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].