<unk>  prescribing information has a black box warning about life-threatening skin reactions, including Stevens–Johnson syndrome (SJS), DRESS syndrome, and toxic epidermal necrolysis (TEN). The manufacturer states that nearly all cases appear in the first two to eight weeks of therapy. Patients should seek medical attention for any unexpected skin rash, as its presence is an indication of a possible serious or even deadly side effect of the drug. Not all rashes that occur while taking<unk>  progress to SJS or TEN. Between 5 and 10% of patients will develop a rash, but only one in a thousand patients will develop a serious rash. Rash and other skin reactions are more common in children, so this medication is often reserved for adults. For patients whose<unk>  has been stopped after development of a rash, rechallenge with<unk>  is also a viable option. However, it is not applicable for very serious cases. The incidence of these eruptions increases in patients who are currently on, or recently discontinued a valproate-type anticonvulsant drug, as these medications interact in such a way that the clearance of both is decreased and the effective dose of<unk>  is increased. Side effects such as rash, fever, and fatigue are very serious, as they may indicate incipient SJS, TEN, DRESS syndrome, or aseptic meningitis. Other side effects include loss of balance or coordination, double vision, crossed eyes, pupil constriction, blurred vision, dizziness and lack of coordination, drowsiness, insomnia, anxiety, vivid dreams or nightmares, dry mouth, mouth ulcers, memory problems, mood changes, itchiness, runny nose, cough, nausea, indigestion, abdominal pain, weight loss, missed or painful menstrual periods, and vaginitis. The side-effects profile varies for different patient populations. Overall adverse effects in treatment are similar between men, women, geriatric, pediatric and racial groups.<unk>  has been associated with a decrease in white blood cell count (leukopenia).<unk>  does not prolong QT/QTc in TQT studies in healthy subjects. A systematic review of the literature revealed that abnormal movements secondary to<unk>  are uncommon. The movement disorders associated with<unk>  were tics, akathisias, dyskinesias, myoclonus, parkinsonism, dystonia, cerebellar syndromes, and stuttering. In people taking antipsychotics, cases of<unk> -precipitated neuroleptic malignant syndrome have been reported. In 2018, the FDA required a new warning for the risk of hemophagocytic lymphohistiocytosis. This reaction can occur between days to weeks after starting the treatment. Women Women are more likely than men to have side effects. This is the opposite of most other anticonvulsants. Some evidence shows interactions between<unk>  and female hormones, which can be of particular concern for women on estrogen-containing hormonal contraceptives. Ethinylestradiol, an ingredient of such contraceptives, has been shown to decrease serum levels of<unk> . Women starting an estrogen-containing oral contraceptive may need to increase the dosage of<unk>  to maintain its level of efficacy. Likewise, women may experience an increase in<unk>  side effects upon discontinuation of birth control pills. This may include the "pill-free" week where<unk>  serum levels have been shown to increase twofold. Pregnancy and breastfeeding Many studies have found no association between<unk>  exposure in utero and birth defects, while those that have found an association have found only slight associations with minor malformations such as cleft palates. Review studies have found that overall rates of congenital malformations in infants exposed to<unk>  in utero are relatively low (1-4%), which is similar to the rate of malformations in the general population. It is known that<unk>  is a weak inhibitor of human dihydrofolate reductase (DHFR) and other, more powerful, human DHFR inhibitors such as methotrexate are known to be teratogenic.<unk>  is expressed in breast milk; the manufacturer does not recommend breastfeeding during treatment. However, recent studies suggest that<unk>  is safe to use while breastfeeding. A frequently updated review of scientific literature rates<unk>  as L3: moderately safe. Other types of effects<unk>  binds to melanin-containing tissues such as the iris of the eye or melanin-rich skin. The long-term consequences of this are unknown. GlaxoSmithKline investigated<unk>  for the treatment of ADHD with inconclusive results. No detrimental effects on cognitive function were observed; however, the only statistical improvement in core ADHD symptoms was an improvement on a Paced Auditory Serial Addition Test that measures auditory processing speed and calculation ability. Another study reported that<unk>  might be a safe and effective treatment option for adult ADHD comorbid with bipolar and recurrent depression.<unk>  is known to affect sleep. Studies with small numbers of patients (10-15) reported that<unk>  increases the duration of REM sleep, decreases the number of phase shifts, and decreases the duration of slow-wave sleep, and that there was no effect on vigilance, daytime somnolence and cognitive function. However, a retrospective study of 109 patients' medical records found that 6.7% of patients experienced an "alerting effect" resulting in intolerable insomnia, for which the treatment had to be discontinued.<unk>  can induce a type of seizure known as a myoclonic jerk, which tends to happen soon after the use of the medication. When used in the treatment of myoclonic epilepsies such as juvenile myoclonic epilepsy, lower doses (and lower plasma levels) are usually needed, as even moderate doses of this drug can induce seizures, including tonic-clonic seizures, which can develop into status epilepticus, which is a medical emergency. It can also cause myoclonic status epilepticus. In overdose,<unk>  can cause uncontrolled seizures in most people. Reported results in overdoses involving up to 15 g include increased seizures, coma, and death.
Lamotrigine
Mesuximide
Propazepine
Topiramate
Ethosuximide
Tiagabine
Carbamazepine
Levetiracetam