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Mysoline / Primidone

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1 Mysoline / Primidone on Wed Sep 30, 2009 12:09 pm

TJW

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Mysoline (MY-soh-leen) is the brand name used in the United States, Canada, and many other countries for the seizure medicine with the generic name primidone (PRIM-ih-dohn).

Mysoline was introduced for epilepsy in the 1950s. It remains a well-known medication but it is used by only a small percentage of people with epilepsy. Although it is very effective, side effects limit its value.

Mysoline is used alone or with other seizure medicines to control tonic-clonic and complex partial seizures. It's often effective for tonic-clonic seizures that are resistant to other seizure medicines.

It is also used to treat myoclonic seizures and all seizure types in people with juvenile myoclonic epilepsy.

Mysoline (primidone) is not used very often but it can be effective. Mysoline is broken down in the body into PEMA and phenobarbital, both of which are effective antiseizure compounds. Therefore, taking Mysoline gives you the effectiveness of phenobarbital plus additional protection. A patient whose seizures have not been controlled by phenobarbital may have better results from Mysoline.

The most important study of Mysoline (primidone) looked at 622 adults who had partial seizures or secondarily generalized tonic-clonic seizures. Each person was treated with one of four medications. The four were primidone, phenobarbital, carbamazepine (Tegretol or Carbatrol), and phenytoin (Dilantin, Phenytek). Overall, the patients who took primidone were more likely to stop taking it because of intolerable side effects than those who took the other medicines. After the first month, however, there was hardly any difference in this regard between the primidone and the carbamazepine or phenytoin.

The patients in this study who had tonic-clonic seizures achieved similar control from all four medications. Of those in this group who took primidone for a year, 63% were seizure-free. Patients were more likely to continue to take carbamazepine (Tegretol, Carbatrol) than the other medications when considering both seizure control and side effects, but Mysoline can be very effective for partial seizures.

A similar study in children—which also included Depakote (valproate)—focused on the rate of side effects. Only 8% of the children who were given Mysoline had to stop taking it because of side effects. Phenobarbital, which can be an excellent medication, often is avoided in children because of the possibility of mental slowing. By using Mysoline alone, children can enjoy many of the same benefits while avoiding this problem because the amount of phenobarbital produced by breaking down the Mysoline is low.

Mysoline is most often used as adjunctive (add-on) therapy in adults whose seizures are not well controlled by other medications. It is frequently paired with carbamazepine (Tegretol or Carbatrol) or phenytoin (Dilantin, Phenytek), but no single combination of antiepileptic medications is perfect for everyone. Sometimes, a series of combinations must be tried before finding what is best for the individual patient.

Many people who take Mysoline (primidone) don't report any side effects. Those who do most often complain of:


unsteadiness
the feeling that the surroundings are spinning (vertigo)
irregular eye movements
nausea
vomiting
blurred or double vision
drowsiness
depression

The problems are mild to moderate and usually disappear with time or when the dose is reduced.

Some other side effects mentioned even less often are:


loss of appetite
irritability
acne or other skin lesions
sexual impotency
decreased sexual desire
blood abnormalities
frozen shoulder

If these problems do not go away within several days, or are really bothersome, call the doctor. Sometimes the doctor can help with these side effects by changing the prescription:


reducing the overall amount of Mysoline
changing the amount taken at certain times, such as taking a greater proportion of the Mysoline at bedtime to reduce daytime sleepiness
prescribing smaller doses, to be taken more often

No one should stop taking Mysoline or change the amount they take or when they take it without their doctor's guidance.

People who have just started taking Mysoline (or who have just started taking a larger amount) should be careful during activities that might be dangerous, until they know whether they are having any side effects.

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