Anticonvulsant
Generic and Trade Names:
| Acetazolamide | Diamox | ||
| Carbamazepine | Tegretol | ||
| Diazepam | Valium | ||
| Divalproex | Depakote | ||
| Ethoserximide | Zarontin | ||
| Ethotoin | Peganone | ||
| Felbamate | Felbamate | ||
| Gabapentin | Neurontin | ||
| Mephenytoin | Mesantoin | ||
| Methsuximide | Celontin | ||
| Phenacemide | Phenurone | ||
| Phenobarbital | Phenobarbital | ||
| Phensuximide | Milontin | ||
| Phenytoin | Dilantin | ||
| Primidone | Mysoline | ||
| Trimethadione | Tridione | ||
| Valproic Acid | Depakene |
Description:
There are several different classes of Anticonvulsants. Each class of drugs works in various ways to prevent or relieve different types of convulsions. Their exact mechanism of action is unknown in many cases, however, it is believed that in part some of these drugs have a membrane stabilizing effect.
The anticonvulsant drugs include phensuximide, valproic acid, and mephenytoin. (Facts and Comparisons 1999)
Nutritional Considerations:
Barbiturate
Nausea, vomiting (Pronsky 1999)
Limit caffeine. (Pronsky 1999)
Calcium, folic acid, vitamin D, vitamin K, B-12, and magnesium levels may be lowered by phenobarbital. (Brinker 1998) (Pronsky 1999)
Greater than 80-400mg pyridoxine supplement may decrease drug effects. (Pronsky 1999)
Carbamazepine
Electrolytes should be maintained (sodium levels may become low). (Pronsky 1999)
Caution with grapefruit juice, do not administer together. (Pronsky 1999)
Also monitor iron levels.
Vitamin D levels may also become deficient. (Ranjantie 1984)
Avoid alcohol . (Pronsky 1999)
Phenytoin
Nausea,vomiting, altered taste. (Pronsky 1999)
Fiber increase may assist absorption and elimination. (Pronsky 1999)
Supplements of Vitamin D and folic acid are often recommended (Berg, Botez, Keith, Reynolds, Bone, Gascon-Barre, Hahn). However, a high folic acid diet can lower the bioavailability of the drug (Ch'ien).
Other vitamins which may be affected have also been mentioned, including: vitamin B-12, vitamin C and vitamin K (Cornelissen, Latham, Krause, Mock).
Avoid alcohol. (Pronsky 1999)
Hyperglycemia, caution in diabetics because it can raise blood glucose levels. (Pronsky 1999) Monitor sugar levels
Vitamin B6 (Pyridoxine) can lower Phenytoin levels. (Brinker 1998)
Osteomalacia (Pronsky 1999) may need Vitamin D supplementation.
Calcium or magnesium supplements inhibit absorption, separate by 2 hrs. (Pronsky 1999)
Excess folic acid in doses greater than 5mg/week can increase drug metabolism and therefore decrease blood levels. (Pronsky 1999). More than 5mg/week of folic acid may cause breakthrough epilepsy among patients on dilantin (phenytoin) therapy. (Kones, 1990) (Brinker 1998)
Vitamins B1, folic acid and K may be depleted. (Botez 1982)(Lewis 1995)(Keith 1983)
Copper levels may be raised with phenytoin. (Brinker 1998)
Folic Acid may be helpful with phenytoin. (Berg 1995)(Pronsky 1999)
Avoid alcohol. (Pronsky 1999)
Limit caffeine, coffee, tea can be eliminated faster by phenytoin. (Brinker 1998)
Primidone
Appetite loss, nausea/vomiting. (Pronsky 1999)
Biotin and folic acid may be depleted.
Protein deficient diets can increase drug effects
High vitamin C intake can increase drug excretion.
Valproic Acid:
Take with meals to decrease GI irritation. (Pronsky 1999)
Do not take syrup form with carbonated beverage, may cause mouth or throat irritation or bad taste. (Pronsky 1999)
Avoid alcohol. (Pronsky 1999)
Increased risk of osteoporosis with long term use. (Pronsky 1999)
Melatonin production in untreated patients with active epilepsy is increased and has a circadian pattern with a phase difference as compared with that of normal subjects. (Schapel, 1995) This seems to open up the possibility that melatonin supplementation could help regulate these phases.
Herbal Considerations:
Herbs with significant levels of salicylates e.g. Meadowsweet , Poplar and White Willow Bark may possibly potentiate phenytoin therapy. (Newall 1996)
The piperine component of Black Pepper and Long Pepper can cause phenytoin to be absorbed more quickly and eliminated more slowly. (Brinker 1998)
Guarana, Mate, Cola and other caffeine containing herbs can clear faster from the body in the presence of Phenytoin and other anticonvulsants. (Brinker 1998)
Gingko seed may interact with anticonvulsants, because of its seizure potential. (Newall 1996)
Motherwort is noted as an antiepileptic, possibly via improvement in cerebral ischemia. (Kuang PG, 1988) While most of our knowledge about this plant is derived from China and a Chinese variety, a related species has a long-standing history of usage with native people in South Africa for headaches. (Jager, 1996)
Kava kava has approval status by the German Commission E regarding its use as an anticonvulsant, however, it may potentiate the effects of other CNS depressant drugs, and is contraindicated for use together. (Brinker 1998)
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