From the Guidelines
When taking anti-seizure medications, it is crucial to prioritize calcium citrate supplements, as they are generally safer and more effective for maintaining bone health, while minimizing potential interactions with anti-seizure medications, as suggested by the most recent guidelines 1. To minimize potential interactions with anti-seizure medications, it is essential to choose mineral supplements carefully.
- A low-dose multivitamin without herbs is usually the safest option, but it is crucial to consult with a neurologist before starting any supplement.
- Calcium supplements, particularly calcium citrate, can be taken in divided doses, with food or without, to aid absorption, as recommended by recent guidelines 1.
- However, it is essential to avoid high doses of calcium (above 1000mg daily), as they may affect the absorption of medications like phenytoin (Dilantin) and carbamazepine (Tegretol) 1.
- Magnesium (200-400mg daily) is usually safe and may even help with seizure control, but it should be taken at least 2 hours apart from the medication.
- Vitamin D (1000-2000 IU daily) is typically safe and important, as many anti-seizure drugs can deplete it, but the optimal dosage may vary depending on individual needs and serum levels, as suggested by recent studies 1.
- Supplements containing St. John's Wort, ginkgo biloba, or high doses of vitamin K should be avoided, as they can significantly interact with medications like valproic acid (Depakote), lamotrigine (Lamictal), and levetiracetam (Keppra). The reason for these precautions is that anti-seizure medications are metabolized through liver pathways that can be affected by certain minerals and herbs, potentially leading to decreased medication effectiveness or increased side effects.
- Recent guidelines emphasize the importance of monitoring and maintaining adequate serum levels of essential nutrients, including calcium, vitamin D, and magnesium, to minimize the risk of deficiency and optimize treatment outcomes 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 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.