Even though you know that it's important to take every single dose of your seizure medicine on time, now and then you might forget. What you should do about it depends on when the next dose is due. If you are supposed to take your medicine just once a day, take the pill as soon as you remember. But if you don't remember until it's time to take the next day's dose, just take one. Don't double up on it unless instructed by your doctor.
If you are supposed to take your medicine two to four times per day, you should adjust the times for the doses so they are evenly spaced. For example, Mary usually took her Tegretol-XR with breakfast and dinner. One day she realized that she had not taken her morning dose. She took the forgotten morning dose at 11 AM, a few hours late, so she delayed the dinner dose until bedtime. If it was dinnertime when Mary remembered her morning dose, however, she should just take one dose (the dinner dose) and skip the forgotten one. As a general rule, never take a double dose unless your doctor or nurse tells you to.
Taking your medicine on time every day is important for you. If you're having trouble remembering to take all your doses, talk to your doctor about whether you might be able to switch to a different form that you won't need to take so often. For instance, if you're taking Tegretol, you might be able to use Tegretol-XR or Carbatrol. Extended-release versions of Dilantin (Phenytek) and Depakote are also available.
You need to decide on a plan that will help you remember even if your regular daily schedule is changed because it's a weekend or a holiday. Some people succeed just by establishing cues to remind them. They plan to take their medicine at the time of routine activities that happen every day, like brushing their teeth or having meals. Other people find that it's helpful to organize their medicines in a special pill box that shows the day of the week or the time of day. Then they can tell at a glance whether they have forgotten a dose. Some people rely on a wristwatch or pill box that can be programmed to beep when a dose is due.
Sometimes generic medications are not exactly the same as the brand name medication that you've been taking. Never make a change in your medicines without checking with your doctor or nurse first (not just the pharmacist). If your seizures are very well controlled or if you are taking a medicine like phenobarbital, you will probably be safe switching to a generic form, but your doctor may want to check the level of medication in your blood before and after the switch. If you have hard-to-control seizures, it is much more risky to switch from brand name to generic, or from one generic manufacturer to another. When you refill your prescription, look at the pills before you leave the pharmacy. If they look different, ask the pharmacist if you were given a generic instead of the brand name, or a different generic than before. If so, check with your doctor to see whether he or she approves and whether you should have your blood level checked.
The Epilepsy Foundation has published a statement recommending that switches involving generic medications should not be permitted without the permission of the doctor and the patient. If you do experience seizures or other bad effects as a result of taking a generic seizure medicine, your doctor should report the problem to the FDA through its MedWatch program.
Most seizure medicines can be taken either with food or between meals. There are a few exceptions, however. To see if your medicine is one of these, find it on our list of seizure medicines and read about how to take it.
If it's OK to take your medicine either way, choose one method and stick with it. Be consistent. Your body may absorb the medication more slowly if you take it with food, but usually the same amount of each dose is absorbed, so the overall effect is the same if you take it in the same way each time.
If you take your medicine on an empty stomach and have unpleasant side effects, try taking it with food instead. Many people find that taking their medicine with food reduces side effects.
In the United States, over 20 drugs are approved to treat epilepsy. Luckily for patients, there are many choices of medication available for each type of epilepsy. If your current seizure medicine doesn't work for you, your doctor may recommend a different first-line medicine or may suggest that a second-line medicine be added or be used alone. These decisions should always be made with the help of your doctor. No patient should stop taking a seizure medicine without a doctor's approval.
If various seizure medicines have been tried at the highest doses you can tolerate and they have all failed to provide good control of your seizures, the chances that a different medicine or combination of medicines will work well are small. (Your doctor may say that your epilepsy is "intractable" or "medically refractory.") You should see an epilepsy specialist to make sure that your seizures have been diagnosed correctly. If your diagnosis is correct and your seizures still cannot be well controlled with seizure medicines, it may be time to consider other types of treatment such as surgery.
Topic Editor: Steven C. Schachter, M.D.
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