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Medscape article 2010

Clinical Implications of Anticonvulsant Treatment Studies of anticonvulsants have identified issues important to the tolerability and efficacy of treatment with these drugs. Baseline laboratory tests for anticonvulsant mood stabilizers should include serum blood levels, complete blood count values and liver function tests. Weight should be recorded at baseline and monitored throughout treatment. Divalproex sodium has been linked to the development of polycystic ovarian syndrome in women who were on the medication for 12 months,[56] and therefore requires monitoring of amylase, liver function tests, estrogen, progesterone, fasting blood sugar and hemoglobin A1C to check for polycystic ovarian syndrome. Before prescribing divalproex sodium, informed consent should be obtained and patients and their families should be educated about the possibility of menstrual irregularities and the importance of effective birth control, as the anticonvulsants can cause birth defects. In addition, adverse effects include hirsutism, acne, alopecia, male pattern hair loss and elevated testosterone. Furthermore, carbamazepine has been associated with a small number of cases of Stevens–Johnson syndrome and can cause oral contraceptives to be ineffective. Additionally, common side effects of all anticonvulsants include weight gain, nausea, sedation, dizziness, tremor, headache, visual disturbances, blood dyscrasias and elevated thyrotropin levels. Rash and Stevens–Johnson syndrome is a symptom that should be monitored closely in children and adolescents on anticonvulsants. Routine divalproex sodium and carbamazapine levels should be obtained.




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