Q: Two years back my mother, 55 then, had her first attack of epileptic seizures. Since then she has been on Eptoin 3 tablets a day and multivitamin & calcium tablets. She now has severe post-menopausal osteoporosis - has a hump in her back, her lower vertebrae were crushed in a fracture (no injury to spine) and she is in constant pain. Last month her EEG showed signs of abnormality and the doctors advised her to be on Eptoin for the rest of her life. Is there a way to improve her osteoporosis, considering Eptoin only worsens it? She is using Miacalcin, the nasal spray. But are there alternative seizure medicines she could take that are more acceptable to her bones? Besides, what is your opinion on the CERCs attempt to ban Eptoin in 2001?

A:Eptoin is a brand name that contains a medicine called phenytoin sodium. While there are many other drugs for seizures, it is a well tried and tested medicine. Besides other drugs have also side effects. Phenytoin sodium, on its own does not cause osteoporosis. However it can interfere in vitamin D metabolism which (along with calcium) is needed for bone strength. However one of the source of vitamin D is sunlight, quite plentiful in India. Therefore normally it is not necessary to take vitamin D. Just to be doubly sure one can take a vitamin D preparation such as Alfa D-3 (GlaxoSmithKline) 0.25mcg one capsule daily. It may be necessary to take phenytoin sodium for several years, if not for life. It is also marketed under the trade name of Epsolin by Cadila Healthcare, a reputed company that produces quality products. The cost of Epsolin is nearly half of the other brand.