Anti-seizure medication	Mechanism of action^a	Maximum dose	Decrease in serum concentrations*	Recommendation to monitor drug levels^#	Interaction with contraception or effect on hormones	Adverse effects	Teratogenicity and lactation^b
Carbamazepine	Binds to voltage-dependent sodium channels and inhibits the generation of rapid action potentials	1600 mg/day	0-12%^c	Optional	Strong inducer	Stevens-Johnson syndrome, toxic epidermal necrolysis and bone marrow suppression; need to screen pts of genetically at-risk ancestry for HLA-B1502 allele before tx initiation	Neural tube defects, craniofacial defects, cardiovascular malformations Monitor breastfeeding infant, low risk of thrombocytopenia (limited human data)
Clobazam	Binds to the GABA(A) receptor and increase the neuronal membrane permeability to chloride ions	40 mg/day	Limited data^**	Optional	Weak inducer	Somnolence, constipation	Risk of neonatal respiratory depression, hypotonia, sedation and withdrawal seizures Possible risk of infant CNS depression (limited human data on breastfeeding)
Lacosamide	Enhances slow inactivation of voltage-dependant sodium channels which leads to stabilisation of neuronal membrane and inhibition of repetitive neuronal firing	400 mg/day	Up to 39.9%^d	Yes	Non-inducer	Dizziness, nausea, abnormal coordination	No known risk of teratogenicity Possible risk of infant sedation with breastfeeding
Lamotrigine	Although not completely understood, it has been shown to block the repetitive firing of neurons by inactivating voltage dependent sodium channels	400-600 mg per day	17-69%^c	Yes	Weak inducer	Severe rash, Steven Johnson syndrome, depression exacerbation among others	Dose adjustment may be needed during pregnancy and postpartum (risk of decreased maternal drug levels during pregnancy) Conflicting human data on possible risk of teratogenicity Consider monitoring infant lamotrigine levels during breast feeding Low risk of infant harm
Levetiracetam	Exact mechanism is unknown, shown to bind to the synaptic vesicle which may modulate synaptic transmission through alteration i=of vesicle fusion	4000 mg per day	40-60%^c	Yes	Non-inducer	Fatigue, somnolence	Dose adjustment may be needed during pregnancy and postpartum (risk of decreased maternal drug levels during pregnancy) Risk of teratogenicity not expected, however there is possible risk of intrauterine growth restriction (limited human data) No known risk of infant harm during breastfeeding (limited data)
Oxcarbazepine	Block voltage-sensitive sodium channels and modulate the activity of high-voltage activated calcium channels	2400 mg per day	Up to 32.6 %^d	Yes	Strong inducer	Sedation, headache, dizziness, rash	Conflicting human data on possible risk of teratogenicity Inadequate human data on risk of breastfeeding
Perampanel	AMPA-type glutamate receptor antagonist and reduces neuronal excitability	12 mg per day	Limited data^**	Yes	Strong inducer	Dizziness, somnolence, irritability, alteration of mood ad aggression	No human data available on pregnancy No human data available for breastfeeding
Phenobarbital	Binds to GABA (A) receptor and causes neuronal hyperpolarization	200 mg/day	Up to 55%^c	Yes	Strong inducer	Sedation, mood changes including depression	Risk of teratogenicity and neonatal respiratory depression, lethargy, hypotonia, withdrawal seizures, vitamin K deficiency-associated bleeding Risk of CNS depression and withdrawal seizures if abrupt cessation of breastfeeding
Phenytoin	Blocks voltage-dependent neuronal sodium channels	600 mg per day	60-70%^c	Yes	Strong inducer	Gingival hypertrophy, rash, folic acid depletion	Risk of teratogenicity and neonatal vitamin K deficiency-associated bleeding Monitor breastfeeding infant closely, low risk of methemoglobinemia (limited human data)
Primidone	Binds to the GABA(A) receptor and extends the duration of the GABA- mediated chloride channel openings	2 g per day	Limited data^**	Yes	Strong inducer	Sedation, impaired concentration, mood changes	Risk of teratogenicity and neonatal vitamin K deficiency-associated bleeding Risk of infant CNS depression during breastfeeding (limited human data)
Topiramate	Blocks voltage-dependent sodium channels, enhances activity of GABA and antagonises AMPA/ kainate-type glutamate receptors	400 mg per day	Up to 30%^c	Yes	Weak inducer	Cognitive impairment, weight loss, sedation, mood changes including depression	Risk of teratogenicity, oral clefts and low birth weight Inadequate human data on risk of infant harm during breastfeeding
Valproate	Blocks voltage-dependent sodium channels and supresses high frequency, repetitive neuronal firing	60 mg/kg/day	Up to 23%^c	Optional	Non-inducer	Nausea, weight gain, teratogenicity, hepatic impairment	Neural tube defects, decreased IQ scores, and neurodevelopmental disorders Monitor breastfeeding infant closely, low risk of thrombocytopenia based on limited data
Zonisamide	Blocks both voltage-dependent sodium and T-type calcium channels	600 mg per day	Up to 35%, limited data^c	Yes	Non-inducer	Somnolence, ataxia, confusion, fatigue	Low risk of teratogenicity (limited human data), dose adjustment may be needed during pregnancy and postpartum Inadequate human data on risk of infant harm during breastfeeding

Journal of the Mississippi State Medical Association