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● For efficient contraception, women treated with the Phase I-inducing anticonvulsants phenytoin, phenobarbital, and carbamazepine need up to double the usual dose of hormonal contraceptives. Weaker inducers of contraceptive metabolism are felbamate, topiramate, and oxcarbazepine.
● Conversely, Lamotrigin may need to be increased due to Phase II-induction by ethinyl estradiol. ≣
● Despite the absence of supporting epidemiological evidence, folic acid (5 mg/d) may be offered to women considering pregnancy, especially to those treated with valproic acid.
● If valproic acid is indispensable in a pregnancy-planning patient, its dosage should remain below 1000 mg/d as both associated side-effects, i.e. developmental defects and IQ reduction are dose-dependent.
Monitor carefully but do not switch anti-convulsives during pregnancy. ≣