Q: I was a patient of focal seizures and had taken Epsolin for four years and then stopped on the advise of my Neurologist. Now, I am pregnant and am taking the same medicine in the 3rd trimester as a protective measure. My drug level is within normal range even though because of gaining weight my Doctor suggested at least 3 tablets of Epsolin in a day. I don't want to take this high dose because of fear that it will affect the fetus, even in my first pregnancy fetal movement were sluggish and I had delivered a pre-mature baby. Please suggest what can I do when I have a normal drug level?

A:The possibility of seizures during pregnancy can never be ruled out; hence medication is essential. Sometimes, the blood levels of Epsolin can fall during pregnancy, particularly during last few months. I think Epsolin 100 mg tablet three times a day is appropriate subject to frequent blood level monitoring. With regard to fetal defects, the most common is neural tube defect which to a very large extent is preventable with folic acid 5 mg daily. I am sure your doctor has suggested the same. Folic acid supplementation is given even to women who do not have any problem. You should also undertake an ultrasound and alpha-fetoprotein measurement if not already done. To counteract the risk of neonatal bleeding sometimes associated with the use of phenytoin, vitamin K1 is recommended for the mother before delivery. Breast-feeding is acceptable with Epsolin.