Medications for Epilepsy

Common Drugs

• Diazepam/Lorazepam
• Carbamazepine
• Sodium Valproate
• Clonazepam
• Lamotrigine
• Gabapentin
• Phenobarbital
• Phenytoin

Uses for Epilepsy and Other Conditions

• Status Epilepticus
• Serial Seizures
• Febrile Convulsions
• Reduces Anxiety
• Sedation for medical procedures
• Muscle Relaxant
• Hypnotic drug (for sleep disorders)
• Pre-operative sedation

Medications for Epilepsy

Common Drugs and Brand Names

• Diazepam/Lorazepam: Dialar, Diazemuls, Diazepam Rectubes, Rimapam, Stesolid, Tensium, Valclair (L), Ativan
• Carbamazepine: Carbagen SR, Epimaz, Tegretol, Tegretol Retard
• Sodium Valproate: Convulex (valproic acid), Epilim, Epilim Chrono, Depakote, Orlept
• Clonazepam: Rivotril
• Gabapentin (for partial seizures): Neurontin
• Lamotrigine: Lamictal
• Phenobarbital: None
• Phenytoin/Fosphenytoin: (P) Epanutin, (F) Pro-Epanutin

Common Drug Side Effects

• Common Side Effects: Most need monitoring. In severe circumstances, discuss with a doctor and in some instances, stop taking the medication.
• Rare Side Effects: Always discuss with a doctor. In some cases, stop taking the medication immediately and call a doctor if the situation is extreme.

Organisation policy and procedure must be followed for dealing with medication side effects, monitoring, and actions to take.

What is Buccal Midazolam?

• Midazolam is an effective short-acting benzodiazepine administered into the buccal cavity.
• It is used to treat prolonged seizures and to prevent progression to status epilepticus.
• It is an alternative to rectal administration of Diazepam.
• It is unlicensed for aborting seizures but is supported by NICE (2004).
• Does not require special storage - Do not refrigerate or freeze.
• Buccolam has a shelf life of 18 months (ensure to check the expiry date).
• Buccolam is administered into the buccal cavity.
• Buccolam is prescribed off-license for those over 18.

Administration

Why Use It?

• To prevent further harm to the person.
• Route of administration can be via the buccal or nasal cavity.
• Dosage: No more than 20mg in a 24-hour period.

Side Effects

Common Side Effects

• Sedation
• Drowsiness
• Light-headedness
• Decreased alertness
• Unsteadiness

Less Common Side Effects

• Low blood pressure
• Slow heart rate
• Skin reactions
• Visual disturbances
• Headache
• Confusion
• Breathing difficulties
• Central Nervous System (CNS) toxicity risk if the patient takes antidepressants, antipsychotics, or lithium

After administering these drugs, monitor the person closely as they often cause sedation, drowsiness, dizziness, and headache. There is a possibility of respiratory depression, though this is less likely with Midazolam than with Diazepam.

Your workplace should have a drug book (often a British National Formulary, BNF) where all side effects will be listed: you need to be aware of these.

General Information

• Most people requiring rescue medication are prescribed Midazolam (Epistatus).
• GPs and specialists are willing to prescribe it.
• Carers and relatives need instruction in its use.
• For paid care staff, recognised training and a signed protocol are essential.