Anticonvulsants

Carbamazepine (Tegretol)
Diazepam (Valium)
Divalproex (Depakote)
Gabapentin (Neurontin)
Phenobarbital (Phenobarbital)
Phenytoin (Dilantin)
Primidone (Mysoline)
Valproic Acid (Depakene)

Nutritional Considerations:

Limit Caffeine. (Pronsky 1999)

Avoid alcohol. (Pronsky 1999)

Calcium, folic acid, vitamin D, and vitamin B-12, may be lowered by phenobarbital and phenytoin, with long-term use of the medications. (Brinker 1998) (Pronsky 1999) Consult your pharmacist regarding possible supplementation.

Vitamin D may also be beneficial during carbamazepine therapy. Ask your pharmacist regarding supplementation. (Collins 1991) (Rajantie 1984)

Take carbamazepine, divalproex, phenytoin, and valproic acid with meals to decrease GI irritation. (Pronsky 1999)

Do not administer carbamazepine and diazepam with grapefruit juice. (Garg 1998) (Ozdemir 1998) (Pronsky 1999)

Avoid magnesium supplements and other antacid products within two hours of neurontin. (Facts and Comparisons 2000) (Pronsky 1999)

Copper levels may be raised with phenytoin. Levels should be checked periodically with long-term use of the medication. (Brinker 1998)

Do not take divalproex or valproic acid with sodas or any carbonated beverage. The carbonation could release valproic acid, which could greatly irritate the mouth and throat. (Rybacki 1997) (Pronsky 1999)

Herbal Considerations:

Cinchona can increase carbamazepine drug levels and should not be used together. (Perlman 1990)

Psyllium can interact with carbamazepine and should not be used together. (Etman 1995)

Tobacco may reduce the effectiveness of Diazepam and should be avoided. (Brinker 1998) (Ferguson 1987)

Avoid using kava with diazepam due to its sedating properties, oversedation may occur. (Almeida 1996) (Brinker 1998) (Davies 1992) (Holm 1991)

Guarana, Mate, Cola and other caffeine containing herbs can clear faster from the body in the presence of Phenytoin and other anticonvulsants. (Brinker 1998)

Avoid borage, evening primrose Oil, ginkgo seed, ground ivy and sage with anticonvulsants because they may increase the risk of seizures. (Newall 1996)

References:

Almeida JC. Coma from the health food store: Interaction between kava and alprazolam. Ann Intern Med 1996;125:940-41.

Brinker, Francis,N.D. Herb Contraindications and Drug Interactions. 1998.

Collins N, Maher J, Cole M, Baker M, Callaghan N. A prospective study to evaluate the dose of vitamin D required to correct low 25-hydroxyvitamin D levels, calcium, and alkaline phosphatase inpatients at risk of developing antiepileptic drug-induced osteomalacia. Q J Med. 1991 Feb; 78(286): 113-22

Davies LP, Drew CA, Duffield P, et al. Kava pyrones and resin: Studies on GABAA, GABAB and benzodiazepine binding sites in rodent brain. Pharm Toxicol 1992;71:120-26.

Etman M. Effect of a bulk forming laxative on the bioavailablility of caramazepine in man. Drug Devel Indus Pharm, 1995; 21:1901-906

Facts and Comparisons, Clinisphere 2.0, Wolters Kluwer Company, 2000

Ferguson, T: The Smoker's Book of Health, New York, 1987.

Garg SK, Kumar N, Bhargava VK, Prabhakar SK. Effect of grapefruit juice on carbamazepine bioavailability in patients with epilepsy. Clin Pharmacol Ther 1998 Sep; 64(3): 286-8.

Holm E, Staedt U, Heep J, et al. Studies on the profile of the neurophysiological effects of D,L-kavain: Cerebral sites of action and sleep-wakefulness rhythm in animals. Arzneim Forsch 1991;41:673-83.

Newall CA, Anderson LA, Phillipson JD. Herbal Medicines: A Guide for Health-care Professionals. London: The Pharmaceutical Press, 1996

Ozdemir M, Aktan Y, Boydag BS. Interaction between grapefruit juice and diazepam in humans. Eur J Drug Metab Pharmacokinet 1998 Jan-Mar; 23(1): 55-9.

Perlman BB, Interaction between lithium salts and ispaghula husk, Lancet, 1990; 335:416

Pronsky, Zaneta. Food Medication Interactions. 11th edition. 1999.

Rajantie J, Lamberg-Allardt C & Wilska M: Does carbamazepine treatment lead to a need of extra vitamin D in some mentally retarded children? Acta Paediatr Scand 1984; 73:325-328.

Rybacki JJ. The Concise Essential Guide to Prescription Drugs, HarperCollins, 1997.