Depakote vs Dilantin vs phenytoin

[M19SOORKB]

I had a seizure perhaps 12 years ago.  Nothing spectacular, just heavy sweats, nausea, vision distortion.  I was standing when the episode occurred and remained standing throughout.  Afterwards I wrote a letter to my internist and opthamalogist about this occurrence, and my M.D. had me given an exam at the hospital.  Don't recall if it was an MRI, or an EEG.  Anyway, it was determined that I was having seizures and was sent to a neurologist, who put me on Depakote to control the seizures.  I have taken a 500 mg tablet of Depakote twice a day to keep the amount of the needed medication in my blood at a "therapeutic" level (whatever that means).

In early January, I will be age 65 and enter Medicare.  Due to the very high cost of Depakote, the various drug calculators for Medicare Part D programs indicate that I will enter the "doughnut hole" in October, 2008, at which time I will be responsible for the TOTAL COST of my Depakote medication.

There is no generic substitute approved by the FDA for Depakote according to my pharmacist.  She says there are alternative anti-seizure meds, most prominently Dilantin and its generic equivalent, phenytoin.  My question is twofold: 1) can Dilantin be substituted for Depakote in my situation? and 2) if "yes", can the generic phenytoin be used instead of Dilantin and keep my seizures under control?

I might add that I ONLY HAD THE ONE SEIZURE back approximately 12 years ago.  Thanks in advance for any/all replies.

[Abhijeet Deshmukh, MD]

Hello.

Have you got any EEG after that ? You may not be needing any medicines after all ! One single episode of seizure is treated for two years, and then the treatment can be stopped depending upon the response. You need to ask your Neurologist's opinion.
It could have been a syncope!

Hope this helps.