Side effects of antiepileptic drugs

Abstract

Blood dyscrasias (leucopenia, thrombocytopenia, agranulocytosis, megaloblastic and aplastic anemia) are among the most serious adverse reactions. Aplastic anemia is connected with high mortality. Of neuro psychic disorders vertigo, ataxia, headache, vision and hearing abnormalities, anxiety, excitement, confusion, delirium, and sleep disorders are reported, and in most cases general apathy, lethargy, drowsiness and depression. Gastrointestinal disorders are characterized first of all by nausea and vomiting. The occurrence of cholestatic jaundice with hepatic necrosis is not exceptional, leading in 40% to death. Dermatological complications, except after barbiturates, are not frequent and include mild reactions as well as serious ones, e.g. lupus erythematosus and erythema multiforme (Steven Johnson syndrome). Gingival hyperplasia is relatively frequent after hydantoin derivatives: on the basis of 15,000 patients the incidence is estimated to be 40%; the etiology is unknown. Sporadical are kidney disorders and abnormalities of heart rhythm and breathing. During the last few years more than a 2 or 3 fold higher incidence of congenital malformations in relation to anticonvulsant medication administered to epileptic mothers was shown. These findings correlate with laboratory experiments. Most studies emphasize the possible association between congenital abnormalities and maternal folic acid deficiency. A very important problem is the interaction of antiepileptics with other drugs. The interaction with steroid hormones, including those used in oral contraceptives, leads to their inactivation. The result of it is inefficacy of this form of contraception.