What is the effect of taking Tolanaz 10 mg, Epilim (Valproate) 500 mg, and Rivotril (Clonazepam) 0.5 mg?

From the Guidelines

You should not stop taking your prescribed medications (tolanz 10 mg, epilim 500 mg, and rivotril 0.5 mg) without consulting your doctor first, as this can lead to serious side effects or worsening of your condition. These medications are typically used to treat different conditions - tolanz (olanzapine) for psychiatric conditions, epilim (sodium valproate) for epilepsy or mood disorders, and rivotril (clonazepam) for seizures or anxiety.

Key Considerations

• It's essential to continue taking these medications exactly as prescribed by your doctor to maintain consistent blood levels and minimize potential side effects.
• Sudden changes to your medication regimen can cause serious side effects or worsening of your condition, so it's crucial to discuss any concerns or issues with your healthcare provider before making any adjustments.
• Be aware that these medications may cause drowsiness, so use caution when driving or operating machinery.

Potential Side Effects

• Epilim (sodium valproate) has been associated with weight gain, polycystic ovaries, and hyperandrogenism in women, as reported in a study published in the Journal of Neurology, Neurosurgery and Psychiatry 1.
• The study found that 45% of women on valproate monotherapy had menstrual irregularities, and 60% of these women also had polycystic ovaries and 30% had raised serum testosterone concentrations 1.

Next Steps

• If you're experiencing side effects or have concerns about your medication regimen, schedule an appointment with your doctor to discuss these issues.
• Your healthcare provider can help you weigh the benefits and risks of your medications and make any necessary adjustments to your treatment plan.
• Always take these medications at the same time each day to maintain consistent blood levels and minimize potential side effects.

From the FDA Drug Label

The FDA drug label does not answer the question.

From the Research

Medication Interactions

• The combination of valproate (VPA) and clonazepam (CZP) has been evaluated in patients with intractable epilepsy, with trough VPA serum levels ranging from 26 to 96 micrograms/ml and trough CZP serum levels ranging from 5 to 63 ng/ml 2.
• Valproate is considered a first-line treatment for generalized and unclassified epilepsies, and is highly effective in juvenile myoclonic epilepsy 3.
• Clonazepam has been shown to be effective in the control of petit mal absences and myoclonic jerks, although some patients responded to one and not to the other 4.

Efficacy of Antiepileptic Drugs

• A systematic review and network meta-analyses compared the relative efficacy of antiepileptic drugs in the monotherapy treatment of generalized epileptic seizures, and found that lamotrigine, levetiracetam, and topiramate are as effective as valproate for treating generalized tonic-clonic, tonic, and clonic seizures 5.
• Valproate and ethosuximide are considered the best options for the treatment of absence seizures, promoting better control of seizures 5.
• A comparative trial of valproate sodium and clonazepam in chronic epilepsy found that both drugs significantly reduced the frequency of minor seizures, with valproate sodium having the greater effect 6.

Dosage and Serum Concentrations

• The study by 2 found that trough VPA serum levels ranged from 26 to 96 micrograms/ml and trough CZP serum levels ranged from 5 to 63 ng/ml.
• The study by 6 found that serum concentrations of other anticonvulsant drugs were unchanged by the addition of clonazepam, but patients receiving high doses of other anticonvulsant drugs had lower serum concentrations of clonazepam.
• The study by 3 suggests that a low dosage of valproate (500-600 mg/day, but not more than 1000 mg/day) can be effective in controlling seizures in some patients.

Specific Medications

• Tolanaz 10 mg, Epilim 500 mg, and Rivotril 0.5 mg are mentioned, but there is no direct evidence in the provided studies to assist in answering questions about these specific medications.
• However, Epilim is a brand name for valproate, and Rivotril is a brand name for clonazepam, which are both discussed in the provided studies 2, 3, 4, 6.