Side Effects Of Anticonvulsants

Anticonvulsants, also commonly called antiepileptics, are medications used to treat seizures caused by epilepsy. In addition, anticonvulsants can be used to treat neuropathic pain, and some are approved to treat migraines. Some bipolar disorder patients benefit from certain anticonvulsants as mood stabilizers. There are many anticonvulsants available, and they have a wide range of potential side effects. The ways they work can also differ. Over the past twenty years, several new anticonvulsants have been developed and approved. These may have fewer side effects than older antidepressants. While taking an anticonvulsant, the doctor may order periodic blood tests to make sure their patient's health is okay.

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Fatigue

Fatigue is one of the most common side effects of anticonvulsant medications. The fatigue is usually worst when patients first start taking the medication, and it should lessen over time. Newer and more traditional anticonvulsants can both cause fatigue. Different drugs might cause different fatigue levels. If patients experience severe fatigue on one anticonvulsant, it's possible switching to another will lessen these effects. Research indicates certain anticonvulsants can cause fatigue in up to thirty percent of patients. The fatigue can present differently and is classed as 'central' or 'peripheral' depending on the symptoms. If there is depression or inhibition of the central nervous system, the result is central fatigue; changes in peripheral nervous system processes cause peripheral fatigue. If a patient's fatigue manifests as tiredness, lethargy, brain fog, trouble concentrating, and a lack of mental energy, that's centralized. Meanwhile, peripheral fatigue manifests in the cardiac or skeletal muscles. It causes an individual's ability to tense their muscles to decline when they're repeatedly stimulated. This can cause their muscles to feel weak, tired, and sore. If either of these things is inhibiting an individual's day-to-day activities, they should talk to their doctor.

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Nausea

Patients might experience nausea when they take an anticonvulsant, especially after first starting the medication. Some might have nausea severe enough to induce vomiting. Gastrointestinal issues are extremely common side effects of anticonvulsants. Because of the discomfort, some patients might stop taking their medication or take it irregularly because they don't want to feel sick. However, patients should always talk to their doctor before discontinuing medication, and until then, take it regularly. Some drugs can cause different digestive effects in comparison to others. For example, one study showed patients who were taking carbamazepine or valproic acid were much more likely to develop nausea and vomiting. However, when patients were being treated with two or more anticonvulsants at once, and gabapentin or phenytoin was added, there was a much higher risk of issues including heartburn, dysphagia, and diarrhea. The highest rate of digestive issues occurred in patients who took gabapentin in addition to two or more other anticonvulsants. This indicates taking multiple anticonvulsants at once might compound digestive issues.

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Dizziness

Both ataxia and dizziness are some of the most common anticonvulsant side effects. Because anticonvulsants can have a significant impact on balance, doctors should use caution and careful monitoring when prescribing them to older patients. Studies have shown the balance-related side effects can become worse when the dosage is increased, and it's common for patients to experience adverse events. Feelings of dizziness and unsteadiness are common.

One study found ataxia symptoms in fifty-four percent of institutionalized patients who had epilepsy. In another study of epileptic patients at least seventy years old, eighty percent of those taking anticonvulsants had falls and balance disorders. Phenytoin can cause dizziness and imbalance in a large number of patients. Despite this, it remains the most commonly prescribed anticonvulsant for adults in nursing homes. Six percent of individuals confined to nursing homes take phenytoin. Carbamazepine can cause increased dizziness as dosages increase. There haven't been many studies establishing why anticonvulsants cause issues with balance and dizziness, and further data is necessary to determine which drugs cause which symptoms of balance problems.

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Tremors

Many medications have the potential to cause tremors, anticonvulsants being one of them. These side effects are called drug-induced tremors. A tremor occurs when part of an individual's body undergoes uncontrolled, rhythmic movement. The trembling is usually fast and happens in cycles of between six and ten seconds. In addition to anticonvulsants, certain antidepressants and antipsychotics can cause tremors to develop. The majority of tremors develop in the hands, though other places they occur include the face, head, arms, trunk, vocal cords, and legs. Patients might not always experience the tremors, though when they do, the tremors tend to occur within an hour of taking the medication. Tremors can become worse with stress, and they tend to stop during sleep. In addition to trembling in the body, patients might have shakiness in their voice. Treatment of tremors usually involves stopping the medication causing them, and the doctor might switch their patient to a different anticonvulsant instead. Patients might still experience tremor symptoms for a few months after stopping the medication. For some, the tremor doesn't fully subside until eighteen months later.

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Liver Issues

Several anticonvulsants can cause liver issues and liver disease. Because of the potential for liver damage, a doctor might monitor the patient through periodic blood tests. If a medication has the potential to cause liver damage, it's important to be aware of the symptoms and seek treatment when needed. This can help prevent the damage from leading to acute liver failure, which can only be treated by a liver transplant. Carbamazepine, valproate, and phenytoin are some of the most common drugs that cause drug-induced liver damage. In addition, if patients already have liver disease, treatment for epilepsy can complicate the progression. It's important to choose the right medication and monitor the effects closely. Picking the right medication can be complicated because the majority of medicines are metabolized through the liver itself.

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Weight Gain

Weight gain is a very common side effect of the majority of anticonvulsants. Each patient may experience weight changes differently. For example, some individuals find they gain only five pounds, and others gain twenty to thirty pounds (or even more). The amount of weight gain a patient has while on anticonvulsants often depends on the specific type of anticonvulsant they are taking and the dosage prescribed. Patients with epilepsy and other conditions that are treated with anticonvulsants could need to take more than one to manage their symptoms, and these individuals might notice more weight gain. To control weight gain while taking these medications, it may be helpful to consult a nutritionist for advice about meal planning and to follow a calorie-controlled diet. Patients can monitor their weight regularly at home, and they should mention any concerning weight changes to their prescribing physician. If weight gain is severe or unmanageable, it may be possible to try different anticonvulsants or anticonvulsant combinations that minimize this.

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Rash

Patients who use anticonvulsants may sometimes notice a skin rash. Generally, most rashes associated with these medications are usually mild. Hives might develop, and itching could occur. Some patients could experience a red or pink maculopapular rash across a large area of the body. Carbamazepine, phenytoin, chlorpromazine, ethosuximide, zonisamide, and lamotrigine are the anticonvulsants most often associated with the formation of skin rashes. Rarely, patients may develop a severe rash that worsens rapidly, and this is most likely to occur with lamotrigine and carbamazepine. Patients should inform their doctor immediately if they notice a rash that quickly spreads, and it may be necessary to go to an urgent care center for treatment. Most rashes resolve once the medication is stopped.

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Blurred Vision

Patients who use carbamazepine have reported experiencing double vision and blurred vision, and these side effects have also been experienced by individuals who take lamotrigine and levetiracetam. Some patients have trouble getting their eyes to adjust while focusing on objects at different distances, and nystagmus could be present as well. If vision changes occur when taking anticonvulsants, patients should speak to their neurologist as soon as possible. Reducing the dose of a particular anticonvulsant or switching to an extended-release form of the same medication could sometimes reduce vision issues like blurred vision. Seeing an eye doctor for a complete eye examination is recommended. Patients should let their neurologist and eye doctor know when the vision changes began, what type of visual changes they are experiencing, and if anything makes the symptoms worse or better. It can also be helpful to note whether vision changes were present before the medication was started.

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Headache

Headaches may sometimes occur in patients who take anticonvulsants. The patient may experience pain in the forehead or on one or both sides of the head, and neck pain might occur as well. To manage headache symptoms, patients may find it useful to keep a symptom diary that notes the time and duration of each headache and the particular symptoms that are present. It can also be beneficial to record any potential food or emotional triggers for the headache. For relief of mild to moderate headache pain, patients may wish to take an over-the-counter pain reliever, and several versions are available to specifically target headache pain. Relaxing in a quiet, dark environment away from noise and bright light might be soothing.

If headaches are intense or frequent, patients should speak to their neurologist as soon as possible to be examined for possible migraines. It is especially important to see a doctor for any headaches that continue for more than twenty-four hours, and patients should also make an appointment if their headaches do not improve with rest or cause significant disruption to their sleep and daily activities. Prescription medication for severe headaches may be prescribed to help manage symptoms, and switching to a different anticonvulsant could help reduce headaches in some individuals. If a headache occurs in conjunction with a high fever, confusion, nausea, vomiting, or weakness, the patient should obtain emergency medical attention.

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Issues With the Pancreas

A type of anticonvulsant known as divalproex sodium may cause potential issues with the pancreas in children and adults who use it. It is associated with pancreatitis, an inflammation of the pancreas that may be life-threatening. Patients taking this medication are more likely to develop pancreatitis if they are male, and the condition appears to be more common in individuals in their forties. Long-term use of divalproex sodium is believed to raise the risk of pancreatitis; it typically occurs in those who have been taking the medication for two to five years, and it has happened in individuals who have taken divalproex sodium for ten years or more as well. Case reports suggest chronic pancreatitis could develop with the use of carbamazepine or phenytoin as well. Symptoms of pancreatitis generally include nausea, vomiting, diarrhea, abdominal swelling, fever, and abdominal pain that radiates to the back. Since pancreatitis can progress rapidly, patients should seek urgent medical attention if these symptoms occur. Individuals diagnosed with pancreatitis while taking divalproex sodium or another anticonvulsant will need to discontinue taking the medication, and this should be done under medical supervision.