonisamide)

Zonisamide is sold under the brands Zonegran and Zonisade. It is approved for adults and for children over age 16. This drug is used to treat partial seizures and is typically used in combination with another anticonvulsant.

Zonisamide, available in capsule form (Zonegran) and as an oral liquid (Zonisade), works by acting on sodium and calcium channels. It is also a carbonic anhydrase inhibitor, which affects the kidneys.

Side effects include:

• Skin rash
• Fevers
• Loss of appetite
• Painful urination

Onfi (Clobazam)

Onfi (clobazam) is used for the treatment of seizures in Lennox-Gastaut syndrome, and is approved for children ages 2 and up. Onfi is available as a tablet and as an oral suspension. It interacts with GABA.

Side effects include:

• Drowsiness
• Dizziness
• Irritability
• Hallucinations

Klonopin (Clonazepam)

Klonopin (clonazepam) is used in both children and adults for the treatment of partial seizures and absence seizures. It is also used for treatment of anxiety and panic disorders.

Klonopin is available as a tablet. It interacts with GABA. 

Side effects include:

• Drowsiness
• Confusion
• Depression
• Itching

Less Commonly Used Anti-Epileptic Drugs

In some cases, other medications may be needed instead of, or in addition to, the more commonly prescribed medications listed above.

Sabril, Vigafyde (Vigabatrin)

Sabril (vigabatrin) is FDA-approved for the treatment of refractory epilepsy (epilepsy that does not improve with standard AEDs) in people 2 years and older. It is also FDA-approved for the treatment of infantile spasms (IS). Sabril is available as a tablet and an oral solution. It interacts with GABA.

Vigafyde (vigabatrin oral solution) is the first and only FDA-approved oral solution for the treatment of infantile spasms in children aged 1 month to 2 years.  

Felbatol (Felbamate)

Felbatol (felbamate) is used for children and adults in the treatment of refractory epilepsy. It is available in tablet and oral suspension form. The mechanism of action is not known. Felbatol can cause a number of side effects, including aplastic anemia and liver failure.

Banzel (Rufinamide)

Banzel (rufinamide) is approved for adults and for children over the age of 1 for treatment of seizures in Lennox-Gastaut syndrome. It is available as a tablet and oral suspension. Banzel interacts with sodium channels.

Side effects include dizziness, difficulty with coordination, and fatigue. 

Fycompa (Perampanel)

Fycompa (perampanel) is approved for the treatment of partial-onset seizures in people aged 4 years and older and for the treatment of generalized seizures in people aged 12 years and older. The exact way Fycompa works is not fully understood.

Fycompa can cause dizziness, fatigue, and neuropsychiatric changes including alterations in mood and aggression. For this reason, it contains a boxed warning.

Aptiom (Eslicarbazepine Acetate)

Aptiom (eslicarbazepine acetate) is approved for adults and for children ages 4 and older. It is used for partial seizures and comes in tablet form. It acts on sodium channels.

Side effects include dizziness, fatigue, and headaches.

Vimpat (Lacosamide)

Vimpat (lacosamide) is approved for adults and for children ages 4 and older. It is used for the treatment of partial seizures. Vimpat is available as a tablet, oral solution, and IV form. It acts on sodium channels.

Side effects include dizziness, nausea, vomiting, and alterations in heart rate.

Lyrica (Pregabalin)

Lyrica (pregabalin) is approved for adults and for children ages 1 month and older. It is usually used for treating pain, but is also used for the treatment of partial seizures. Lyrica is typically used in addition to another anticonvulsant rather than on its own. It is available as a tablet or oral solution, and it acts on calcium channels.

Side effects include trouble sleeping, anxiety, irritability, and suicidal ideation.

Cannabidiol (CBD)

Cannabidiol (CBD) was approved in June 2018 for the treatment of epilepsy in adults and in children ages 2 and older. It is approved for seizures associated with Dravet syndrome and Lennox-Gastaut syndrome.

CBD oil is available as an oral solution. The mechanism of action is not known.

Side effects include fatigue, liver damage, and suicidal ideation.

Emergency Anticonvulsants

Some medications are commonly used to stop seizures during an emergency situation. While they can rapidly bring seizures to a stop, these AEDs are not taken on a regular schedule to prevent seizures. They can also be used as sedatives during medical procedures.

Side effects include dizziness, tiredness, confusion, and slurred speech.

• Ativan (lorazepam) is available as a tablet, oral solution, or injectable form. It may interact with GABA.
• Valium, Diastat (diazepam) is available as a tablet, oral solution, or injectable form.

A Word From Verywell

AEDs can be highly effective in preventing seizures if you have epilepsy. Some of these medications can be taken together to achieve seizure control, while some can produce harmful interactions when used together. Because AEDs can produce a number of serious side effects, it is important that you follow your healthcare provider’s instructions when starting or stopping any AED.

If you experience any of the side effects above, you should seek prompt medical attention. It is unsafe to stop any AED abruptly or on your own, as withdrawal can induce a seizure.

If you take an AED, you can experience an adverse event if you drink alcohol or use drugs. Eating certain foods, such as grapefruit, is not advised with some AEDs as it can alter their effects. If you are taking an anticonvulsant, you must let your medical team know if you are pregnant or planning to become pregnant, as many AEDs are associated with birth defects.