10 Common Antiepileptic Seizure Medications to Know

Epilepsy is a health condition in which people experience seizures repeatedly. It’s one of the more common conditions affecting the brain and nerves. What’s more, it occurs in people of all ages. And, there are many anti-seizure medications that treat epilepsy.

What happens in the body during a seizure?

Electrical activity allows signals to travel within the brain. Seizures occur when there’s a sudden burst of electrical activity between brain cells (neurons). But it can also happen when there’s too little activity between neurons. Symptoms can vary depending on the type of seizures people experience. It can range from violently shaking to symptoms that are hardly noticeable.

There are three major groups of seizures:

1. Generalized onset seizures affect both sides of the brain.

2. Focal onset seizures affect one area or side of the brain. These were previously known as partial seizures.

3. Unknown onset seizures occur when it’s unknown when a seizure began.

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10 common antiepileptic seizure medications

Antiepileptic (anti-seizure) medications are used to treat epilepsy. Many people take just one antiepileptic drug to manage their seizures. But some people may need to take multiple medications for their condition.

There are many medications that can treat seizures. Below are 10 of the most common.

1. Lamotrigine (Lamictal)

Lamotrigine (Lamictal) can be used for both focal onset 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 oral disintegrating tablet (ODT). It can be taken either once or twice daily.

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 FDA approved to treat focal onset seizures. 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.

EXPERT PICKS: WHAT TO READ NEXT

• What should you do if someone is having a seizure? This article provides step-by-step instructions on how to safely help someone during a seizure.

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• Struggling to balance life and epilepsy? One woman shares tips that help her manage her epilepsy.

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 well-controlled with one medication.

3. Levetiracetam (Keppra, Spritam)

Levetiracetam (Keppra, Spritam) is an anti-seizure medication that treats focal onset and generalized seizures. 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 can be given in hospitals. When taken by mouth, you’ll likely take it once or twice a day.

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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 onset and generalized seizures. 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 onset seizures. But it should be used together with 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 onset and generalized seizures. It can also be used for mixed seizures (when you experience multiple types of seizure). 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 onset seizures. 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 onset 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 available as an oral capsule and liquid. Divalproex comes as a delayed-release (DR) capsule and an ER or DR tablet.

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)

Topiramate (Topamax) can treat focal onset 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

You’ll likely take topiramate once or twice a day, depending on which dosage form you have.

10. Phenobarbital

Phenobarbital is a barbiturate that can treat focal onset and generalized seizures. 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.

What are common side effects of anti-seizure medications?

Some people may experience unwanted side effects while taking anti-seizure medications. Luckily, these side effects are usually mild and short lived.

Examples of common side effects include:

• Dizziness

• Tiredness

• Upset stomach

• Blurry vision

• Memory problems

• Trouble focusing or concentrating

Anti-seizure medications can also cause more serious side effects such as:

• A low number of white blood cells (cells that fight infections)

• A low number of platelets (cells that help control bleeding)

• Rashes

• Problems with the pancreas

• Aplastic anemia (a life-threatening problem with the bone marrow)

• Liver damage

Older adults can sometimes be at a higher risk for side effects when taking anti-seizure medications.

Make sure to contact your prescriber right away if you develop a rash. This can be a sign of a more serious issue, like SJS. Rashes typically happen during the first 6 months of starting a new anti-seizure medication.

Some side effects may be more common with certain medications than others. Make sure to let your prescriber know if you’re experiencing any bothersome side effects. They may recommend taking a different dose or changing to a different medication.

Things to consider when taking anti-seizure medications

Beyond side effects, there are other things to consider when taking anti-seizure medications. Keeping these in mind can help you get the most from your medication while staying safe:

• Don’t stop your anti-seizure medication without your prescriber’s OK. This can cause your seizures to return or worsen. Some anti-seizure medications, such as carbamazepine, can also cause withdrawal symptoms if you stop them suddenly. 

• Take your medication exactly as prescribed. Forgetting or skipping doses may lead to seizures. If you need to change your anti-seizure medication dose schedule, contact your prescriber first.

• Go for any recommended lab tests. Many anti-seizure medications require you to go for regular lab tests. These tests help make sure your medication is working safely and effectively.

• Follow your medication’s recommended storage instructions. Storing medications at the right temperature is key. Keeping them at extreme temperatures can cause the medication not to work properly. If you’re unsure how to store your anti-seizure medication, ask your pharmacist.

• Manage interactions before they happen. Every anti-seizure medication has its own set of interactions. Share a medication list with your prescriber and pharmacist so they can pinpoint interactions.

• Know when to seek help. It’s important to know when side effects can’t be managed at home. Your healthcare team can review your medication’s unique risks and side effects with you.

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Written by:

Kevin Le, PharmD, BCPS, BCPPS

Kevin Le, PharmD, BCPS, BCPPS is a clinical pharmacy specialist in solid organ transplant at Ann & Robert H. Lurie Children’s Hospital of Chicago. He has been working as a pediatric pharmacist since 2016.

Edited by:

Christina Aungst, PharmD

Christina Aungst, PharmD, is a pharmacy editor for GoodRx. She began writing for GoodRx Health in 2019, transitioning from freelance writer to editor in 2021.

Reviewed by:

Joshua Murdock, PharmD, BCBBS

Joshua Murdock, PharmD, BCBBS, is a licensed pharmacist in Arizona, Colorado, and Rhode Island. He has worked in the pharmacy industry for more than 10 years and currently serves as a pharmacy editor for GoodRx.

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