Primidone Piracetam

Myoclonic seizures are best treated with valproate but, as a second choice, with clobazam, clonazepam, ethosuximide, lamotrigine, phenobarbitone, piracetam or primidone. 

Treatments of first choice for cortical myoclonus are valproic acid (sodium valproate) and clonazepam. Primidone and phenobarbital may also be useful. Piracetam has advantages in these circumstances, as its addition to existing treatments is rarely accompanied by sedation. 

Piracetam does not appear to alter the levels of sodium valproate or primidone. No interaction has been found between piracetam and carbamazepine, clonazepam, phenobarbital, or phenytoin. 

The addition of piracetam (2 to 4 g three times daily, increased to a maximum of 18 to 24 g daily) did not affect plasma levels of sodium valproate or primidone in patients with myoclonus. The exact number of patients taking these drugs is unelear, sinee the report just states that 28 patients were taking clonazepam, sodium valproate, or primidone, alone or in combination. Another similar report, briefly noted the same finding. The manufacturer notes that, although based on a small number of patients, no interaction has been found between piracetam and clonazepam, carbamazepine, phenytoin, phenobarbital and sodium valproate. No special precautions appear to be required if piracetam is used with these antiepileptics. 

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