Half of people with newly diagnosed epilepsy will become seizure-free with the first epilepsy drug they try. For the rest, it's try, try again: You switch epilepsy medications, adjust to side effects, and wait to see if the new drug works. Or you might get your seizures under control but find you can't handle the drug's side effects.
Before you ask your doctor about a switch, make sure you're taking the current medicine exactly as prescribed. Missing doses, splitting pills, or not following instructions to the letter could make a difference. It can affect your control over seizures or side effects. If you're following directions to a T but you still have breakthrough seizures, talk to your neurologist or epileptologist (an expert in treating epilepsy). They'll decide if you should switch medications.
Over time, most people become seizure-free with minimal side effects while taking epilepsy drugs. But switching meds takes time and patience. Finding the right drug for you can require equal parts art and science -- and sometimes a bit of luck.
A Leap of Faith
Even the best doctors don't know which drug will work best for any given person.
As part of managing the condition, your doctors will try to get a sense of the full picture: your type of seizures, your age and gender, other medical conditions, medicines you're on or may be on later, and epilepsy drugs you've tried in the past.
Based on that information, they may narrow down the field to a few drugs to try. But after that, it's an educated leap of faith.
Where Do You Start?
What does the switching process involve? It will be different for each person. One common factor: Success depends on a good partnership between you and your doctor. Switching meds may include these steps:
1. Choose a new drug. Your doctor will work closely with you to decide on the next drug to try. That includes a detailed talk about the pros and cons of the medicine, its likely side effects, and any rare but potentially serious effects. If you're a young woman, now is the time to discuss any plans for pregnancy. Some medications interact with birth control pills. And women of childbearing age who take certain seizure medications should also take daily folate supplements. The more you're involved in choosing your epilepsy drug, the better the chances for long-term success.
2. The "double-cover" period. Most people start taking the new drug while still on the old one. This protects you from seizures until the new drug takes effect. The new drug's doses will go up at weekly intervals.
3. Wean from the older drug (or not). Your doctor may keep you on both drugs for a while. Or they may tell you to gradually reduce, then stop the first drug. During this time, you and your loved ones should watch for and record any seizures. From start to finish, switching medications can take several weeks.
What to Expect
What happens after you switch? You won't know if your new drug works until you've gone seizure-free for twice the usual time. So if you previously went 2 months between seizures, it will take 4 months between seizures to be sure the new medicine works.
What About Generics?
Many people feel squeezed by the bills for their brand-name meds. Switching to a generic can lower the price tag of living with epilepsy. Other people don't choose to switch; their insurance company substitutes generic drugs for them.
Though generics save money, there is concern. One generic drug is often switched for another, on as frequently as a monthly basis. Although generic drugs are tightly regulated by the FDA, small differences are allowed.
Most epilepsy experts believe frequent switches among generic drugs can increase chances for seizures. Until scientific studies settle the issue, they generally advise sticking with brand-name drugs if you can afford them.