From the Guidelines
When taking anti-seizure medications, calcium and vitamin D supplements are generally considered safe, with calcium citrate being a preferred option, and should be taken in divided doses, with a daily intake of 500-1000 mg of calcium and 1000-2000 IU of vitamin D, while avoiding high-dose zinc supplements. To minimize potential interactions, it is essential to consult with a neurologist before starting any supplement regimen 1. The choice of mineral supplements is crucial as some can interfere with the effectiveness of anti-seizure medications. Some key considerations for supplement intake include:
- Taking supplements at least 2-4 hours apart from seizure medications to prevent absorption issues
- Monitoring for changes in seizure activity or new side effects, which should be reported to the doctor immediately
- Considering liquid or chewable supplements for better absorption in some individuals
- Starting with lower doses and gradually increasing while monitoring for any adverse effects
- Ensuring adequate dietary intake of calcium, with requirements potentially higher in certain individuals, and considering a combined vitamin D and calcium supplement if necessary 1
- Being aware that some anti-seizure drugs can deplete certain nutrients over time, particularly vitamin D, folate, calcium, and vitamin K, and considering supplementation to prevent deficiencies 1.
From the Research
Mineral Supplements and Anti-Seizure Medications
- The use of anti-seizure medications has been associated with bone loss and decreased levels of certain minerals, including vitamin D and calcium 2, 3, 4.
- Studies have shown that patients on anti-seizure medications often have low levels of vitamin D, with one study finding that 90% of patients had low levels of vitamin D 5.
- Vitamin D and calcium supplementation may be beneficial for patients on anti-seizure medications, as it can help to reduce the risk of bone loss and fractures 2, 3, 4.
- However, one study found that calcium and vitamin D supplementation did not reduce the risk of fractures in patients on anti-seizure medications 6.
Safe Mineral Supplements
- Vitamin D: supplementation with vitamin D may be beneficial for patients on anti-seizure medications, with a suggested dose of 37.5-125 micrograms per week 3.
- Calcium: calcium supplementation may also be beneficial, particularly in patients with low dietary intake of calcium 2, 4.
- Vitamin B1: patients on anti-seizure medications may also have low levels of vitamin B1, and supplementation with this vitamin may be beneficial 5.
- Vitamin C: vitamin C levels may also be low in patients on anti-seizure medications, and supplementation with this vitamin may be beneficial 5.
Considerations
- Patients on anti-seizure medications should have their mineral levels regularly monitored, including vitamin D, calcium, vitamin B1, and vitamin C 5.
- The use of anti-seizure medications, particularly phenytoin, may be associated with an increased risk of fractures, and supplementation with calcium and vitamin D may not be sufficient to prevent this risk 6.