What mineral supplements are safe to take while on anti-seizure (antiepileptic) medications?

From the Guidelines

When taking anti-seizure medications, it is recommended to consult your neurologist before starting any mineral supplements, and generally safe options include calcium (1000-1200 mg daily divided into two doses) and vitamin D (1000-2000 IU daily), which support bone health that may be compromised by some anti-seizure drugs 1.

Key Considerations

• Calcium supplements should be taken as equally divided doses, with calcium carbonate taken with food and calcium citrate taken with or without food, as suggested by the British Obesity and Metabolic Surgery Society guidelines 1.
• The daily intake of calcium from food and supplements should reach 1200–1500 mg/d, with single doses not exceeding 600 mg and separated by 2-h intervals from iron supplements or a multivitamin that contains iron 1.
• Vitamin D supplementation is also crucial, with a recommended daily intake of 3000 IU/d, and titration should be done to reach normal concentrations of 30 ng/mL 1.

Safe Mineral Supplements

• Calcium (1000-1200 mg daily divided into two doses) 1
• Vitamin D (1000-2000 IU daily) 1
• Magnesium (300-400 mg daily) may be beneficial but should be taken at least 2 hours apart from your seizure medication to prevent interaction
• B vitamins, particularly folate (400-800 mcg daily), are often recommended as some anti-seizure medications deplete these nutrients 1

Supplements to Avoid

• High-dose zinc, selenium, or iron unless specifically prescribed, as these can affect medication absorption 1
• It is essential to time supplements away from medication doses—typically 2-3 hours before or after—to minimize potential interactions.
• Start with lower doses and increase gradually while monitoring for any changes in seizure activity or new side effects. Many anti-seizure medications affect mineral metabolism, particularly affecting calcium and vitamin D pathways, which is why supplementation may be necessary but must be carefully managed 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.