Epilepsy

  my son has epilepsy and is currently taking dilantin and depakene, he just got a cold and cough and I would like to know what kind of over the counter medicine he could take for the cold and cough, he also is congested. the nurse for his nuerologist said he shouldn't take anything bacause of his medicine he's on but what do i do just let him suffer with it also what would you take for a fever(tylenol or motrin) he doesn't have a fever now wha tif. thanks tom
Dear Tom:
This is a question that seems to be asked alot.  First of all I am assuming that your son is in good balance with phenytoin and VPA.  Unless the cold is really causing him problems with breathing at night and the like, it is safest to just do symptomatic care such as cool mist in his room at night and hard candy for his cough.  The cold remedies that contain antihistamines may interact with the metabolizing system that affects dilantin breakdown.  This is theoretical and the concentrations of antihistamines would likely not affect dilantin levels.  However, you should know that most studies do not show any benefit for cold symptom relief.  So, I would just stay away from them.  You might talk to your pediatrician about nasal sprays such as rhinocort or the newer nasal chromolyn sprays for the rhinorrhea (running nose).  As far as fever goes, large doses of tylenol and aspirin-like compounds will decrease the levels of dilantin.  But, fever can lower the seizure threshold.  The usual doses and short span of usage would favor the use of either for fever.  I tell my patients to go ahead and use tylenol or ibuprofen for fever.  I hope that I helped.  Best of luck.
Sincerely,
CCF Neuro:Pediatrics, MD, RPS