Q: I am epileptic since my childhood. I am on phenytoin sodium 200 mg at supper and some time 100 mg during the day along with phenobarbital 60 mg at supper regularly. But still I suffer 2-3 seizures in a month regularly. I am mentally prepared to live my life with this. How can I live a smoother life? I am taking these medicines regularly. What type of adverse reactions can I face?

A:Epilepsy is a common problem with millions suffering from this disorder in India. There are over half a dozen medicines available to control seizures; hence there is no need to be unduly worried. The failure to control seizures is usually because of one of the three reasons: inadequate dose of medicines; substandard brands and gradual loss of efficacy over years needing a change over. The normal dose of phenytoin is 200-400 mg daily (maximum: 600) to be taken in a single or two divided doses. You are taking the lowest dose of 200 mg; it can be safely increased to say 300 or even 400 mg. The usual dose of phenobarbitone is 60-240 mg daily to be taken in 2 or 3 divided doses. You are taking the lowest dose of 60 mg that too just once a day; it can be safely increased to say 120 mg or even more in at least 2 divided doses. In the unlikely event of seizures still not coming under control, there are many other medicines that can be taken under advice of your doctor. You have not mentioned the brands. I hope they are from good manufacturers who produce quality medicines such as Epsolin (phenytoin sodium) and Gardenal or Luminal (phenobarbitone). Please see the general statement on quality of medicines in India below: General statement on selection of brands: There are scores, sometimes hundreds, of brands of the same medicine. Against about 300 pharmaceutical manufacturers in western countries like Britain, there are over 20,000 producers in India that market more than 40,000 brands. Most manufacturers do not have quality testing laboratories. Hence selection of brands is important. Many companies give incentives to prescribers to patronise their products. Patients should check the reputation of manufacturers before consuming medicines.