11 Common Antiepileptic Seizure Medications to Know

1. Lamotrigine (Lamictal)

Lamotrigine (Lamictal) can be used for both focal and generalized seizures. It isn’t completely understood how it manages seizures. But experts think it works by lowering the release of chemicals like glutamate. Glutamate is a chemical messenger that helps trigger electrical activity in the brain.

Lamotrigine is commonly prescribed as an oral immediate-release (IR) tablet. But it also comes as an extended-release (ER) tablet, a chewable tablet, and an orally disintegrating tablet (ODT). It can be taken either once or twice daily. Most forms are FDA approved for people ages 2 and older. But the ER tabs are approved only for people ages 13 and older.

Lamotrigine interacts with many other antiepileptic medications, including carbamazepine (Tegretol), phenytoin (Dilantin), and valproic acid derivatives (Depakote and Depakene). If you’re taking any of these medications, make sure to discuss this with your prescriber and pharmacist.

2. Gabapentin (Neurontin)

Gabapentin (Neurontin) is approved to treat focal seizures for people ages 3 and older. The way gabapentin works for seizures also isn’t quite clear. But it’s thought to act similarly to a brain chemical called gamma-aminobutyric acid (GABA). GABA is believed to help soothe nerves in the brain.

Gabapentin comes as an oral capsule, tablet, and liquid. It’s typically taken 3 times a day for seizures. It’s sometimes used as an add-on medication for people whose seizures aren’t managed well with one medication.

Good to know: Gabapentin also comes as ER tablets (Gralise, Horizant). But these dosage forms aren’t approved for seizures. They’re approved only to manage nerve pain related to shingles.

3. Levetiracetam (Keppra, Spritam)

Levetiracetam (Keppra, Spritam) is an anti-seizure medication that treats focal and generalized seizures. Its approved age ranges depend on the type of seizure you’re treating:

• Focal seizures: Ages 1 month and older

• Juvenile myoclonic epilepsy (a type of generalized seizure condition): Ages 12 and older

• Tonic-clonic seizures: Ages 6 and older

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It’s not clear how levetiracetam works. Researchers believe that it lowers electrical signals by attaching to certain proteins in the brain.

You can take levetiracetam orally as an IR or ER tablet, ODT, or liquid. It also comes as an IV solution that’s typically used in hospitals. When taken by mouth, you’ll likely take it once or twice a day.

Levetiracetam is usually tolerated well. But it can sometimes cause behavioral problems, including aggression. Some research suggests that taking vitamin B6 (pyridoxine) can help lessen this.

4. Phenytoin (Dilantin)

Phenytoin (Dilantin) is an anti-seizure medication that treats focal and generalized seizures. It can be given to people of all ages, including infants. It works by reducing abnormal brain signals.

People taking phenytoin need to get regular lab tests done to make sure it’s working as it should. Healthcare professionals may also recommend genetic testing before starting this medication. This is because some people are at higher risk for developing a serious rash called Stevens-Johnson syndrome (SJS).

Phenytoin is available as an oral capsule, liquid, and chewable tablet. There’s an IV solution available to use in hospital settings, too. When taken orally, most people take phenytoin 3 to 4 times a day.

5. Zonisamide (Zonegran, Zonisade)

Zonisamide (Zonegran, Zonisade) helps treat focal seizures in adults. But it should be used alongside other anti-seizure medications (not by itself). It’s thought to work by preventing neurons from sending irregular electrical signals.

Zonisamide is available as an oral capsule and liquid suspension. Most people take it once or twice a day. It’s recommended to check zonisamide blood levels regularly while taking it. This helps make sure it’s working properly.

6. Carbamazepine (Tegretol)

Carbamazepine (Tegretol) is an anti-seizure medication that treats focal and generalized seizures. It can also be used for mixed seizures (when you experience multiple types of seizures). Carbamazepine is approved for people of all ages. It works by calming down communication between brain cells.

Genetic testing may be suggested before starting carbamazepine. Similar to phenytoin, some people have a higher risk for developing SJS when taking carbamazepine.

Carbamazepine interacts with many medications. Make sure to share a full medication list with your prescriber and pharmacist. Carbamazepine is available in several dosage forms:

• IR tablet

• ER tablet

• ER capsule

• Chewable tablet

• Oral liquid

Depending on the dosage form you have, you may take this medication 1 to 4 times a day.

7. Oxcarbazepine (Trileptal)

Oxcarbazepine (Trileptal) is an anti-seizure medication used to manage focal seizures for people ages 2 and older. It works by calming brain signals that cause seizures.

Like phenytoin and carbamazepine, healthcare professionals may recommend genetic testing before starting oxcarbazepine due to the risk of SJS. It’s important to monitor blood sodium levels while taking this medication. This is because it can cause low sodium levels.

Oxcarbazepine has many medication interactions. Make sure to let your prescriber and pharmacist know what else you take. Oxcarbazepine comes as an IR and ER oral tablet and an oral liquid. You’ll likely take it once or twice per day.

8. Valproic acid derivatives

Valproic acid derivatives refers to two medications: valproic acid and divalproex (Depakote). They’re both FDA-approved for focal and generalized seizures. They treat seizures in several ways. But a major way they work is by raising the level of GABA in the brain. This helps calm the nerves.

You’ll need regular blood tests while taking valproic acid or divalproex. This helps make sure the medication is working properly. Valproic acid is approved for people ages 2 and older and is available as an oral capsule and liquid. Divalproex comes as a delayed-release (DR) capsule and an ER or DR tablet. The DR capsules and ER tablets are approved for people ages 10 and older. The DR tablets are approved for people ages 2 and older.

The dosages for valproic acid and divalproex are based on your body weight and lab results. So your schedule will be unique and tailored for you. You may take doses once or multiple times per day.

9. Topiramate (Topamax, Trokendi XR, Qudexy XR, Eprontia)

Topiramate (Topamax, Trokendi XR, Qudexy XR, Eprontia) can treat focal or generalized seizures. It’s not clear how topiramate works. But it’s believed to lower electrical signals in the brain that cause seizures.

People taking topiramate should talk to their healthcare team before drinking alcohol. This is because alcohol affects topiramate levels in your body. But keep in mind that alcohol isn’t safe to combine with any anti-seizure medication.

Topiramate is available in several different dosage forms:

• IR tablet

• IR capsule

• ER capsule

• Sprinkle capsule (meant to be opened so the contents can be sprinkled over soft foods)

• Oral liquid

Most topiramate dosage forms are approved for people ages 2 and older. But Trokendi XR (one brand name for topiramate ER capsules) is approved for those ages 6 and older. You’ll likely take topiramate once or twice a day, depending on which dosage form you have.

10. Ethosuximide (Zarontin)

Ethosuximide (Zarontin) can treat absence seizures in people ages 3 and older. This is a type of generalized seizure that causes people to stare or “blank out” for short periods of time. It works by blocking calcium channels in the brain. This interrupts a cycle of electrical signals that are thought to cause absence seizures.

You shouldn’t drink alcohol while taking ethosuximide. This can worsen certain side effects, such as drowsiness. Other anti-seizure medications interact with ethosuximide. If you’re combining them, you may need dosage adjustments of one or more medications.

You’ll need to go for routine blood tests while taking ethosuximide. These help your prescriber watch for signs of serious side effects, such as abnormal blood cell counts.

Ethosuximide is available as an oral capsule and solution. Typically, you’ll start by taking the medication once a day. But your maintenance (long-term) dosage will be based on your response. So follow your prescriber’s instructions carefully.

11. Phenobarbital

Phenobarbital is a barbiturate that can treat focal and generalized seizures for people of all ages. Originating in 1912, it’s one of the oldest anti-seizure medications. Phenobarbital works by slowing down brain activity, including electrical signals that cause seizures.

Phenobarbital is a controlled substance because it has a risk of dependence. It also has a number of medication interactions to be aware of. Your prescriber should monitor phenobarbital blood levels to make sure it’s working safely and effectively.

Phenobarbital is available as an oral tablet and liquid. Your dosage will be unique, based on your response and lab results. You may take it once or multiple times a day.

Good to know: You won’t see the words “FDA approved” on phenobarbital’s labeling. That’s because it was brought to market before 1962. This was when the FDA started evaluating medications for both safety and effectiveness. Because it had already been available, phenobarbital’s manufacturer didn’t need to seek official FDA approval to stay on the market.

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