Managing Side Effects of Epilepsy Medications: A Patient's Concerns

Adverse symptoms of epilepsy medications (Divalproex + Lamotrigine)?

Hello, Doctor.
I am a patient with epilepsy.
When I first started treatment, I was prescribed one tablet of Depakote in the morning and evening.
After about four months, I experienced dizziness and drowsiness.
The doctor at the hospital adjusted my medication to half a tablet of Lamictal in the morning and evening, along with two tablets of Depakote at bedtime.
I have been on this regimen for about a month now, but I have noticed symptoms of dizziness, difficulty concentrating, constipation, and gastrointestinal discomfort after taking Lamictal.
Additionally, I have noticed an unpleasant odor in my urine and stool that seems to be related to the medication.
I am unsure of the cause and would appreciate your guidance.
Thank you!

Steve, 30~39 year old female. Ask Date: 2010/04/27

Dr. Lin Zijing reply Neurology

The most common side effect of Keppra (levetiracetam) is drowsiness, while less common side effects include fatigue, dizziness, and agitation.
Keppra has minimal sedative effects, and symptoms such as dizziness and unsteady gait typically occur only with excessive dosing.
Therefore, it is suspected that your discomfort is caused by Keppra, and it is recommended to discuss medication adjustment strategies with your physician during your follow-up appointment.

Reply Date: 2010/04/27

More Info

Managing the side effects of epilepsy medications can be a complex and challenging process for patients. Your experience with the medications, particularly with the side effects you are encountering, is not uncommon among individuals undergoing treatment for epilepsy. Let’s break down your concerns and provide some insights based on medical knowledge.

Firstly, it’s important to recognize that many antiepileptic drugs (AEDs) can cause side effects, and these can vary significantly from person to person. In your case, you mentioned experiencing dizziness, drowsiness, gastrointestinal discomfort, constipation, and changes in urine and stool odor after adjusting your medication regimen. These symptoms can be attributed to the pharmacological effects of the medications you are taking.

1. Dizziness and Drowsiness: These are common side effects associated with many AEDs, including those that affect neurotransmitter levels in the brain. Dizziness can occur due to the sedative effects of the medication, especially if the dosage is higher than what your body can tolerate. It’s crucial to communicate these symptoms to your healthcare provider, as they may need to adjust your dosage or consider alternative medications.

2. Gastrointestinal Issues: Medications like the ones you mentioned can lead to gastrointestinal side effects, including nausea, constipation, and changes in bowel habits. Constipation can be particularly troublesome and may require dietary adjustments, such as increasing fiber intake, staying hydrated, and possibly using over-the-counter laxatives if recommended by your doctor.

3. Odor Changes in Urine and Stool: The presence of a strong odor in urine or stool can sometimes be linked to the metabolism of certain medications. Some AEDs can alter the composition of urine, leading to changes in odor. This is generally not a cause for concern unless accompanied by other symptoms such as pain, blood, or significant changes in urinary habits. If the odor persists or worsens, it would be wise to discuss this with your doctor.

4. Mental Concentration Issues: Difficulty concentrating can be a side effect of many AEDs, particularly those that have sedative properties. This can impact your daily activities and quality of life. If you find that your cognitive function is significantly impaired, it’s essential to bring this up with your healthcare provider, as they may need to reassess your treatment plan.

5. Adjusting Your Treatment Plan: Given the side effects you are experiencing, it may be beneficial to have a thorough discussion with your neurologist or the physician managing your epilepsy treatment. They can evaluate whether the benefits of your current medication regimen outweigh the side effects you are experiencing. Sometimes, a gradual adjustment of dosages or switching to a different medication can alleviate these issues.

6. Monitoring and Follow-Up: Regular follow-up appointments are crucial in managing epilepsy and the associated side effects of medications. Keeping a diary of your symptoms, medication schedule, and any side effects can provide valuable information to your healthcare provider, helping them make informed decisions about your treatment.

In conclusion, while managing epilepsy and its treatment can be challenging, open communication with your healthcare provider is key. They can help tailor your treatment plan to minimize side effects while effectively controlling your seizures. Remember, never adjust or stop your medication without consulting your doctor, as this can lead to adverse effects, including the potential for seizure recurrence. Your health and well-being are paramount, and with the right support and adjustments, you can find a balance that works for you.

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