Anticonvulsants: Uses, common brands, and safety info

Anticonvulsants are commonly used to treat seizure disorders but may also be used to treat other medical conditions, including chronic nerve pain and mental health disorders. There are many different types of anticonvulsants, and they may work in slightly different ways. However, in general, they work by stabilizing nerve cell impulses. 

Continue reading to learn more about anticonvulsants, their uses, and their side effects.

Other anticonvulsants

• Mebaral (mephobarbital)

• Luminal (phenobarbital)

• Diamox (acetazolamide)

• Carbatrol (carbamazepine)

• Equetro (carbamazepine)

• Oxtellar XR (oxcarbazepine)

• Carnexiv (carbamazepine)

• Depakene (valproic acid)

• Stavzor (valproic acid)

• Depacon (valproic acid)

• Horizant (gabapentin enacarbil)

• Gralise (gabapentin)

• Gaborone (gabapentin)

• Sabril (vigabatrin)

• Fanatrex (gabapentin)

• Diacomit (stiripentol)

• Phenytek (phenytoin)

• Peganone (phenytoin)

• Mesantoin (mephenytoin)

• Cerebyx (fosphenytoin)

• Finetelpla (fenfluramine)

• Epidiolex (cannabidiol)

• Potiga (ezogabine)

• Tridione (trimethadione)

• Briviact (brivaracetam)

• Spritam (levetiracetam)

• Roweepra (levetiracetam)

• Zarontin (ethosuximide)

• Celontin (methsuximide)

• Fycompa (perampanel)

• Klonopin (clonazepam)

• Versed (midazolam)

• Felbatol (felbamate)

• Xcopri (cenobamate)

• Mysoline (primidone)

• Onfi (clobazam)

• Ativan (lorazepam)

• Tranxene-T (clorazepate)

• Banzel (rufinamide)

• Trokendi XR (topiramate)

What are anticonvulsants?

Anticonvulsants, also known as anti-seizure or antiepileptic drugs (AEDs), are medications that calm and regulate nerve impulses and transmission. Because of their nerve-calming actions, anticonvulsants can often be used to treat a variety of medical conditions. Although they are a standard treatment of epilepsy, anticonvulsants can also be used to treat migraines, neuropathic pain, and mental health disorders, such as bipolar disorder. There are many different categories of anticonvulsants that have different mechanisms of action. Not all anticonvulsants work the same, and certain anticonvulsants are prescribed depending on the condition being treated. 

How do anticonvulsants work?

Anticonvulsants differ in how they work; however, in general, anticonvulsants work by decreasing excitation or increasing inhibition of nerve activity. In other words, anticonvulsants help calm nerve impulses and decrease how easily those impulses are activated. Nerve cells that might otherwise fire rapidly during a seizure are kept under control. 

Anticonvulsants can act as mood stabilizers to treat mental health disorders, migraines, and other brain disorders. Anticonvulsants can also reduce the transmission of pain signals from overly sensitive or damaged nerves to help relieve pain from conditions like diabetic neuropathy, trigeminal neuralgia, and postherpetic neuralgia.

What are anticonvulsants used for?

Anticonvulsants are FDA-approved and sometimes used off-label to manage different medical conditions:

• Epilepsy

• Bipolar disorder

• Migraines

• Seizures

• Mania

• Neuropathy

• Trigeminal neuralgia

• Postherpetic neuralgia

• Fibromyalgia

• Restless leg syndrome

• Anxiety

Types of anticonvulsants

AMPA receptor antagonists

AMPA receptors are glutamate receptors involved with excitatory nerve activity. AMPA receptor antagonists block these receptors to reduce and stabilize nerve activity. These medicines can be used to treat partial seizures in patients with epilepsy. An example of an AMPA receptor antagonist is Fycompa (perampanel). 

Barbiturate anticonvulsants

Barbiturates work by increasing the activity of a neurotransmitter known as gamma-aminobutyric acid (GABA), which is an inhibitory neurotransmitter responsible for slowing down electrical activity in the brain. Barbiturate anticonvulsants can treat all seizures except for a specific type of seizure known as an absence seizure. Mysoline (primidone), Mebaral (mephobarbital), and Luminal (phenobarbital) are in the barbiturate category.

Benzodiazepine anticonvulsants

Benzodiazepines act on GABA-A receptors and increase the activity of GABA neurotransmitters. Benzodiazepines may be used to treat febrile seizures, partial and generalized seizures, acute repetitive seizures, alcohol withdrawal seizures, and status epilepticus. Benzodiazepines may also be used as anti-anxiety or sedative medicines. Examples of benzodiazepines include Klonopin (clonazepam), Ativan (lorazepam), and Valium (diazepam).

Carbamate anticonvulsants

The exact way in which carbamate anticonvulsants work is unknown, but they are believed to inhibit NMDA receptors while increasing GABA activity. Because these medications carry a risk of potentially serious side effects, such as aplastic anemia, hepatitis, and liver failure, they are only used after trying other anticonvulsant options first. Examples of carbamate anticonvulsants include Felbatol (felbamate) and Xcopri (cenobamate).

Carbonic anhydrase inhibitor anticonvulsants

Carbonic anhydrase inhibitors work by inhibiting the carbonic anhydrase enzyme. These medications can treat epilepsy, migraines, glaucoma, and mountain sickness. Examples of carbonic anhydrase inhibitors include Diamox (acetazolamide) and Zonegran (zonisamide). 

Dibenzazepine anticonvulsants

Dibenzazepine anticonvulsants work by blocking voltage-gated sodium channels, which are involved in the transmission of nerve signals. These medications can decrease the severity and frequency of seizures. Dibenzazepine anticonvulsants are also used to treat bipolar disorder and schizophrenia. Aptiom (eslicarbazepine) is an anticonvulsant approved as an adjunctive treatment for partial-onset seizures. Other examples of benzodiazepines include Tegretol (carbamazepine) and Trileptal (oxcarbazepine). 

Fatty acid derivative anticonvulsants

Fatty acid derivative anticonvulsants work by increasing the activity of GABA. These medicines also block sodium and calcium channels, which helps slow nerve activity that can otherwise result in seizures. Fatty acid derivatives are useful for most seizure types. They may be given to treat absence seizures, tonic-clonic seizures, juvenile myoclonic epilepsy, and complex partial seizures. Additionally, these medications may be used to treat bipolar disorder, migraines, and schizophrenia. Examples of fatty acid derivatives include Depakote (divalproex) and Depakene (valproic acid).

GABA analogs

GABA analogs are medicines that have a structure very similar to GABA. These medicines can stabilize the nervous system and reduce impulses that could trigger seizure activity. GABA analogs are given for seizures, epilepsy, fibromyalgia, neuropathic pain, and restless leg syndrome. Examples of medications in this category include Lyrica (pregabalin), Neurontin (gabapentin), and Sabril (vigabatrin). 

GABA reuptake inhibitors

GABA reuptake inhibitors are another category of seizure medications that increase the availability of GABA in the brain. These medicines increase GABA activity by binding to and blocking transporters that reabsorb GABA. GABA reuptake inhibitors are used to treat different types of seizures. Examples of GABA reuptake inhibitors include Gabitril (tiagabine) and Diacomit (stiripentol).

Hydantoin anticonvulsants

Hydantoin anticonvulsants work by blocking sodium channels and slowing nerve impulses through these channels. Hydantoin anticonvulsants are used to treat many different types of seizures. Examples of hydantoin anticonvulsants include Dilantin (phenytoin), Peganone (ethotoin), and Sesquient (fosphenytoin).

Neuronal potassium channel openers

Neuronal potassium channel openers help decrease the excitability of nerve cells. They work by activating potassium channels. Potiga (ezogabine) is a neuronal potassium channel opener.

Oxazolidinedione anticonvulsants

The mechanism of action for oxazolidinedione anticonvulsants is unknown, but they are effective in treating absence seizures. An example of an oxazolidinedione anticonvulsant is Tridione (trimethadione).

Pyrrolidine anticonvulsants

Pyrrolidine anticonvulsants work by slowing the transmission of nerve signals. The exact mechanism of action of these anticonvulsants is unknown. They are typically used as adjunctive treatments for tonic-clonic and partial seizures. Examples of pyrrolidine anticonvulsants are Keppra (levetiracetam) and Briviact (brivaracetam).

Succinimide anticonvulsants

Succinimide anticonvulsants inhibit calcium channels and increase the seizure threshold. The seizure threshold refers to the strength of an impulse that will trigger a seizure. The higher the seizure threshold, the less likely a seizure is to occur. Succinimide anticonvulsants are primarily used to treat absence seizures. Examples of succinimide anticonvulsants include Zarontin (ethosuximide) and Celontin (methsuximide).

Triazine anticonvulsants

Triazine anticonvulsants work on sodium channels and inhibit the release of glutamate and aspartate, which are neurotransmitters that excite the nervous system. These medications treat seizures, partial seizures, tonic-clonic seizures, bipolar disorder, and schizophrenia. Lamictal (lamotrigine) is a triazine anticonvulsant. 

Who can take anticonvulsants?

Adults

Adults with epilepsy, bipolar disorder, and other neurological conditions can safely take anticonvulsants. Anticonvulsant agents given as monotherapy may be sufficient to control symptoms, however, multiple anticonvulsants may be needed to achieve the desired effect. 

Doses of anticonvulsants vary and need to be closely monitored or adjusted. Some medications require blood tests to monitor the blood levels of the drug. Doses may need to be adjusted based on liver or kidney function. 

Many seizure medicines must be maintained at a certain blood level. For this reason, it is essential to make sure doses are not missed. Missed doses may cause drug levels to fall, which could result in an increased risk of seizure activity.

Children

The Food and Drug Administration (FDA) has approved anticonvulsants to treat seizure disorders and migraine headaches in children. However, not every drug is approved for every type of pediatric seizure disorder. 

Drug levels of certain medications may need to be monitored. It is critical to avoid missed doses of medication to maintain proper blood levels of medication. The dosing of anticonvulsants in children is usually calculated according to weight. Many anticonvulsant medications are available in liquid form for easier administration in children. 

Seniors

Seniors may safely take anticonvulsants with proper monitoring. Doses may be adjusted if the particular person has decreased kidney or liver function. Some medications may require regular monitoring of drug levels in the blood, and it is important to avoid missed doses. 

Because seniors are often taking other medications with an anticonvulsant, prescribers should consider potential drug interactions. Seniors may be more sensitive to experiencing sedation from anticonvulsants. They may also have an increased fall risk with certain anticonvulsants. Seniors may need to be monitored carefully for any possible adverse effects from anticonvulsants. 

Are anticonvulsants safe?

In general, anticonvulsants, when monitored appropriately, are safe. However, certain groups of people should not take certain anticonvulsants. 

Tell your doctor if you have a history of the following before taking an anticonvulsant: 

• Any drug allergies 

• Kidney disease

• Liver disease

• Use of other medications

• Pregnancy

• Breastfeeding

Black box warnings

Carbamazepine

Carbamazepine carries a black box warning for dermatologic conditions, including toxic epidermal necrolysis (TEN) and Stevens-Johnson Syndrome (SJS). These conditions are rare but potentially fatal skin disorders characterized by blistering and peeling of the skin. 

Carbamazepine also carries a black box warning for aplastic anemia and agranulocytosis. These conditions are characterized by decreased blood cell counts. Lab tests may need to be evaluated before starting carbamazepine and monitored throughout therapy. 

Felbamate

Felbamate carries a black box warning for aplastic anemia and liver failure. Blood testing should be performed before starting therapy and monitored throughout treatment with Felbamate.

Lamotrigine

Serious skin rashes, including SJS, are listed in a black box warning for lamotrigine. Lamotrigine should be discontinued if a rash develops.

Perampanel

Perampanel carries a black box warning for serious psychiatric and behavioral reactions. A patient taking perampanel should be monitored for aggression, hostility, irritability, anger, and homicidal ideation. If these behaviors develop, the medication should be discontinued. 

Valproic acid and divalproex

Valproic acid and divalproex carry a black box warning for hepatotoxicity, teratogenicity, and pancreatitis. Liver function should be checked before and throughout therapy. 

Teratogenicity refers to the effects these medications may have on an unborn child. The potential effects of valproic acid and divalproex include congenital malformations and neural tube defects (spina bifida). Use in pregnancy is not generally recommended, and women are cautioned to avoid becoming pregnant while taking these medications.

Vigabatrin

Vigabatrin carries a black box warning for vision loss. Patients taking this medication should have their vision tested within four weeks of beginning medication and every three months throughout the duration of therapy. 

Anticonvulsant recalls

• Phenytoin recall, 2/21/2020

• Lamotrigine recall, 1/10/2020

• Levetiracetam recall, 12/18/2019

Anticonvulsant restrictions

Those with a known sensitivity or prior allergic reaction should not take an anticonvulsant. Other contraindications to treatment with an anticonvulsant include liver failure, certain blood disorders, narrow-angle glaucoma, and familial short QT syndrome. 

Kidney failure or dialysis may require dose adjustments and frequent monitoring of anticonvulsant treatment. 

Can you take anticonvulsants while pregnant or breastfeeding?

It is recommended to avoid pregnancy while taking anticonvulsants. However, depending on the drug prescribed, the American Academy of Neurology does not recommend stopping or changing treatment in pregnant women as the risk of breakthrough seizure may be high. Valproic acid should be avoided during pregnancy due to the risk of fetal harm.

Anticonvulsants are found in measurable levels in breastmilk. However, the benefits of continuing medication may outweigh the risk of harm to an infant. Consult a healthcare provider before taking an anticonvulsant while breastfeeding. 

Are anticonvulsants controlled substances

Some anticonvulsants are classified as controlled substances. These include:

• Pregabalin: Schedule V

• Lacosamide: Schedule V

• Perampanel: Schedule III

• Clonazepam: Schedule IV

• Diazepam: Schedule IV

• Lorazepam: Schedule IV

• Phenobarbital: Schedule IV

Common anticonvulsants side effects

The most common side effects of anticonvulsants include:

• Nausea

• Rash

• Diarrhea

• Low sodium levels

• Fluid retention

• Hair loss

• Fatigue

• Dizziness

• Headache

• Weight gain

• Mood changes

• Poor appetite

More severe but rare side effects include:

• Aplastic anemia

• Liver failure

• Stevens-Johnson syndrome

• Pancreatitis

• Thrombocytopenia

• Blood disorders

• Loss of vision

This list of side effects is not comprehensive. Consult a healthcare provider for a complete list of side effects, warnings, and precautions before starting treatment with an anticonvulsant.

How much do anticonvulsants cost?

Anticonvulsants can vary in price. Brand-name medications may cost considerably more than other drugs that are available in generic forms. Most anticonvulsants are available in brand-name and generic formulations. Medicare plans may only cover specific formulations while other insurance plans may cover most types of anticonvulsants. Costs will vary depending on your insurance plan. Without insurance, the price can vary widely depending on the medication and quantity of medication prescribed. However, using a prescription discount card from SingleCare may help reduce the cost of anticonvulsants.