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This medication has been associated with rare but potentially fatal liver complications, particularly within the first six months of usage. It is crucial to conduct blood tests before initiating treatment and regularly thereafter, especially during the initial six months, to detect any liver issues.

• Children under two years are at a higher risk for severe liver problems, especially if they have inherited metabolic disorders, severe seizure disorders with mental retardation, or organic brain disease, or if they are on multiple seizure medications. It is important to discuss the potential risks and benefits of this medication with a healthcare provider before use in this age group.
• Individuals with specific inherited metabolic disorders, such as Alpers-Huttenlocher syndrome, should not take this medication due to the increased risk of liver complications. Children under two years suspected of having these disorders should avoid this medication, while those over two years should be monitored closely during treatment.
• There is a rare risk of severe and sometimes fatal pancreatitis associated with this medication, which can occur at any point during treatment and may progress rapidly.

Seek immediate medical attention if you experience symptoms indicative of liver issues or pancreatitis, such as persistent nausea or vomiting, unusual fatigue, weakness, facial swelling, abdominal pain, loss of appetite, dark urine, or yellowing of the skin or eyes.

During pregnancy, this medication can lead to birth defects, reduce a child's IQ, and increase the risk of brain or mental disorders such as autism and ADHD. Both men and women using this medication should thoroughly discuss potential risks, alternative treatments, and reliable contraception options with their healthcare provider. If you are planning a pregnancy, suspect pregnancy, or become pregnant while on this medication, contact your doctor immediately. This medication should not be used to prevent migraine headaches during pregnancy. If you are using it to manage seizures or mental health conditions like bipolar disorder, do not discontinue use without a doctor's guidance, as these untreated conditions can pose serious risks to both the pregnant individual and the developing fetus.

You may experience some common side effects such as diarrhea, dizziness, drowsiness, hair loss, blurred or double vision, changes in menstrual periods, ringing in the ears, shakiness, unsteadiness, and weight fluctuations. These effects are usually mild and may improve over time. If any of these persist or worsen, it's important to consult a healthcare professional. You might also notice coated particles in your stool; these are harmless and nothing to worry about.

While the medication is generally well-tolerated, there are some rare but serious side effects to be aware of. A small number of individuals taking anticonvulsants could experience mental health changes, including depression or suicidal thoughts. Immediate medical attention is necessary if you or someone close to you notices sudden mood changes or thoughts of self-harm.

Additionally, in rare cases, a severe brain disorder called encephalopathy may occur, especially in those with certain metabolic conditions. Symptoms like unexplained weakness, vomiting, or sudden mental changes require urgent medical attention. Furthermore, very serious side effects such as chest pain, unusual bruising or bleeding, irregular heartbeat, swelling of extremities, uncontrolled eye movements, feeling cold, rapid breathing, or loss of consciousness warrant immediate medical help.

Allergic reactions to this drug are rare but can be severe. Seek urgent medical assistance if you experience symptoms such as fever, swollen lymph nodes, rash, severe dizziness, or difficulty breathing. This summary covers the key side effects, but if you notice other unusual symptoms, it's important to reach out to a healthcare provider for advice.