Prescribing Safety Assessment (PSA) Practice Exam

For women, which drug is the first-line choice for generalised tonic-clonic seizures?

1. Ethosuximide

2. Valproate

3. Lamotrigine

4. Phenytoin

The correct answer is: Lamotrigine

The first-line choice for generalized tonic-clonic seizures in women is lamotrigine. This is due to several important factors. Lamotrigine is effective in controlling seizures while also having a favorable safety profile in terms of its effects on reproductive health. Unlike some other antiepileptic medications, lamotrigine is less likely to interact adversely with hormonal contraceptives and has a lower risk of teratogenic effects, which is particularly significant for women who might become pregnant. Additionally, lamotrigine is well-tolerated, has a lower incidence of sedation compared to some other antiepileptic drugs, and can also be utilized in women with pre-existing mood disorders. This multifaceted benefit makes it a preferred option in this demographic, taking into account both efficacy in seizure control and safety in the context of reproductive health. While ethosuximide is effective primarily for absence seizures and not used for generalized tonic-clonic seizures, valproate, although effective, carries higher risks related to teratogenicity and effects on the menstrual cycle, and phenytoin can also have significant side effects and interactions, which makes lamotrigine the more suitable first-line treatment for women.