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Suggest effective alternative medication for Phenobarbital

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Posted on Thu, 21 May 2015
Question: I have been on phenobarbital for over 20 years for a seizure disorder, it has worked well. Now at age 81 My drug insurance won't pay for it. Saying that it can generate falls and make me unstable. On my feet. What. Are my choices to replace the phenobarbital and should I.?

I do feel unstable on my feet. Would like to get off the phenobarbital but nervous about doing this. Advice??
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Answered by Dr. Ajay Panwar (7 hours later)
Brief Answer:
You can take it unless,you don't have a problem.

Detailed Answer:
Hi XXXX,
Thanks for being on healthcaremagic.com.
I am Dr.Ajay Panwar,a neurologist,here to answer your query.

If you would have presented to me as an outpatient,I would have told you that-'this is absolutely clear here with no doubt, that if you are having good seizure control with a single antiepileptic drug,with no apparent adverse effect,you should continue with that drug only'.

Ok,It is acceptable that some patients with phenobarbital may develop ataxia or imbalance.So,if you feel like you are getting imbalanced.You should get an objective assessment done for it.Please get in touch with a neurologist for a neurological examination for ataxia.MRI Brain may also be needed to rule out any distinct cerebellar atrophy.I am asking you to get examined because I don't want you to stop the drug,if its just a subjective temporary feeling of imbalance.Ataxia should be confirmed on examination.

Though,there are other viable options as well like Levetiracetam,valproate,carbamazepine and many others.Considering your old age,Levetiracetam would be the safest,effective option available.

So,if it is a must to switch the drug,let it be Levetiracetam.Switch over has to be done with overlapping.That means,gradual tapering of Phenobarbital along with introduction of Levetiracetam.Any antiepileptic should not be stopped abruptly.

Hope that I have answered your query.If you have some follow-up questions,I shall be glad to answer else,please close the thread-rate it and write a review as your rating will be of help to me.

Regards and Thanks
Dr.Ajay Panwar,
MD,DM(Neurology)




Above answer was peer-reviewed by : Dr. Prasad
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Follow up: Dr. Ajay Panwar (19 hours later)
There are too many side effects with levetiracetam. How about gabapebtin neuron -
Tin?
I have taken that before for shingles . No side effects.
doctor
Answered by Dr. Ajay Panwar (20 minutes later)
Brief Answer:
Gabapentin is not a first line antiepileptic drug.

Detailed Answer:
Hi XXXX,
Thanks for being in follow-up.

I appreciate your web research.But,the point here is that if you go on looking side effects for any drug on the web,you are going to get a long list.Likewise,Levetiracetam also shows up the same.Clinically,only notable side effect of Levetiracetam is neuropsychiatric abnormalities like behaviour changes,mood changes or even suicidal tendencies.These side effects however,have a very low incidence of approx.1 in 500 patients.Moreover,these are gradual in onset and patient's attendants can recognise them if they start creeping in.This drug can be stopped and switched with some other if anything happens like that.

Inspite of the side effects mentioned,Levetiracetam is the safest first line antiepileptic drug,even for elderly patients.

Gabapentin though has less side effects,but it lacks on effects too.It is so,because Gabapentin is not a first line antiepileptic drug.Rather, it is taken as an add-on antiepileptic.


Hope that I have answered your query.If you have some follow-up questions,I shall be glad to answer else,please close the thread-rate it and write a review as your rating will be of help to me.

Regards and Thanks
Dr.Ajay Panwar,
MD,DM(Neurology)

Above answer was peer-reviewed by : Dr. Shanthi.E
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Dr. Ajay Panwar

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Suggest effective alternative medication for Phenobarbital

Brief Answer: You can take it unless,you don't have a problem. Detailed Answer: Hi XXXX, Thanks for being on healthcaremagic.com. I am Dr.Ajay Panwar,a neurologist,here to answer your query. If you would have presented to me as an outpatient,I would have told you that-'this is absolutely clear here with no doubt, that if you are having good seizure control with a single antiepileptic drug,with no apparent adverse effect,you should continue with that drug only'. Ok,It is acceptable that some patients with phenobarbital may develop ataxia or imbalance.So,if you feel like you are getting imbalanced.You should get an objective assessment done for it.Please get in touch with a neurologist for a neurological examination for ataxia.MRI Brain may also be needed to rule out any distinct cerebellar atrophy.I am asking you to get examined because I don't want you to stop the drug,if its just a subjective temporary feeling of imbalance.Ataxia should be confirmed on examination. Though,there are other viable options as well like Levetiracetam,valproate,carbamazepine and many others.Considering your old age,Levetiracetam would be the safest,effective option available. So,if it is a must to switch the drug,let it be Levetiracetam.Switch over has to be done with overlapping.That means,gradual tapering of Phenobarbital along with introduction of Levetiracetam.Any antiepileptic should not be stopped abruptly. Hope that I have answered your query.If you have some follow-up questions,I shall be glad to answer else,please close the thread-rate it and write a review as your rating will be of help to me. Regards and Thanks Dr.Ajay Panwar, MD,DM(Neurology)