Drug |
Indications |
|
Side Effects |
Brivaracetam (Briviact®) |
- Focal epilepsy in patients 16 years or older
|
 |
- Rash
- Swelling
- Feeling sad
- Depression/suicidal thoughts
|
Carbamazepine (Tegretol®. Tegretol® XR, Carbatrol) |
- Monotherapy and adjunctive for focal epilepsy and generalized tonic-clonic seizures
- Trigeminal neuralgia
- Contra-indicated in absence and myoclonic seizures
|
 |
- Changes in blood cell counts
- Sleepiness, dizziness, blurred vision
- Vomiting, diarrhea, constipation
- Depression/suicidal thoughts
|
Clobazam (Onfi®) |
- Adjunctive for LGS in patients two years or older
|
 |
- Serious Skin rash/Stevens-Johnson Syndrome
- Trouble using the bathroom,
- Tiredness
- Suicidal thoughts/depression
|
Clonazepam (Klonopin®) |
- Monotherapy or Adjunctive for LGS, akinetic and myoclonic seizures,
- Refractory absence seizures
- Panic disorder
- Periodic leg movement
- Neuralgia
|
 |
- Drowsiness
- Withdrawal seizures
- Depression/Suicidal behavior
- Tolerance is common in long-term use: seizures may recur and require dosage increases
|
Clorazepate (Tranxene T-tab®) |
- Adjunctive treatment of focal seizures
- Treatment for anxiety disorders
- Acute alcohol withdrawal
|
 |
- Depression: sleepiness, behavioral issues
- Suicidal behavior/ideation
- Withdrawal seizures/status
- Trouble sleeping, nervousness
|
Eslicarbazepine (Aptiom®) |
- Adjunctive or monotherapy treatment for focal seizures (age 18+)
|
 |
- Rash,
- Dizziness
- Extreme tiredness
- Depression/suicidal behavior
|
Ethosuximide (Zarontin®) |
- Absence Epilepsy (age 3 and older)
|
 |
- Abnormalities in liver and kidney function
- Nausea, abdominal discomfort, drowsiness, anorexia, headache, rash
- Depression/Suicidal behavior
|
Ethotoin (Peganone®) |
- Generalized tonic-clonic seizures and focal seizures
|
 |
- Liver damage
- Depression/Suicidal behavior
|
Felbamate (Felbatol®) 2nd generation |
- Focal epilepsy
- Primary and Adjuvant for LGS
- Contraindicated in blood and hepatic
- Last resort drug.
|
 |
- Rarely causes blood counts to go down and liver failure
- Anorexia, vomiting, trouble sleeping, headache, dizziness
- Drug rash
- Depression/Suicidal behavior
|
Gabapentin (Neurontin®) |
- Adjunctive therapy in focal seizures with sec GTC > 12 yo and focal seizures in 3-12 yo
- Trigeminal neuralgia and postherpetic neuralgia
|
 |
- Dizziness, fatigue,
- Dose-related weight gain
- Depression/Suicidal behavior
|
Lacosamide (Vimpat®) |
- Monotherapy or Adjuvant therapy for focal onset epilepsy age >17.
|
 |
- Dizziness, headaches, nausea
- Severe cardiac disease
- Depression/Suicidal behavior
|
Lamotrigine (Lamictal®) |
- Adjunctive tx for focal seizures, primary generalized tonic-clonic seizures, LGS (> 2 yo)
- Monotherapy for focal seizures for those who have tried 1st generation AEDs (> 16 yos)
- Bipolar disorder ( > 18 yo)
|
 |
- Serious Skin rash/Stevens-Johnson Syndrome
- Mild tremor
- Headache
- Insomnia
- Dizziness
- Depression/Suicidal behavior
|
Levetiracetam (Keppra®) |
- Adjunctive tx for focal onset seizures (>4 yo)
- Adjunctive tx for myoclonic seizures in JME (>12 yos)
- Adjunctive tx for primary GTC (>6 yo)
|
 |
- Coordination difficulties
- Behavioral problems
- Depression/Suicidal behavior
|
Oxcarbazepine (Trileptal®) |
- Monotherapy or adjunctive tx for focal onset seizures in adults and 4-16 yos.
- Not for 1° gen epilepsy because it worsens myoclonic and absence seizures
- Trigem neuralgia
|
 |
- Dizziness, headache, nausea, vomiting
- Blurred vision, tremor
- Depression/Suicidal behavior
- Rash and Stevens-Johnson syndrome
|
Perampanel (Fycompa™) |
- Monotherapy tx for focal onset seizures ± GTC (> 12 yos)
- Adjunctive for PGTC (>12yo)
|
 |
- Mood changes and irritability
- Dizziness, fatigue, falls
- Nausea
- Weight gain
|
Phenobarbital |
- Focal onset seizures and generalized tonic-clonic seizures
- Neonatal seizures
- Status epilepticus
- Sedation
- Not usually used chronically due to dose-related side effects
|
 |
- Depression/Suicidal behavior
- Withdrawal seizures if stopped abruptly
|
Phenytoin (Dilantin®, Phenytek) |
- Focal epilepsy with generalized tonic-clonic seizures
- Focal epilepsy seizures
- Status epilepticus
|
 |
- Extreme tiredness
- Abnormal movements
- Confusion, cognitive changes
- Depression/Suicidal behavior
|
Pregabalin (Lyrica®) |
- Adjunctive tx for partial seizures in adults
- Diabetic neuropathic pain
- Post-herpetic neuralgia
- fibromyalgia
|
 |
- Weight gain, poor concentration
- Blurred vision
- Depression/Suicidal behavior
|
Primidone (Mysoline®) |
- Monotherapy and Adjuvant tx for generalized tonic-clonic, focal and psychomotor seizures (> 8 yo)
- Refractory GTCs
- Essential tremor
|
 |
- Sleepiness, rash, nausea/ vomiting
- Depression/Suicidal behavior
|
Rufinamide (Banzel®) |
- Adjunctive tx of seizures with LGS in > 4 yos
|
 |
- Contra-indicated in Familial Short QT syndrome
- Headache
- Dizziness
- Depression/Suicidal behavior
|
Tiagabine (Gabitril®) |
- Adjunctive therapy for partial seizures (over age 12)
- Not for patients with primary generalized epilepsy as may worsen myoclonus and absence seizures
|
 |
- Tiredness, dizziness, headache, tremor, abnormal thinking
- Seizures in patients without epilepsy: new onset seizures
- Depression/Suicidal behavior
|
Topiramate (Topamax®, Trokendi XR®, Qudexy XR®) |
- Monotherapy and adjunctive tx in focal or primary GTC seizures (> 2 yo)
- Adjuvant for LGS (> 2 yo)
- Migraines in adults
|
 |
- Somnolence
- Weight loss
- Speech disturbance
- Dizziness
- Depression/Suicidal behavior
|
Topiramate extended-release Forms
Trokendi™ XR
Qudexy™ XR |
Trokendi XR:
- Monotherapy in ≥ 10 yo with focal or primary GTC, LGX in pts ≥ 6 yo
Qudexy XR:
- Monotherapy in ≥ 10 yo for focal or primary GTC, adjunctive in pts ≥ 2 yo for focal or primary GTC, adjuvant for LGS ≥ 2 yo
|
 |
- Depression/Suicidal behavior
- Somnolence, tiredness
- Weight loss
- Speech disturbance
- Dizziness
|
Valproic acid (Depakene®)
Divalproex sodium (Depakote®, Depakote ER®) |
- Monotherapy and Adjunctive tx for focal onset seizures
- Monotherapy and Adjunctive tx for focal onset seizures with and without loss of consciousness
- Adjunctive for multiple seizure types that include absence seizures
|
 |
- Liver failure, pancreatitis
- High risk of major congenital malformations in children of women taking valproic acid
- Drowsiness
- Nausea, vomiting, weight gain, transient hair loss
- Depression/Suicidal behavior
|
Vigabatrin (Sabril®) |
- Adjunctive tx for refractory focal epilepsy in adults who have failed other alternatives
- Monotherapy for infantile spasms, especially in TS
|
 |
- Progressive and permanent visual field constriction requires consent
- Depression/Suicidal behavior
- Tiredness
- Weight gain
- Tremor
|
Zonisamide (Zonegran®) |
- Adjunctive therapy for partial seizures in adults with epilepsy
- May be effective in myoclonus (not approved in US)
|
 |
- Rash/Stevens-Johnson syndrome
- Weight loss, dizziness, eating problems, slowed thinking
- Depression/Suicidal behavior
|