You may be started on a low dose to reduce side effects, and then gradually increase up to a higher dose. Some of the more common side effects are drowsiness, dizziness, nausea, headaches, confusion and difficulty co-ordinating movement. Some of these problems may be worse when starting the medicine or increasing the dose, but then improve as you get used to taking the medicine. If these side effects are causing you problems please speak to your doctor. In a very small number of people more serious side effects can occur, such as allergies or problems with your liver, blood or skin. It is important that you read the leaflet provided with your medicine which warns about the symptoms to watch out for which might indicate these more serious effects. If you develop a rash, fever, flu like symptoms, swollen glands or feeling ill in any oth-er way within the first few weeks of starting it may be an allergic reaction. You should consult your GP immediately in case the medicine needs to be stopped. Some of these medicines may reduce the effectiveness of contraceptive pills (‘the pill’ or ‘the mini-pill’) and contraceptive injections, implants and vaginal rings. This could make the contraceptive fail, leading to unwanted pregnancy. Please discuss this with your neurologist or specialist nurse if you are unsure whether this applies to you. Women of child bearing age should also be aware that some of these medicines, if taken during pregnancy, can affect the baby, causing various abnormalities. The risk of this happening, and the type of abnormality possible depends on the exact medicine. You should have been informed about this potential problem. If you would like further information please ask your neurologist or specialist nurse straight away. It is important to take your medicine as prescribed, particularly if you are taking it for epilepsy. Try to get into a daily routine. Forgetting an occasional dose is not a problem for some people who have epilepsy; however, for others this could lead to breakthrough seizures. One of the reasons why seizures can recur is if the medicine to stop them is not taken regularly as prescribed. Note: You should not stop taking a medicine suddenly except on medical advice. If you notice a side-effect, you should ask a doctor for advice before stopping the medicine. Diazepam / Midazolam Some people with epilepsy are prescribed a medicine that a relative or friend can administer in emergencies to stop a prolonged seizure. In most people with epilepsy, seizures do not last more than a few minutes. However, in some cases a seizure lasts longer and a medicine can be used to stop it. A doctor or nurse should give instruction on how and when to administer the medicine. One commonly used medicine for this is diazepam. This can be squirted from a tube into the person’s back passage ('rectal diazepam'). The medicine is absorbed quickly into the bloodstream and so works quickly. More recently a medicine called midazo-lam is often used which is easier to administer. It is squirted into the sides of the mouth (‘buccal midazolam’) where it is absorbed directly into the bloodstream. At present, strictly speaking, midazolam is only licensed in children but it is recommended in national epilepsy guidelines and is commonly prescribed for adults. Pyridostigmine (Mestinon®) Pyridostigmine is used in the treatment of myasthenia gravis (a disease causing muscle weakness) to improve the strength of the muscles. It often needs to be taken frequently throughout the day to manage symptoms. Possible side effects include nausea (feeling sick) and vomiting, increased saliva production, diarrhoea and abdominal cramps. Propantheline Propantheline works in the gut to help to reduce any nausea, vomiting, increased saliva production, diarrhoea and abdominal cramps due to pyridostigmine treatment. It should be taken at least one hour before food or on an empty stomach. Prednisolone Steroids such as prednisolone suppress the immune system. Prednisolone can be used in a variety of different diseases where the body’s own immune system is harming itself. It is different to the 'anabolic' steroids which some athletes and bodybuilders use, which have very different effects. For many diseases, the benefit of taking steroids usually outweighs the side-effects. However, side effects can sometimes be troublesome. You should read the information leaflet that comes with your medicine packet for a full list of possible side-effects. Prednisolone may cause mood or behavior changes especially at the beginning of your treatment or if you are taking a high dose. If you become confused, irritable or start having worrying thoughts about harming yourself, speak with your doctor as soon as possible. Steroids can also increase appetite, and may cause weight gain. If you have diabetes, be aware that steroids may increase your blood sugar levels. Your diabetes treatment may need adjusting when prednisolone is started, stopped or the dose is changed, so discuss this with your doctor or nurse. You should usually take the full day’s dose of prednisolone in one go, in the morning after breakfast, unless you have been told to take it in a different way. If you have been taking prednisolone for more than 3 weeks, you must not stop taking it suddenly. If you need to stop treatment, speak with your doctor who will advise you on how to reduce your dose gradually. If you become ill or come into contact with anyone who has measles, shingles or chicken pox (or suspects they might have them) you must see your doctor as soon as possible. If you have been given a steroid treatment card, carry it with you at all times. Prednisolone tablets are often used in the treatment of myasthenia gravis. A low dose, often on alternate days, is usually enough for people where symptoms only affect muscles around the eye. Higher doses may be needed to prevent symptoms if muscles elsewhere in the body are affected. Patients on steroids for more than a few weeks often need additional medicines to protect them from osteoporosis (bone thinning), which can occur with steroid treatment. Azathioprine An immunosuppressant medicine such as azathioprine may be advised in addition to a steroid medicine. These medicines work by suppressing the immune system. You will need regular blood tests and your doctor here will advise you and your GP about this. There are certain side effects you should watch out for. If you experience any of these speak with your doctor immediately or go to your local accident and emergency department without delay. These side effects include unexplained bruising or bleeding, a high temperature or other sign of an infection, signs of an allergic reaction such as extreme tiredness, dizziness, being sick, diarrhoea, fever, muscle pain or stiffness, skin rash or kidney problems such as a change in the amount or colour of your urine. Methotrexate Methotrexate is an anti-cancer medicine which is also used in other conditions to suppress your immune system. When being used for these other conditions, methotrexate must only be taken once weekly, on the same day each week. Never take it more often than this. You should have been given an information leaflet about methotrexate. If you have not, please tell your nurse, doctor or pharmacist. You should also read the manufacturer’s information leaflet in the packet. You will need regular blood tests and your doctor here will advise you and your GP about this. You should also be given another tablet called folic acid to take regularly while you are on methotrexate. This can help prevent some side effects of methotrexate. If you have not been given folic acid, please ask your doctor about this.CyclophosphamideCyclophosphamide is an anti-cancer medicine that is also used in other conditions to suppress your immune system. If you have been started on cyclophosphamide you should have been given an information leaflet. If you have not, please tell your nurse, doctor or pharmacist. You will need regular blood tests and your doctor here will advise you and your GP about this. You should also read the manufacturer’s information leaflet in the packet. Calcium and colecalciferol (Adcal D3®) There are various brands of calcium and colecalciferol tablets, and we usually use Ad-cal D3®. Colecalciferol is a form of vitamin D. Calcium and vitamin D are important for bone health. Your body needs adequate supplies of vitamin D in order to absorb (take up) the calcium that you eat or drink in your diet. If you are taking steroid tablets you may be given Adcal D3® to help prevent osteoporosis (thinning of the bones). The usual dose is one tablet twice daily. The chewable tablets should be sucked or chewed, not swallowed whole. Dispersible tablets are also available and these should be dispersed in water before taking. Alendronic Acid (Alendronate) Alendronic acid is used to prevent or treat osteoporosis (thinning of the bones). It can help to restore some lost bone, and help to prevent further bone loss. If you are taking steroid tablets you may be given alendronic acid to help prevent osteoporosis as a side effect of the steroid. Read the information sheet that comes with the tablets, and carefully follow the instructions on how to take them. The majority of patients will be started on alendronic acid 70mg tablets. These are taken as a once weekly dose (one tablet each week) that should be taken on the same day every week. You need to take alendronic acid tablets whilst you are sitting up and with plenty of water, as they can cause irritation of your oesophagus (gullet). This can lead to indigestion-type symptoms such as heartburn or difficulty swallowing. After you have taken the tablet, remain sitting up or standing (do not lie down) for at least half an hour. Other side-effects may include diarrhoea or constipation. You should NOT take alendronic acid at the same time as food or milk. It is best to take the tablet first thing in the morning (once weekly only) on an empty stomach, and wait at least half an hour before eating, drinking milk or taking calcium tablets. A rare side-effect from alendronic acid is a condition called osteonecrosis of the jaw. This condition can result in severe damage to the jaw bone. So, if you take alendronic acid, if you experience pain, swelling or numbness of the jaw, a heavy jaw feeling or loosening of a tooth, you should tell your doctor.