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Common side effects of antiseizure drugs

Drug Systemic side effects Neurologic side effects

Brivaracetam* Nausea, vomiting, constipation Headache, somnolence, dizziness, fatigue, ataxia, abnormal coordination,
nystagmus

Carbamazepine Nausea, vomiting, diarrhea, hyponatremia, rash, pruritus Drowsiness, dizziness, blurred or double vision, lethargy, headache

Clobazam Increased salivation, nausea, vomiting, constipation Somnolence, aggression, irritability, ataxia, insomnia

Eslicarbazepine Nausea, vomiting, diarrhea, fatigue, hyponatremia, rash Dizziness, drowsiness, headache, diplopia, vertigo, ataxia, attention
disturbance, blurred vision, tremor
(Note: Dizziness, diplopia, and ataxia reported more frequently in
combination with carbamazepine)

Ethosuximide Nausea, vomiting Sleep disturbance, drowsiness, hyperactivity

Felbamate Nausea, vomiting, anorexia, weight loss Insomnia, dizziness, headache, ataxia

Gabapentin Infrequent Somnolence, dizziness, ataxia

Lacosamide Nausea, vomiting, fatigue Ataxia, dizziness, headache, diplopia

Lamotrigine Rash, nausea Dizziness, tremor, diplopia

Levetiracetam Infection Fatigue, somnolence, dizziness, agitation, anxiety, irritability, depression

Oxcarbazepine Nausea, rash, hyponatremia Sedation, headache, dizziness, vertigo, ataxia, diplopia

Perampanel Weight gain, fatigue, nausea Dizziness, somnolence, irritability, gait disturbance, falls, aggression,
mood alteration

Phenytoin Gingival hypertrophy, rash Confusion, slurred speech, double vision, ataxia

Pregabalin Weight gain, peripheral edema, dry mouth Dizziness, somnolence, ataxia, tremor

Primidone, phenobarbital Nausea, rash Alteration of sleep cycles, sedation, lethargy, behavioral changes,
hyperactivity, ataxia, tolerance, dependence

Rufinamide Nausea, vomiting, fatigue Dizziness, somnolence, headache

Tiagabine Abdominal pain Dizziness, lack of energy, somnolence, nausea, nervousness, tremor,
difficulty concentrating

Topiramate Weight loss, paresthesias Fatigue, nervousness, difficulty concentrating, confusion, depression,
anorexia, language problems, anxiety, mood problems, tremor

Valproate Weight gain, nausea, vomiting, hair loss, easy bruising Tremor, dizziness

Vigabatrin Vision loss Drowsiness, fatigue, dizziness

Zonisamide Nausea, anorexia Somnolence, dizziness, ataxia, confusion, difficulty concentrating,

depression

* Based upon limited experience from preapproval clinical trials.

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19-01-2019 Bipolar disorder in adults: Choosing maintenance treatment - UpToDate

Selected adverse effects of antipsychotic medications for schizophrenia

Weight
Hyper- Prolactin Anticholinergic Orthostatic QTc
gain/diabetes EPS/TD Sedation
cholesterolemia elevation side effects hypotension prolongation
mellitus

First generation agents

Chlorpromazine +++ +++ + ++ +++ +++ +++ +

Fluphenazine + + +++ +++ + –/+ – ND

Haloperidol + + +++ +++ ++ –/+ – +

Loxapine ++ ND ++ ++ ++ + + +

Perphenazine ++ ND ++ ++ ++ + – ND

Pimozide + ND +++ ++ + + + ++

Thioridazine* ++ ND + +++ +++ ++++ ++++ +++

Thiothixene ++ ND +++ ++ + + + +

Trifluoperazine ++ ND +++ ++ + + + ND

Second generation agents

Aripiprazole + – + – + – – –/+

Asenapine ++ – ++ ++ ++ – + +

Brexpiprazole ¶ + + + –/+ + –/+ –/+ –/+

Cariprazine ¶ + –/+ ++ –/+ + –/+ –/+ –/+

Clozapine Δ ++++ ++++ –/+ –/+ +++ +++ +++ +

Iloperidone ++ ++ –/+ –/+ + + +++ ++

Lurasidone –/+ –/+ ++ –/+ ++ – + –/+

Olanzapine ++++ ++++ + + ++ ++ + +

Paliperidone +++ + +++ +++ + – ++ +

Pimavanserin + - -/+ - + + ++ +

Quetiapine +++ +++ –/+ –/+ ++ ++ ++ +

Risperidone +++ + +++ +++ + + + +

Ziprasidone –/+ –/+ + + + – + ++

Adverse effects may be dose dependent.

EPS: extrapyramidal symptoms; TD: tardive dyskinesia; ND: no data.

* Thioridazine is also associated with dose-dependent retinitis pigmentosa. Refer to text.
¶ Based upon limited experience.
Δ Clozapine also causes granulocytopenia or agranulocytosis in approximately 1 percent of patients requiring regular blood cell count monitoring. Clozapine has been associated with excess risk
of myocarditis and venous thromboembolic events including fatal pulmonary embolism. These issues are addressed in the UpToDate topic review of guidelines for prescribing clozapine section on
adverse effects.

References:
1. Lexicomp Online. Copyright © 1978-2017 Lexicomp, Inc. All Rights Reserved.
2. The Medical Letter on Drugs and Therapeutics (April 2016); Some Relative Adverse Effects of Second-Generation Antipsychotics (table 3); Vol. 58 (1493):52. www.medicalletter.org.
3. Rummel-Kluge C, et al. Head-to-head comparisons of metabolic side effects of second generation antipsychotics in the treatment of schizophrenia: a systematic review and meta-analysis.
Schizophr Res 2010; 123:225.
4. Durán CE, Azermai M, Vander Stichele RH. Systematic review of anticholinergic risk scales in older adults. Eur J Clin Pharmacol 2013; 69:1485.

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