Brand Names:

• Ativan
• Banzel
• Carbatrol
• Celontin Kapseals
• Depakene
• Depakote
• Diamox Sequels
• Dilantin
• Dilantin Infatabs
• Diphen
• Felbatol
• Gabitril
• Gen-Xene
• Keppra
• Klonopin
• Lamictal
• Lyrica
• Mebaral
• Mesantoin
• Mysoline
• Neurontin
• Peganone
• Seconal
• Topamax
• Trileptal
• Vimpat
• Zarontin
• Zonegran
• Alti-Valproic
• Dilantin-125
• Dilantin-30
• Milontin
• Sabril
• Tegretol

Dosage Forms:

• Tablet, Delayed Release
• Capsule
• Elixir
• Tablet, Disintegrating
• Solution
• Tablet
• Capsule, Extended Release
• Capsule, Delayed Release
• Capsule, Liquid Filled
• Tablet, Chewable
• Tablet, Enteric Coated
• Suspension
• Tablet, Extended Release
• Syrup
• Liquid
• Powder

Uses of This Medicine:

Dione anticonvulsants are used to control certain types of seizures in the treatment of epilepsy. They act on the central nervous system (CNS) to reduce the number of seizures. These medicines cannot cure epilepsy and will only work to control seizures for as long as you continue to take them.

Dione anticonvulsants are available only with your doctor's prescription.

Paramethadione was withdrawn from the United States market in 1995.

Before Using This Medicine:

Allergies

Tell your doctor if you have ever had any unusual or allergic reaction to medicines in this group or any other medicines. Also tell your health care professional if you have any other types of allergies, such as to foods dyes, preservatives, or animals. For non-prescription products, read the label or package ingredients carefully.

Children

Although there is no specific information comparing use of dione anticonvulsants in children with use in other age groups, these medicines are not expected to cause different side effects or problems in children than they do in adults.

Older adults

This medicine has been tested in a very small number of older people. Dione anticonvulsants are removed from the body more slowly in older people than in younger people. Higher blood levels of the medicine may occur, which may increase the chance of unwanted effects. Your doctor may give you a different dose than a younger person would receive.

Pregnancy

There have been reports of increased birth defects when dione anticonvulsants were used during pregnancy. The use of an effective method of birth control is recommended during treatment with dione anticonvulsants. Be sure you have discussed this with your doctor before taking this medicine. Dione anticonvulsants may also cause a bleeding problem in the mother during delivery and in the newborn. Doctors can help prevent this by giving vitamin K to the mother before and during delivery, and to the baby immediately after birth.

Breast-feeding

It is not known whether this medicine passes into breast milk. However, dione anticonvulsants may have serious unwanted effects, and breast-feeding is not recommended.

Other medicines

Using medicines in this class with any of the following medicines is not recommended. Your doctor may decide not to treat you with a medication in this class or change some of the other medicines you take.

• Clorgyline
• Disulfiram
• Iproniazid
• Isocarboxazid
• Moclobemide
• Nefazodone
• Nialamide
• Pargyline
• Phenelzine
• Procarbazine
• Ranolazine
• Selegiline
• Toloxatone
• Tranylcypromine
• Voriconazole

Using medicines in this class with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

• Acenocoumarol
• Adenosine
• Adinazolam
• Alfentanil
• Alprazolam
• Amobarbital
• Anileridine
• Anisindione
• Apazone
• Aprobarbital
• Arsenic Trioxide
• Beclamide
• Bromazepam
• Brotizolam
• Buprenorphine
• Butabarbital
• Butalbital
• Carbamazepine
• Carisoprodol
• Chloral Hydrate
• Chlordiazepoxide
• Chlorzoxazone
• Clobazam
• Clonazepam
• Clorazepate
• Clozapine
• Codeine
• Dantrolene
• Darunavir
• Dasatinib
• Delavirdine
• Diazepam
• Dicumarol
• Digitalis
• Droperidol
• Erlotinib
• Ertapenem
• Estazolam
• Ethchlorvynol
• Ethinyl Estradiol
• Etravirine
• Fentanyl
• Flunitrazepam
• Flurazepam
• Fospropofol
• Gestodene
• Halazepam
• Hydrocodone
• Hydromorphone
• Imatinib
• Imipenem
• Irinotecan
• Itraconazole
• Ixabepilone
• Ketazolam
• Lamotrigine
• Lapatinib
• Levomethadyl
• Levorphanol
• Licorice
• Lidocaine
• Lopinavir
• Lorazepam
• Lormetazepam
• Maraviroc
• Medazepam
• Meperidine
• Mephenesin
• Mephobarbital
• Meprobamate
• Meropenem
• Metaxalone
• Methocarbamol
• Methohexital
• Methotrexate
• Methoxyflurane
• Midazolam
• Morphine
• Morphine Sulfate Liposome
• Nelfinavir
• Nilotinib
• Nitrazepam
• Nordazepam
• Oxazepam
• Oxycodone
• Oxymorphone
• Pentobarbital
• Phenindione
• Phenobarbital
• Phenprocoumon
• Posaconazole
• Prazepam
• Primidone
• Propoxyphene
• Proscillaridin
• Quazepam
• Quetiapine
• Quinidine
• Remifentanil
• Secobarbital
• Sirolimus
• Sodium Oxybate
• Sotalol
• St John's Wort
• Sufentanil
• Sunitinib
• Tacrolimus
• Temazepam
• Temsirolimus
• Teniposide
• Thiopental
• Tramadol
• Triazolam
• Valproic Acid
• Vigabatrin
• Voriconazole
• Vorinostat

Other interactions

Certain medicines should not be used at or around the time of eating food or eating certain types of food since interactions may occur. Using alcohol or tobacco with certain medicines may also cause interactions to occur. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.

Other medical problems

The presence of other medical problems may affect the use of medicines in this class. Make sure you tell your doctor if you have any other medical problems, especially:

• Blood disease or
• Diseases of the eye or optic nerve or
• Kidney disease or
• Liver disease Dione anticonvulsants may make the condition worse. Liver disease may cause higher blood levels of this medicine, which may increase the chance of side effects.

• Porphyria Trimethadione may make the condition worse.

Proper Use of This Medicine:

For patients taking trimethadione solution:

• Use a specially marked measuring spoon, a plastic syringe, or a small marked measuring cup to measure each dose accurately. The average household teaspoon may not hold the right amount of liquid.

For patients taking trimethadione chewable tablets :

• The tablets should be crushed and dissolved in a small amount of water or chewed before they are swallowed.

If this medicine upsets your stomach, take it with a small amount of food or milk unless otherwise directed by your doctor.

Take this medicine only as directed by your doctor , to benefit your condition as much as possible. Do not take more or less of it and do not take it more or less often than your doctor ordered.

Dosing

The dose medicines in this class will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of these medicines. If your dose is different, do not change it unless your doctor tells you to do so.

The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.

• For oral dosage forms (capsules, solution, tablets):
  • Adults and teenagers To start, 300 milligrams (mg) three times a day. Your doctor may increase your dose by 300 mg every week until seizures are controlled or side effects appear. However, the dose is usually not more than 2400 mg a day, taken in three or four smaller doses.
  • Children 6 years of age and over 300 mg three or four times a day.
  • Children 2 to 6 years of age 200 mg three times a day.
  • Children up to 2 years of age 100 mg three times a day.

Missed dose

If you miss a dose of this medicine, take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not double doses.

If only one dose is missed, it may be taken at bedtime.

Storage

Keep out of the reach of children.

Store the medicine in a closed container at room temperature, away from heat, moisture, and direct light. Keep from freezing.

Do not keep outdated medicine or medicine no longer needed.

Store trimethadione chewable tablets in the refrigerator.

Keep the liquid form of this medicine from freezing.

Precautions While Using This Medicine:

It is very important that your doctor check your progress at regular visits. This is necessary to allow dose adjustments and to test for serious unwanted effects.

Tell your doctor as soon as possible if you have a sore throat, fever, or general feeling of tiredness, or if you notice any unusual bleeding or bruising, such as red or purple spots on the skin, nosebleed, or bleeding gums.

Dione anticonvulsants may cause your eyes to become more sensitive to bright light than they are normally, making it difficult for you to see well. Wearing sunglasses and avoiding too much exposure to bright light may help lessen the discomfort. You may also have difficulty seeing in light that changes in brightness. If you notice this effect, be especially careful when driving at night.

This medicine will add to the effects of alcohol and other CNS depressants (medicines that slow down the nervous system, possibly causing drowsiness). Some examples of CNS depressants are antihistamines or medicine for hay fever, other allergies, or colds; sedatives, tranquilizers, or sleeping medicine; prescription pain medicine or narcotics; barbiturates; medicine for seizures; muscle relaxants; or anesthetics, including some dental anesthetics. Check with your doctor before taking any of the above while you are using this medicine.

Dione anticonvulsants may cause some people to become drowsy or less alert than they are normally. Make sure you know how you react to this medicine before you drive, use machines, or do anything else that could be dangerous if you are not alert. After you have taken this medicine for a while, this effect may not be so bothersome.

Before having any kind of surgery, dental treatment, or emergency treatment, tell the medical doctor or dentist in charge that you are taking this medicine. Taking dione anticonvulsants together with medicines that are used during surgery or dental or emergency treatments may increase the CNS depressant effects.

Check with your doctor as soon as possible if you suspect you have become pregnant.

Do not stop taking dione anticonvulsant medicines without first checking with your doctor. Your doctor may want to reduce your dose gradually. Stopping this medicine suddenly may cause seizures.

Side Effects of This Medicine:

Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Check with your doctor as soon as possible if any of the following side effects occur:

More common

Changes in vision, especially night blindness, glare or snowy image caused by bright light, or double vision

Rare

Confusion

convulsions (seizures)

dark or cloudy urine

dizziness

fever

loss of appetite or weight

muscle weakness (severe), especially drooping eyelids, or difficulty in chewing, swallowing, talking, or breathing

nausea or vomiting

pain in abdomen, chest, muscles or joints

shortness of breath

skin rash or itching

sore throat and fever

swelling of face, hands, legs, and feet

swollen lymph nodes

unusual bleeding or bruising, such as recurring nosebleeds, bleeding gums, or vaginal bleeding, or red or purple spots on skin

unusual tiredness or weakness

yellow eyes or skin

Symptoms of overdose

Clumsiness or unsteadiness

coma

dizziness (severe)

drowsiness (severe)

nausea (severe)

problems with vision

Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:

More common

Dizziness

drowsiness

headache

increased sensitivity of eyes to light

irritability

Less common

Behavior or mood changes

blood pressure changes

hair loss

hiccups

loss of appetite

stomach pain, nausea, or vomiting

tingling, burning, or prickly sensations

trouble in sleeping

unusual weight loss

Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.