What is diazepam? Diazepam is a benzodiazepine (ben-zoe-dye-AZE-eh-peen)). It is thought that benzodiazepines work by enhancing the activity of certain neurotransmitters in the brain. Diazepam is used to treat anxiety disorders, or alcohol withdrawal symptoms. Diazepam is sometimes used with other medications to treat muscle spasms and stiffness, or seizures. Warnings Diazepam can slow or stop your breathing, especially if you have recently used an opioid medication, alcohol, or other drugs that can slow your breathing. MISUSE OF DIAZEPAM CAN CAUSE ADDICTION, OVERDOSE, OR DEATH, especially in a child or other person using the medicine without a prescription. Keep the medication in a place where others cannot get to it. Fatal side effects can occur if you use this medicine with opioid medicine, alcohol, or other drugs that cause drowsiness or slow your breathing. You should not use this medicine if you are allergic to diazepam or similar medicines (Klonopin>, Xanax, and others), or if you have myasthenia gravis, severe liver disease, narrow-angle glaucoma, a severe breathing problem, or sleep apnea. Do not stop using this medicine without asking your doctor. You may have life-threatening withdrawal symptoms if you stop using the medicine suddenly after long-term use. Some withdrawal symptoms may last up to 12 months or longer. Get medical help right away if you stop using diazepam and have symptoms such as: unusual muscle movements, being more active or talkative, sudden and severe changes in mood or behavior, confusion, hallucinations, seizures, or thoughts about suicide. Before taking this medicine You should not use diazepam if you are allergic to it, or if you have: myasthenia gravis (a muscle weakness disorder); a severe breathing problem; sleep apnea (breathing stops during sleep); narrow-angle glaucoma; untreated or uncontrolled open-angle glaucoma; or severe liver disease. Diazepam should not be given to a child younger than 6 months old. Do not give this medicine to a child without a doctor's advice. To make sure this medicine is safe for you, tell your doctor if you have ever had: breathing problems; glaucoma; kidney or liver disease; seizures (unless you are taking diazepam to treat a seizure disorder); a drug or alcohol addiction; or depression, a mood disorder, or suicidal thoughts or behavior. Some people have thoughts about suicide while taking diazepam. Stay alert to changes in your mood or symptoms. Your family or caregivers should also watch for sudden changes in your behavior. May harm an unborn baby. Do not use if you are pregnant or may become pregnant. If you use diazepam during pregnancy, your baby could be born with life-threatening withdrawal symptoms, and may need medical treatment for several weeks. Do not start or stop seizure medication during pregnancy without your doctor's advice. Diazepam may harm an unborn baby, but having a seizure during pregnancy could harm both mother and baby. Preventing seizures may outweigh these risks. Tell your doctor right away if you become pregnant. There may be other seizure medications that are safer to use during pregnancy. You should not breastfeed. How should I take diazepam? Take diazepam exactly as prescribed by your doctor. Follow the directions on your prescription label and read all medication guides or instruction sheets. Never use diazepam in larger amounts, or for longer than prescribed. Tell your doctor if you feel an increased urge to use more of this medicine. Never share this medicine with another person, especially someone with a history of drug addiction. MISUSE CAN CAUSE ADDICTION, OVERDOSE, OR DEATH. Keep the medicine where others cannot get to it. Selling or giving away this medicine is against the law. Measure liquid medicine with the supplied measuring device (not a kitchen spoon). Diazepam should be used for only a short time. Do not take this medicine for longer than 4 months without your doctor's advice. Do not stop using diazepam without asking your doctor. You may have increased seizures or life-threatening withdrawal symptoms if you stop using the medicine suddenly after long-term use. You will need frequent medical tests. Store at room temperature away from moisture, heat, and light. Keep your medicine in a place where no one can use it improperly.   What happens if I miss a dose? Take the medicine as soon as you can, but skip the missed dose if it is almost time for your next dose. Do not take two doses at one time. What happens if I overdose? Seek emergency medical attention or call the Poison Help line at 1-800-222-1222. An overdose of diazepam can be fatal if you take it with alcohol, opioid medicine, or other drugs that cause drowsiness or slow your breathing. Overdose symptoms may include extreme drowsiness, loss of balance or coordination, limp or weak muscles, slow breathing, or coma. What should I avoid while taking diazepam? Avoid drinking alcohol. Dangerous side effects or death could occur. Grapefruit may interact with diazepam and lead to unwanted side effects. Avoid the use of grapefruit products. Avoid driving or hazardous activity until you know how this medicine will affect you. Dizziness or drowsiness can cause falls, accidents, or severe injuries. Diazepam side effects Get emergency medical help if you have signs of an allergic reaction to diazepam: hives; difficult breathing; swelling of your face, lips, tongue, or throat. Diazepam can slow or stop your breathing, especially if you have recently used an opioid medication or alcohol. A person caring for you should seek emergency medical attention if you have slow breathing with long pauses, blue colored lips, or if you are hard to wake up. Tell your doctor right away if you have new or sudden changes in mood or behavior, including new or worse depression or anxiety, panic attacks, trouble sleeping, or if you feel impulsive, irritable, agitated, hostile, aggressive, restless, more active or talkative, or have thoughts about suicide or hurting yourself. Call your doctor at once if you have: severe drowsiness or dizziness; trouble breathing; confusion, paranoia; or new or worsening seizures. Drowsiness or dizziness may last longer in older adults. Use caution to avoid falling or accidental injury. Common diazepam side effects may include: drowsiness; feeling tired; muscle weakness; or problems with balance or muscle movement. After you stop using diazepam, get medical help right away if you have symptoms such as: unusual muscle movements, being more active or talkative, sudden and severe changes in mood or behavior, confusion, hallucinations, seizures, suicidal thoughts or actions. Some withdrawal symptoms may last up to 12 months or longer after stopping this medicine suddenly. Tell your doctor if you have ongoing anxiety, depression, problems with memory or thinking, trouble sleeping, ringing in your ears, a burning or prickly feeling, or a crawling sensation under your skin. This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.   What other drugs will affect diazepam? Taking diazepam with other drugs that make you sleepy or slow your breathing can cause dangerous side effects or death. Ask your doctor before using opioid medication, a sleeping pill, a muscle relaxer, or medicine for anxiety or seizures. Other drugs may interact with diazepam, including prescription and over-the-counter medicines, vitamins, and herbal products. Tell your doctor about all other medicines you use.

Clinical Overview Use Superoxide dismutase (SOD) enzymes are found in all living cells in several common forms. These enzymes have been used for anti-inflammatory effects (in osteoarthritis, rheumatoid arthritis, and idiopathic pulmonary fibrosis), but limited clinical trials are available to support use. Clinical trials evaluating the use of SOD in cancer, cardiovascular disease, and other conditions in which antioxidant status plays a role, are also lacking. No evidence exists regarding long-term use of SOD. Dosing Oral supplementation is limited by the enzyme’s inactivation by gastric acid; however, newer formulations may overcome this limitation. Daily intravenous (IV) administration of 40 or 80 mg of lecithinized SOD over 28 days was compared with placebo in idiopathic pulmonary fibrosis. Weekly administration of an intra-articular injection of SOD 8 to 32 mg has been studied. A 500 mg dosage of plant-derived oral SOD (commercial product) taken once daily over 6 weeks was used in one clinical study. Contraindications Contraindications have not been identified. Pregnancy/Lactation Avoid use. Information regarding safety and efficacy in pregnancy and lactation is lacking. Interactions None well documented. Adverse Reactions Information from large clinical studies is lacking; however, adverse effects appear to be limited. Pain and irritation at injection sites have been reported. Toxicology SOD is regarded as nontoxic, based on data from earlier studies. Data on newer formulations are lacking. Source SOD was initially biochemically extracted from the serum and liver of animals, as well as from plant sources; however, this process was inefficient.1 Induction of oxidative stress in microbes has been the mainstay of SOD production; however, a method in which recombinant Cu/Zn SOD is produced in Escherichia coli and bound to lecithin has been developed.2, 3 Commercial preparations previously relied on bovine-derived SOD (orgotein and palosein), with patents also filed for yeast- and marine-derived SOD.1 History In 1967, geneticist George J. Brewer described the protein indophenol oxidase, which was later identified as superoxide dismutase, in his work analyzing starch gels.4 The enzymatic activity of SOD was first described in 1968 by biochemists Irwin Fridovich and Joe M. McCord.5 In Germany, SOD (as orgotein) has long been used in general medicine as an anti-inflammatory agent.6 Chemistry SOD has 3 recognized forms in humans and other mammals. SOD1 and SOD2 (intracellular) contain copper and zinc, and SOD2 (found in mitochondria) relies on manganese for reactivity. The enzymatic forms found in plants also have an iron form.1, 5 SOD enzymes catalyze the conversion of superoxide, a reactive oxygen species (ROS) produced during aerobic respiration, to oxygen and hydrogen peroxide.5 Uses and Pharmacology The role of SOD as a dietary supplement is examined in this monograph; for information on SOD deficiency states, see standard medical references.1 Anti-inflammatory effects The use of SOD as an anti-inflammatory agent has been postulated because increased production of ROS is recognized to cause tissue damage associated with inflammation.7, 8, 9 Associated effects of decreased peroxynitrite production, decreased influx of neutrophils, and release of proinflammatory cytokines have been discussed.7 Animal data Anti-inflammatory effects of SOD have been demonstrated in animal models.7, 9 Parenteral SOD has been used in the treatment of soft tissue inflammation in horses and dogs; however, in a study comparing exercise with oral SOD supplementation, biomarkers of inflammation were unaffected by SOD.10 In a study of oral SOD in horses undergoing a 60-day training regimen, creatine kinase activity, a marker of hemolysis, was steady in the SOD group compared with an increase in the placebo group.11 Clinical data Limited, older clinical trials with intra-articular, bovine-derived SOD were conducted in patients with osteoarthritis.7 Superiority to placebo at 3 months has been demonstrated,12, 13 and a single trial evaluated the effectiveness of intramuscular bovine SOD in rheumatoid arthritis.14 In a double-blind, randomized, multicenter study in idiopathic pulmonary fibrosis (N = 55), daily IV administration of 40 or 80 mg of lecithinized SOD was compared with placebo over 28 days. Forced vital capacity did not improve in the treated arm; however, lactate dehydrogenase and surfactant protein-A makers were improved.15 Oral supplementation with plant-derived SOD improved SOD activity and reduced C-reactive protein in a study of 19 athletes. However, no effect on oxidative damage from exhaustive exercise was demonstrated.16 Cancer Animal data The relationship between ROS and cancer has been studied extensively, and the role of SOD expression in cancer cells has been evaluated, with most attention given to mitochondrial manganese SOD3.17, 18, 19 Animal model studies of supplemental SOD are limited.18 In vitro/in vivo data A study of recombinant manganese SOD (rMnSOD) for pediatric acute lymphoblastic leukemia found increased apoptotic death in leukemic cells, with no effect on healthy lymphocytes at low and moderate concentrations.20 Clinical data In a study evaluating the relationship between serum SOD levels and risk of cancer mortality, elevated serum SOD levels were associated with an increased risk of death from all cancers combined; this result may indicate an increased response to stress.21 Clinical studies of supplemental SOD in cancer treatment are limited. SOD has been evaluated in limited studies for its protective effects against irradiation-induced toxicities, with some reduction in late toxicity noted in one study of patients receiving pelvic radiation.9, 22 A lecithinized human recombinant SOD was not protective against the cardiotoxic effects of anthracycline treatment in breast cancer patients.23 Antiangiogenic properties of an inhibitor of Cu/Zn SOD have been evaluated in 47 patients with prostate cancer.24 Other uses Antioxidant effects, such as in reperfusion injury, have been studied in rodents.25 No evidence exists regarding long-term use of SOD. Dermatological applications have been evaluated, and a role for SOD3 supplementation has been theorized.26, 27 In a small clinical study of vitiligo (N = 25), topical application of a combination preparation containing catalase and SOD was similarly effective as compared with a topical corticosteroid.28 Limited clinical studies report equivocal results in psychometric scale measures and depression for oral administration of gliadin-SOD supplements compared with placebo.29, 30 Post hoc analysis of data in a subgroup of newborns suggested a reduction in the risk of retinopathy of prematurity with intratracheal administration of recombinant human Cu/Zn SOD.31 Combination preparations of alpha-lipoic acid and SOD are available and have been studied in diabetic neuropathy and chronic neck pain; however, attributing the observed effects to either of the compounds alone was not possible.32, 33 A rodent study reported benefit for angiotensin II–dependent hypertension using a nanozyme (nanomedicine-based delivery system) CuZnSOD; however, significance of results is limited due to limitations of the intracerebroventricular route of administration.34 Pretreatment with rMnSOD greatly reduced contrast-induced nephropathy in rats, including both intratubular cysts and tubular necrosis.35 Dosing Orally administered SOD alone (including that occurring naturally in food) is rapidly degraded by gastric acids when ingested, even if enteric coated.36, 37 Methods such as liposomal encapsulation and coating with wheat-derived gliadin attempt to overcome poor oral bioavailability.25 Daily IV administration of 40 or 80 mg of lecithinized SOD over 28 days was compared with placebo in idiopathic pulmonary fibrosis.15 Weekly administration of an intra-articular injection of SOD 8 to 32 mg has been studied.12, 13 A 500 mg dosage of plant-derived oral SOD (commercial product) taken once daily over 6 weeks was used in one clinical study.16 Pharmacokinetic studies of a recombinant-derived SOD have evaluated IV doses of up to 160 mg and report a mean terminal half-life of 25 hours (standard deviation [SD] = 4 hours) for an 80 mg dose and 31 hours (SD = 15 hours) for a single 160 mg dose.2, 3 Pregnancy / Lactation Avoid use. Information regarding safety and efficacy in pregnancy and lactation is lacking. Interactions None well documented. Adverse Reactions Information from large clinical studies is lacking; however, adverse effects appear to be limited.25 Pain and irritation at injection sites have been reported.7, 8 Toxicology SOD is regarded as nontoxic, based on data from earlier studies. Data on newer formulations are lacking.38 The safety of SOD has been investigated in numerous animal models using doses up to 40,000 times the average human clinical dose of 0.1 mg/kg/day. Abnormalities were noted rarely following acute or long-term parenteral administration in mice, rats, dogs, and monkeys. SOD did not induce embryonic or teratogenic changes in rats or rabbits.39 The minimal lethal dose in animals was greater than 40,000 times the anticipated human clinical dose.40

What is gabapentin? Gabapentin is an anti-epileptic drug, also called an anticonvulsant. It affects chemicals and nerves in the body that are involved in the cause of seizures and some types of pain. Gabapentin is used together with other medicines to treat partial seizures in adults and children at least 3 years old. Gabapentin is also used to treat neuropathic pain (nerve pain) caused by herpes virus or shingles (herpes zoster) in adults. Use only the brand and form of gabapentin your doctor has prescribed. Check your medicine each time you get a refill to make sure you receive the correct form. The Gralise brand of gabapentin is indicated for the management of neuropathic pain only. It is not used for epilepsy. Horizant is used to treat nerve pain and restless legs syndrome (RLS). The Neurontin brand is used to treat seizures in adults and children who are at least 3 years old, in addition to neuropathic pain. Warnings Gabapentin can cause life-threatening breathing problems, especially if you already have a breathing disorder or if you use other medicines that can make you drowsy or slow your breathing. Seek emergency medical attention if you have very slow breathing. Some people have thoughts about suicide or behavior changes while taking gabapentin. Stay alert to changes in your mood or symptoms. Report any new or worsening symptoms to your doctor. Avoid driving or hazardous activity until you know how gabapentin will affect you. Dizziness or drowsiness can cause falls, accidents, or severe injuries. Do not stop using gabapentin suddenly, even if you feel fine. Before taking this medicine You should not use gabapentin if you are allergic to it. To make sure gabapentin is safe for you, tell your doctor if you have ever had: breathing problems or lung disease, such as chronic obstructive pulmonary disease (COPD); kidney disease (or if you are on dialysis); diabetes; depression, a mood disorder, or suicidal thoughts or actions; a drug addiction; a seizure (unless you take gabapentin to treat seizures); liver disease; heart disease; or (for patients with RLS) if you are a day sleeper or work a night shift. Some people have thoughts about suicide while taking this medicine. Children taking gabapentin may have behavior changes. Stay alert to changes in your mood or symptoms. Report any new or worsening symptoms to your doctor. It is not known whether this medicine will harm an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant. Seizure control is very important during pregnancy, and having a seizure could harm both mother and baby. Do not start or stop taking gabapentin for seizures without your doctor's advice, and tell your doctor right away if you become pregnant. If you are pregnant, your name may be listed on a pregnancy registry to track the effects of gabapentin on the baby. It may not be safe to breastfeed while using this medicine. Ask your doctor about any risk. How should I take gabapentin? Take gabapentin exactly as prescribed by your doctor. Follow all directions on your prescription label. Do not take in larger or smaller amounts or for longer than recommended. If your doctor changes your brand, strength, or type of gabapentin, your dosage needs may change. Ask your pharmacist if you have any questions about the new kind of gabapentin you receive at the pharmacy. Both Gralise and Horizant should be taken with food. Neurontin can be taken with or without food. If you break a Neurontin tablet and take only half of it, take the other half at your next dose. Any tablet that has been broken should be used as soon as possible or within a few days. Swallow the capsule or tablet whole and do not crush, chew, break, or open it. Measure liquid medicine carefully. Use the dosing syringe provided, or use a medicine dose-measuring device (not a kitchen spoon). Do not stop taking this medicine suddenly, even if you feel fine. Stopping suddenly may cause increased seizures. Follow your doctor's instructions about tapering your dose. In case of emergency, wear or carry medical identification to let others know you have seizures. This medicine can cause unusual results with certain medical tests. Tell any doctor who treats you that you are using gabapentin. Store both the tablets and capsules at room temperature away from light and moisture. Store the liquid medicine in the refrigerator. Do not freeze. Dosing information Usual Adult Dose for Epilepsy: Initial dose: 300 mg orally on day one, 300 mg orally 2 times day on day two, then 300 mg orally 3 times a day on day three Maintenance dose: 300 to 600 mg orally 3 times a day Maximum dose: 3600 mg orally daily (in 3 divided doses) -Maximum time between doses in the 3 times a day schedule should not exceed 12 hours -The safety and effectiveness of gabapentin available under the trade name Gralise or Horizant in patients with epilepsy has not been studied. Use: Adjunctive therapy in the treatment of partial onset seizures, with and without secondary generalization Usual Adult Dose for Postherpetic Neuralgia: -Initial dose: 300 mg orally on day one, 300 mg orally 2 times day on day two, then 300 mg orally 3 times a day on day three -Titrate up as needed for pain relief -Maximum dose: 1800 mg per day (600 mg orally 3 times a day) Gabapentin available under the trade name Gralise: -Maintenance dose: Gralise should be titrated to 1800 mg orally once daily with the evening meal. -Recommended titration schedule: Day 1: 300 mg orally with the evening meal Day 2: 600 mg orally with the evening meal Days 3 through 6: 900 mg orally with the evening meal Days 7 through 10: 1200 mg orally with the evening meal Days 11 through 14: 1500 mg orally with the evening meal Day 15: 1800 mg orally with the evening meal COMMENT: -Gralise is not interchangeable with other gabapentin products because of differing pharmacokinetic profiles that affect the frequency of administration. Gabapentin enacarbil extended release tablets are available under the trade name Horizant: -The recommended dosage is 600 mg orally 2 times a day. Therapy should be initiated at a dose of 600 mg orally in the morning for 3 days of therapy, then increased to 600 mg 2 times a day (1200 mg/day) on day four. COMMENT: Gabapentin enacarbil extended release tablets available under the trade name Horizant and gabapentin are not interchangeable. Use: Postherpetic neuralgia Usual Adult Dose for Restless Legs Syndrome: Gabapentin enacarbil available under the trade name Horizant: 600 mg orally once daily with food at about 5 PM Use: For the treatment of moderate-to-severe primary Restless Legs Syndrome (RLS) in adults Usual Pediatric Dose for Epilepsy: Less than 3 years: Not recommended Greater than or equal to 3 and less than 12 years: Starting Dose: Ranges from 10 to 15 mg/kg/day in 3 divided doses Effective Dose: Reached by upward titration over a period of approximately 3 days; the effective dose in patients 5 years of age and older is 25 to 35 mg/kg/day in divided doses (3 times a day). The effective dose in pediatric patients ages 3 and 4 years is 40 mg/kg/day and given in divided doses (3 times a day). Gabapentin may be administered as the oral solution, capsule, or tablet, or using combinations of these formulations. Dosages up to 50 mg/kg/day have been well tolerated in a long term clinical study. The maximum time interval between doses should not exceed 12 hours. Greater than 12 years: -Initial dose: 300 mg orally on day one, 300 mg orally 2 times a day on day two, then 300 mg orally 3 times a day on day three -Maintenance dose: 900 to 1800 mg orally in 3 divided doses; the dose may be increased up to 1800 mg/day. Dosages up to 2400 mg/day have been well tolerated in long term clinical studies. Doses of 3600 mg/day have also been administered to a small number of patients for a relatively short duration, and have been well tolerated. The maximum time between doses in the three times a day schedule should not exceed 12 hours. Use: Adjunctive therapy in the treatment of partial onset seizures, with and without secondary generalization in patients 3 years of age and older   What happens if I miss a dose? Take the medicine as soon as you can, but skip the missed dose if it is almost time for your next dose. Do not take two doses at one time. If you take Horizant: Skip the missed dose and use your next dose at the regular time. Do not use two doses of Horizant at one time. What happens if I overdose? Seek emergency medical attention or call the Poison Help line at 1-800-222-1222. What to avoid Avoid driving or hazardous activity until you know how gabapentin will affect you. Your reactions could be impaired. Dizziness or drowsiness can cause falls, accidents, or severe injuries. Avoid taking an antacid within 2 hours before you take gabapentin. Antacids can make it harder for your body to absorb gabapentin. Avoid drinking alcohol while taking gabapentin. Gabapentin side effects Get emergency medical help if you have signs of an allergic reaction to gabapentin: hives; difficult breathing; swelling of your face, lips, tongue, or throat. Seek medical treatment if you have a serious drug reaction that can affect many parts of your body. Symptoms may include: skin rash, fever, swollen glands, muscle aches, severe weakness, unusual bruising, upper stomach pain, or yellowing of your skin or eyes. Report any new or worsening symptoms to your doctor, such as: mood or behavior changes, anxiety, panic attacks, trouble sleeping, or if you feel impulsive, irritable, agitated, hostile, aggressive, restless, hyperactive (mentally or physically), depressed, or have thoughts about suicide or hurting yourself. Call your doctor at once if you have: weak or shallow breathing; blue-colored skin, lips, fingers, and toes; confusion, extreme drowsiness or weakness; problems with balance or muscle movement; unusual or involuntary eye movements; or increased seizures. Gabapentin can cause life-threatening breathing problems. A person caring for you should seek emergency medical attention if you have slow breathing with long pauses, blue colored lips, or if you are hard to wake up. Breathing problems may be more likely in older adults or in people with COPD. Some side effects are more likely in children taking gabapentin. Contact your doctor if the child taking this medicine has any of the following side effects: changes in behavior; memory problems; trouble concentrating; or acting restless, hostile, or aggressive. Common gabapentin side effects may include: fever, chills, sore throat, body aches, unusual tiredness; jerky movements; headache; double vision; swelling of your legs and feet; tremors; trouble speaking; dizziness, drowsiness, tiredness; problems with balance or eye movements; or nausea, vomiting. This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.   What other drugs will affect gabapentin? Using gabapentin with other drugs that make you drowsy or slow your breathing can cause dangerous side effects or death. Ask your doctor before using opioid medication, a sleeping pill, cold or allergy medicine, a muscle relaxer, or medicine for anxiety or seizures. other drugs may interact with gabapentin, including prescription and over-the-counter medicines, vitamins, and herbal products. Tell your doctor about all your current medicines and any medicine you start or stop using.

What is lamotrigine? Lamotrigine is an anti-epileptic medication, also called an anticonvulsant. Lamotrigine is used alone or with other medications to treat epileptic seizures in adults and children. Lamotrigine is also used to delay mood episodes in adults with bipolar disorder (manic depression). Immediate-release lamotrigine can be used in children as young as 2 years old when it is given as part of a combination of seizure medications. However, this form should not be used as a single medication in a child or teenager who is younger than 16 years old. Extended-release lamotrigine is for use only in adults and children who are at least 13 years old. Lamotrigine may also be used for purposes not listed in this medication guide. Warnings Lamotrigine may cause a severe or life-threatening skin rash, especially in children and in people who take a very high starting dose, or those who also take valproic acid (Depakene) or divalproex (Depakote). Seek emergency medical attention if you have a skin rash, hives, blistering, peeling, or sores in your mouth or around your eyes. Call your doctor at once if you have signs of other serious side effects, including: fever, swollen glands, severe muscle pain, bruising or unusual bleeding, yellowing of your skin or eyes, headache, neck stiffness, vomiting, confusion, or increased sensitivity to light. Some people have thoughts about suicide while taking lamotrigine. Stay alert to changes in your mood or symptoms. Report any new or worsening symptoms to your doctor. Before taking this medicine You should not take lamotrigine if you are allergic to it. Lamotrigine may cause a severe or life-threatening skin rash, especially in children and in people who take a very high starting dose, or those who also take valproic acid (Depakene) or divalproex (Depakote). Tell your doctor if you have ever had: a rash or allergic reaction after taking another seizure medication; kidney or liver disease; heart problems such as heart block or irregular heartbeats; depression, suicidal thoughts or actions; or meningitis (inflammation of the tissue that covers the brain and spinal cord) after taking lamotrigine. Some people have thoughts about suicide while taking lamotrigine. Your doctor will need to check your progress at regular visits. Your family or other caregivers should also be alert to changes in your mood or symptoms. Do not start or stop taking seizure medication during pregnancy without your doctor's advice. Having a seizure during pregnancy could harm both mother and baby. Tell your doctor right away if you become pregnant. If you are pregnant, your name may be listed on a pregnancy registry to track the effects of lamotrigine on the baby. Birth control pills can make lamotrigine less effective, resulting in increased seizures. Tell your doctor if you start or stop using birth control pills. Your lamotrigine dose may need to be changed. It may not be safe to breastfeed while using lamotrigine. Ask your doctor about any risk. How should I take lamotrigine? Follow all directions on your prescription label and read all medication guides or instruction sheets. Your doctor may occasionally change your dose. Use the medicine exactly as directed. Taking too much lamotrigine at the start of treatment may increase your risk of a severe life-threatening skin rash. You may need frequent blood tests to help your doctor make sure you are taking the right dose. Extended-release and immediate-release lamotrigine may be used for different conditions. Always check your refills to make sure you have received the correct size, color, and shape of tablet. Avoid medication errors by using only the form and strength your doctor prescribes. If you switch to lamotrigine from another seizure medicine, carefully follow your doctor's instructions about the timing and dosage of your medicine. Swallow the tablet whole and do not crush, chew, or break it. Read and carefully follow any Instructions for Use provided with the orally disintegrating or dispersible tablets. Ask your doctor or pharmacist if you do not understand these instructions. Do not stop using lamotrigine suddenly, even if you feel fine. Stopping suddenly may cause increased seizures. Follow your doctor's instructions about tapering your dose. In case of emergency, wear or carry medical identification to let others know you use seizure medication. Lamotrigine may affect a drug-screening urine test and you may have false results. Tell the laboratory staff that you use lamotrigine. Store at room temperature away from light and moisture.   What happens if I miss a dose? Take the medicine as soon as you can, but skip the missed dose if it is almost time for your next dose. Do not take two doses at one time. Get your prescription refilled before you run out of medicine completely. What happens if I overdose? Seek emergency medical attention or call the Poison Help line at 1-800-222-1222. Overdose symptoms may include blurred vision, problems with coordination, increased seizures, feeling light-headed, or fainting. What should I avoid while taking lamotrigine? Avoid driving or hazardous activity until you know how lamotrigine will affect you. Your reactions could be impaired. Lamotrigine side effects Get emergency medical help if you have signs of an allergic reaction (hives, difficult breathing, swelling in your face or throat) or a severe skin reaction (fever, sore throat, burning eyes, skin pain, red or purple skin rash with blistering and peeling). If you have to stop taking lamotrigine because of a serious skin rash, you may not be able to take it again in the future. Report any new or worsening symptoms to your doctor, such as: mood or behavior changes, depression, anxiety, or if you feel agitated, hostile, restless, hyperactive (mentally or physically), or have thoughts about suicide or hurting yourself. Call your doctor at once if you have: fast, slow, or pounding heartbeats or fluttering in your chest; chest pain, shortness of breath; fever, swollen glands, weakness, severe muscle pain; any skin rash, especially with blistering or peeling; painful sores in your mouth or around your eyes; headache, neck stiffness, increased sensitivity to light, nausea, vomiting, confusion, drowsiness; jaundice (yellowing of the skin or eyes); or pale skin, cold hands and feet, easy bruising, unusual bleeding. Common side effects may include: headache, dizziness; blurred vision, double vision; tremor, loss of coordination; dry mouth, nausea, vomiting, stomach pain, diarrhea; fever, sore throat, runny nose; drowsiness, tired feeling; back pain; or sleep problems (insomnia). This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.   What other drugs will affect lamotrigine? Sometimes it is not safe to use certain medications at the same time. Some drugs can affect your blood levels of other drugs you take, which may increase side effects or make the medications less effective. Other drugs may affect lamotrigine, including prescription and over-the-counter medicines, vitamins, and herbal products. Tell your doctor about all your current medicines and any medicine you start or stop using.

What is lamotrigine? Lamotrigine is an anti-epileptic medication, also called an anticonvulsant. Lamotrigine is used alone or with other medications to treat epileptic seizures in adults and children. Lamotrigine is also used to delay mood episodes in adults with bipolar disorder (manic depression). Immediate-release lamotrigine can be used in children as young as 2 years old when it is given as part of a combination of seizure medications. However, this form should not be used as a single medication in a child or teenager who is younger than 16 years old. Extended-release lamotrigine is for use only in adults and children who are at least 13 years old. Lamotrigine may also be used for purposes not listed in this medication guide. Warnings Lamotrigine may cause a severe or life-threatening skin rash, especially in children and in people who take a very high starting dose, or those who also take valproic acid (Depakene) or divalproex (Depakote). Seek emergency medical attention if you have a skin rash, hives, blistering, peeling, or sores in your mouth or around your eyes. Call your doctor at once if you have signs of other serious side effects, including: fever, swollen glands, severe muscle pain, bruising or unusual bleeding, yellowing of your skin or eyes, headache, neck stiffness, vomiting, confusion, or increased sensitivity to light. Some people have thoughts about suicide while taking lamotrigine. Stay alert to changes in your mood or symptoms. Report any new or worsening symptoms to your doctor. Before taking this medicine You should not take lamotrigine if you are allergic to it. Lamotrigine may cause a severe or life-threatening skin rash, especially in children and in people who take a very high starting dose, or those who also take valproic acid (Depakene) or divalproex (Depakote). Tell your doctor if you have ever had: a rash or allergic reaction after taking another seizure medication; kidney or liver disease; heart problems such as heart block or irregular heartbeats; depression, suicidal thoughts or actions; or meningitis (inflammation of the tissue that covers the brain and spinal cord) after taking lamotrigine. Some people have thoughts about suicide while taking lamotrigine. Your doctor will need to check your progress at regular visits. Your family or other caregivers should also be alert to changes in your mood or symptoms. Do not start or stop taking seizure medication during pregnancy without your doctor's advice. Having a seizure during pregnancy could harm both mother and baby. Tell your doctor right away if you become pregnant. If you are pregnant, your name may be listed on a pregnancy registry to track the effects of lamotrigine on the baby. Birth control pills can make lamotrigine less effective, resulting in increased seizures. Tell your doctor if you start or stop using birth control pills. Your lamotrigine dose may need to be changed. It may not be safe to breastfeed while using lamotrigine. Ask your doctor about any risk. How should I take lamotrigine? Follow all directions on your prescription label and read all medication guides or instruction sheets. Your doctor may occasionally change your dose. Use the medicine exactly as directed. Taking too much lamotrigine at the start of treatment may increase your risk of a severe life-threatening skin rash. You may need frequent blood tests to help your doctor make sure you are taking the right dose. Extended-release and immediate-release lamotrigine may be used for different conditions. Always check your refills to make sure you have received the correct size, color, and shape of tablet. Avoid medication errors by using only the form and strength your doctor prescribes. If you switch to lamotrigine from another seizure medicine, carefully follow your doctor's instructions about the timing and dosage of your medicine. Swallow the tablet whole and do not crush, chew, or break it. Read and carefully follow any Instructions for Use provided with the orally disintegrating or dispersible tablets. Ask your doctor or pharmacist if you do not understand these instructions. Do not stop using lamotrigine suddenly, even if you feel fine. Stopping suddenly may cause increased seizures. Follow your doctor's instructions about tapering your dose. In case of emergency, wear or carry medical identification to let others know you use seizure medication. Lamotrigine may affect a drug-screening urine test and you may have false results. Tell the laboratory staff that you use lamotrigine. Store at room temperature away from light and moisture.   What happens if I miss a dose? Take the medicine as soon as you can, but skip the missed dose if it is almost time for your next dose. Do not take two doses at one time. Get your prescription refilled before you run out of medicine completely. What happens if I overdose? Seek emergency medical attention or call the Poison Help line at 1-800-222-1222. Overdose symptoms may include blurred vision, problems with coordination, increased seizures, feeling light-headed, or fainting. What should I avoid while taking lamotrigine? Avoid driving or hazardous activity until you know how lamotrigine will affect you. Your reactions could be impaired. Lamotrigine side effects Get emergency medical help if you have signs of an allergic reaction (hives, difficult breathing, swelling in your face or throat) or a severe skin reaction (fever, sore throat, burning eyes, skin pain, red or purple skin rash with blistering and peeling). If you have to stop taking lamotrigine because of a serious skin rash, you may not be able to take it again in the future. Report any new or worsening symptoms to your doctor, such as: mood or behavior changes, depression, anxiety, or if you feel agitated, hostile, restless, hyperactive (mentally or physically), or have thoughts about suicide or hurting yourself. Call your doctor at once if you have: fast, slow, or pounding heartbeats or fluttering in your chest; chest pain, shortness of breath; fever, swollen glands, weakness, severe muscle pain; any skin rash, especially with blistering or peeling; painful sores in your mouth or around your eyes; headache, neck stiffness, increased sensitivity to light, nausea, vomiting, confusion, drowsiness; jaundice (yellowing of the skin or eyes); or pale skin, cold hands and feet, easy bruising, unusual bleeding. Common side effects may include: headache, dizziness; blurred vision, double vision; tremor, loss of coordination; dry mouth, nausea, vomiting, stomach pain, diarrhea; fever, sore throat, runny nose; drowsiness, tired feeling; back pain; or sleep problems (insomnia). This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.   What other drugs will affect lamotrigine? Sometimes it is not safe to use certain medications at the same time. Some drugs can affect your blood levels of other drugs you take, which may increase side effects or make the medications less effective. Other drugs may affect lamotrigine, including prescription and over-the-counter medicines, vitamins, and herbal products. Tell your doctor about all your current medicines and any medicine you start or stop using.

What is oxcarbazepine? Oxcarbazepine is an anticonvulsant. It works by decreasing nerve impulses that cause seizures and pain. Oxcarbazepine is used either alone or with other medicines to treat partial seizures. The Trileptal brand of oxcarbazepine is used as a single medicine in adults and children who are at least 4 years old. Trileptal is used with other medicines in adults and children who are at least 2 years old. The Oxtellar XR brand of oxcarbazepine is used with other medicines in adults and children who are at least 6 years old. Oxcarbazepine may also be used for purposes not listed in this medication guide. Warnings Seek medical treatment if you have symptoms of a serious drug reaction: skin rash, fever, swollen glands, flu-like symptoms, unusual bruising or bleeding, or yellowing of your skin or eyes. Call your doctor right away if you have symptoms of low sodium levels in your body, such as nausea, confusion, severe weakness, muscle pain, or increased seizures. Some people have thoughts about suicide while taking seizure medicine. Stay alert to changes in your mood or symptoms. Report any new or worsening symptoms to your doctor. Do not stop using oxcarbazepine suddenly. Before taking this medicine You should not take oxcarbazepine if you are allergic to oxcarbazepine or eslicarbazepine. Tell your doctor if you have ever had: liver disease; kidney disease; mood problems or suicidal thoughts; or an allergy to carbamazepine (Carbatrol, Tegretol). Some people have thoughts about suicide while taking oxcarbazepine. Your doctor will need to check your progress at regular visits. Your family or other caregivers should also be alert to changes in your mood or symptoms. Do not start or stop taking oxcarbazepine during pregnancy without your doctor's advice. Having a seizure during pregnancy could harm both mother and baby. Tell your doctor right away if you become pregnant while taking oxcarbazepine for seizures. If you are pregnant, your name may be listed on a pregnancy registry to track the effects of oxcarbazepine on the baby. Oxcarbazepine can make birth control pills less effective. Ask your doctor about using a non-hormonal birth control (condom, diaphragm with spermicide) to prevent pregnancy. You should not breast-feed while you are taking oxcarbazepine. Do not give this medicine to a child without medical advice. There are specific age restrictions for the use of oxcarbazepine in children, depending on the dose form and whether it is used alone or with other medicines. How should I take oxcarbazepine? Follow all directions on your prescription label and read all medication guides or instruction sheets. Your doctor may occasionally change your dose. Use the medicine exactly as directed. Shake the oral suspension (liquid) before you measure a dose. Use the dosing syringe provided, or use a medicine dose-measuring device (not a kitchen spoon). Give the liquid directly from the oral syringe, or mix the medicine with a small glass of water. After using the syringe, rinse it with water and allow it to air dry. Take the oxcarbazepine extended-release tablet on an empty stomach, at least 1 hour before or 2 hours after a meal. You may take the oxcarbazepine oral liquid or regular tablet with or without food. Swallow the extended-release tablet whole and do not crush, chew, or break it. You may need frequent blood tests. Do not stop using oxcarbazepine suddenly, even if you feel fine. Stopping suddenly may cause increased seizures. Follow your doctor's instructions about tapering your dose. In case of emergency, wear or carry medical identification to let others know you use oxcarbazepine. Seizures are often treated with a combination of drugs. Use all medications as directed by your doctor. Read the medication guide or patient instructions provided with each medication. Do not change your doses or medication schedule without your doctor's advice. Store at room temperature away from moisture and heat. Throw away any unused liquid 7 weeks after opening the bottle.   What happens if I miss a dose? Take the medicine as soon as you can, but skip the missed dose if it is almost time for your next dose. Do not take two doses at one time. What happens if I overdose? Seek emergency medical attention or call the Poison Help line at 1-800-222-1222. What should I avoid while taking oxcarbazepine? Do not drink alcohol. Drinking alcohol can increase certain side effects, and may increase the risk of seizures. Avoid becoming overheated or dehydrated during exercise, in hot weather, or by not drinking enough fluids. Follow your doctor's instructions about the type and amount of liquids you should drink. Avoid driving or hazardous activity until you know how oxcarbazepine will affect you. Your reactions could be impaired. Oxcarbazepine side effects Get emergency medical help if you have signs of an allergic reaction: hives; difficult breathing; swelling of your face, lips, tongue, or throat. Seek medical treatment if you have a serious drug reaction that can affect many parts of your body. Symptoms may include: skin rash, fever, swollen glands, flu-like symptoms, muscle aches, severe weakness, unusual bruising, or yellowing of your skin or eyes. Oxcarbazepine can reduce the sodium in your body to dangerously low levels, which can cause a life-threatening electrolyte imbalance. Call your doctor right away if you have nausea, lack of energy, confusion, feeling tired or irritable, severe weakness, muscle pain, or increased seizures. Report any new or worsening symptoms to your doctor, such as: mood or behavior changes, depression, anxiety, or if you feel agitated, hostile, restless, hyperactive (mentally or physically), or have thoughts about suicide or hurting yourself. Common side effects may include: dizziness, drowsiness, tiredness; balance or coordination problems; nausea, vomiting; tremors or shaking; double vision; or rash. This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.   What other drugs will affect oxcarbazepine? Using oxcarbazepine with other drugs that make you drowsy can worsen this effect. Ask your doctor before using opioid medication, a sleeping pill, a muscle relaxer, or medicine for anxiety or seizures. Sometimes it is not safe to use certain medications at the same time. Some drugs can affect your blood levels of other drugs you take, which may increase side effects or make the medications less effective. Many drugs can affect oxcarbazepine. This includes prescription and over-the-counter medicines, vitamins, and herbal products. Not all possible interactions are listed here. Tell your doctor about all your current medicines and any medicine you start or stop using.