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| Adverse Drug Reaction Acute Side Effects | |||
|---|---|---|---|
| Drug | Concentration Dependent | Idiosyncratic | Chronic Side Effects |
| Carbamazepine |
Diplopia Dizziness Drowsiness Nausea Unsteadiness Lethargy |
Blood dyscrasias Rash (HLA antigen testing may be relevant to avoid Stevens–Johnson or toxic epidermal necrolysis) |
Hyponatremia Metabolic bone disease (monitor vit D and serum calcium) |
| Clobazam | Somnolence | Drooling | |
| Sedation | Aggression | ||
| Pyrexia | Irritability | ||
| Ataxia | Constipation | ||
| Ethosuximide | Ataxia | Blood dyscrasias | Behavior changes |
| Drowsiness | Rash | Headache | |
| GI distress (avoid by multiple daily dosing) | |||
| Unsteadiness | |||
| Hiccoughs | |||
| Ezogabine |
Dizziness Somnolence Fatigue Confusion Vertigo Tremors Blurred vision |
Urinary retention QT prolongation (get baseline EKG and during treatment) Euphoria |
Not established |
| Felbamate | Anorexia | Aplastic anemia (follow CBC) | Not established |
| Nausea | Acute hepatic failure (follow liver enzymes) | ||
| Vomiting | |||
| Insomnia | |||
| Headache | |||
| Gabapentin | Dizziness | Pedal edema | Weight gain |
| Fatigue | |||
| Somnolence | |||
| Ataxia | |||
| Lacosamide | Dizziness | Liver enzyme elevation | Not established |
| Vertigo | |||
| Headache | |||
| Nausea | |||
| Vomiting | |||
| PR interval increase (get baseline EKG and during treatment) | |||
| Lamotrigine |
Diplopia Dizziness Unsteadiness Headache |
Rash (slower titration of dose may decrease chance of occurrence) | Not established |
| Levetiracetam |
Sedation Behavioral disturbance |
Psychosis (rare but more common in elderly or persons with mental illness) | Not established |
| Oxcarbazepine | Sedation | Rash | Hyponatremia |
| Dizziness | |||
| Ataxia | |||
| Nausea | |||
| Phenobarbital | Ataxia | Blood dyscrasias | Behavior changes |
| Hyperactivity | Rash | Connective tissue disorders | |
| Headache | Intellectual blunting | ||
| Unsteadiness | Metabolic bone disease | ||
| Sedation | Mood change | ||
| Nausea | Sedation | ||
| Phenytoin |
Ataxia Nystagmus Behavior changes Dizziness Headache Incoordination Sedation Lethargy Cognitive impairment Fatigue Visual blurring |
Blood dyscrasias Rash (HLA antigen testing may be relevant to avoid Stevens–Johnson or toxic epidermal necrolysis) Immunologic reaction |
Behavior changes Cerebellar syndrome (occurs high serum levels) Connective tissue changes Skin thickening Folate deficiency Gingival hyperplasia Hirsutism Coarsening of facial features Acne Cognitive impairment Metabolic bone disease (monitor vit D and serum calcium) Sedation |
| Pregabalin | Dizziness | Pedal edema | Weight gain |
| Somnolence | Creatine kinase elevation | ||
| Incoordination | Decrease platelets | ||
| Dry mouth | |||
| Blurred vision | |||
| Primidone | Behavior changes | Blood dyscrasias | Behavior change |
| Headache | Rash | Connective tissue disorders | |
| Nausea | Cognitive impairment | ||
| Sedation | Sedation | ||
| Unsteadiness | |||
| Rufinamide | Dizziness | Multiorgan hypersensitivity | Not established |
| Nausea | Status epilepticus | ||
| Vomiting | Leukopenia | ||
| Somnolence | QT shortening | ||
| Tiagabine | Dizziness | Spike-wave stupor | Not established |
| Fatigue | |||
| Difficulties concentrating | |||
| Nervousness | |||
| Tremor | |||
| Blurred vision | |||
| Depression | |||
| Weakness | |||
| Topiramate | Difficulties concentrating | Metabolic acidosis | Kidney stones |
| Psychomotor slowing | Acute angle glaucoma | Weight loss | |
| Speech or language problems | Oligohydrosis | ||
| Somnolence, fatigue | |||
| Dizziness | |||
| Headache | |||
| Valproic acid |
GI upset Sedation Unsteadiness Tremor Thrombocytopenia |
Acute hepatic failure Acute pancreatitis Alopecia |
Polycystic ovary-like syndrome (increase incidence in females <20 y or overweight) Weight gain Hyperammonemia Menstrual cycle irregularities |
| Vigabatrin |
Permanent vision loss Fatigue Somnolence Weight gain Tremor Blurred vision |
Abnormal MRI brain signal changes (infants with infantile spasms) Peripheral neuropathy Anemia |
Permanent vision loss (greater frequency, adults vs children vs infants) |
| Zonisamide | Sedation | Rash (is a sulfa drug) | Kidney stones |
| Dizziness | Metabolic acidosis | Weight loss | |
| Cognitive impairment | Oligohydrosis | ||
| Nausea | |||
Reproduced with permission from Rogers SJ, Cavazos JE. Rogers S.J., Cavazos J.E. Epilepsy. In: DiPiro JT, Talbert RL, Yee GC, Matzke GR, Wells BG, Posey L. DiPiro J.T., Talbert R.L., Yee G.C., Matzke G.R., Wells B.G., Posey L eds. Pharmacotherapy: A Pathophysiologic Approach, 9e. New York: McGraw-Hill; 2014:chap 40.
Data from French et al, Leppi, Halford and Lapointe, Cada et al, Sabril [package insert], Onfi [package insert], and Potiga [package insert].
