From the Guidelines
When taking anti-seizure medications, it is recommended to take low-dose calcium (500-600mg daily) and vitamin D3 (1000-2000 IU daily) as safe mineral supplement options, while avoiding high-dose zinc supplements and taking precautions with folate supplements, especially with lamotrigine, as suggested by general medical knowledge and guidelines 1.
Key Considerations for Mineral Supplements
- Calcium supplements, such as calcium citrate, can be taken with or without food, and it is advised to take them in equally divided doses to aid absorption, as noted in the British Obesity and Metabolic Surgery Society guidelines 1.
- Vitamin D3 supplements are essential, especially if the patient is at risk of deficiency, and the dose should be adjusted based on blood test results to achieve normal concentrations, as recommended in the nutritional guidelines for adult bariatric surgery patients 1.
- Magnesium glycinate or citrate (200-300mg daily) can also be considered as a safe option, although the provided evidence does not directly address magnesium supplementation in the context of anti-seizure medications.
- High-dose zinc supplements should be avoided, as they may interfere with certain anti-seizure medications, and patients should be cautious with folate supplements, especially if taking lamotrigine, due to potential interactions.
General Guidance for Supplement Regimens
- It is crucial to consult with a neurologist before starting any supplement regimen to ensure safe and effective management of seizure control and overall health.
- Supplements should be taken at least 2-4 hours apart from seizure medications to prevent absorption issues, and patients should start with lower doses and gradually increase as needed and under medical supervision.
- Regular blood tests to check mineral levels can help personalize supplement needs and ensure that the patient is not at risk of deficiency or toxicity, which is particularly important for patients taking anti-seizure medications that may deplete certain nutrients over time.
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 adult epilepsy patients 6.
Specific Mineral Supplements
- Vitamin D: supplementation with vitamin D 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, 5.
- Calcium: supplementation with calcium 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, 6.
- Vitamin B1: one study found that serum levels of vitamin B1 were below the reference range in 46% of epileptic patients, suggesting that supplementation with vitamin B1 may be beneficial for some patients 5.
- Vitamin C: one study found that serum levels of vitamin C were below the reference range in 72% of epileptic patients, suggesting that supplementation with vitamin C may be beneficial for some patients 5.
Considerations for Supplementation
- Patients on anti-seizure medications should be carefully evaluated for the presence of drug-induced osteomalacia and treated appropriately with vitamin D and calcium supplementation 4.
- The type and dose of anti-seizure medication, as well as the individual patient's needs and medical history, should be taken into account when considering supplementation 2, 3, 4, 5, 6.