Bromide for epilepsy

Bromide is a type of medication used to treat severe epilepsy, particularly causing myoclonic seizures. Bromide comes in two formulations: triple bromide (contains three different variations of bromide:  ammonium bromide, potassium bromide and sodium bromide) and potassium bromide. The precise way it works to help epilepsy is unclear but it has been used safely for over 150 years. This page from Great Ormond Street Hospital (GOSH) explains about bromide, how it is given and some of its possible side effects.

Bromide is taken by mouth, usually once a day. It is available in two formats: an elixir (liquid) and tablets.

The elixir is available as a triple bromide 1200mg/5ml strength – this means that every 5ml contains 1200mg of the active ingredient. Triple bromide elixir is currently unlicensed – this is not necessarily hazardous and the doctor has prescribed it because no licensed alternative is available.

The elixir has an unpleasant taste so the dose should be mixed with a small amount of undiluted no-added-sugar squash. Most children find blackcurrant squash works best for masking the taste but you can try other flavours if your child prefers them. Undiluted squash will mask a lot of the taste but some children will still be unable to cope with it. If this occurs, the doctor may suggest trying the bromide tablets instead.

To give the elixir:

1. Pour a small volume of undiluted squash into a glass
2. Add the dose of triple bromide solution to the squash using the oral syringe provided
3. Swirl the squash and elixir to mix
4. Draw the entire amount back up into the oral syringe and give to your child.
5. Give the dose into the side of their mouth and give them time to swallow
6. Offer another drink afterwards to take away any remaining taste and ask them to brush their teeth.
7. Wash the glass and oral syringe in warm soapy water ready for the next day’s dose

Bromide is also available as potassium bromide 850mg tablets. These are not available in the UK so have to be imported from abroad. Currently, GOSH is importing the tablets from Germany so the package and insert are only available in German.

The tablets should be taken once a day with food. If your child struggles to take tablets, you can crush them using a tablet crusher then disperse them in a small amount of water. You can then add the solution to undiluted squash as above.

The dosage of bromide is usually started at a low level and gradually increased until your child reaches the best level for controlling their seizures without troublesome side effects.

Your child will need to have regular blood tests to monitor the amount of bromide in their blood – this usually happens around four weeks or so after starting to take the medication, or four weeks after the dose is increased.

People with the following conditions should discuss using bromide with their doctor.

• Hypersensitivity to bromide or any of its ingredients

The elixir also contains benzoic acid, sucrose, ethanol, vanilla and orange flavour, propylene glycol, amaranth
The tablets also contain crospovidone, cellulose microcrystalline, povidone k 25, stearic palmitic acid, highly dispersed silica.

• Existing kidney conditions
• Pregnant, could be pregnant, trying to become pregnant or breast feeding

Side effects tend to occur more commonly when bromide is taken for a long time or the active ingredient builds up in the body. They can include:

• Drowsiness and lethargy
• Concentration and memory difficulties
• Loss of appetite which may lead to weight loss
• Uncontrolled jerky movements (ataxia)
• Acne or spots developing on the face and chest – these can be treated in the conventional way. Bromide can be continued if the spots are not troublesome but the dosage may be reduced.
• A skin rash that forms blisters that burst to leave a dent in the skin. If this occurs, the doctor will stop bromide and change subsequent treatment.
• Neurological side effects such as agitation, seeing or hearing things that are not there (hallucinations) and changes in memory, mood or thinking speed. 

Each person reacts differently to medicines and so your child will not necessarily suffer from every side effect mentioned and may not experience any side effects.

Some medicines can react with bromide, altering how well it works. Always check with your doctor or pharmacist before giving your child any other medicines, including herbal or complementary medicines.

Salt and salty foods can reduce how well bromide works. Try to limit the amount of salty foods your child eats and do not add salt to cooked foods if possible.

• Keep medicines in a safe place where children cannot see or reach them.
• Keep medicines at room temperature, away from bright light or direct sunlight, and away from heat.
• Always give the medicine as prescribed by your doctor
• If your child misses a dose of the medicine and you remember up to six hours afterwards, give the forgotten dose immediately. If you remember at or near the time that the next dose is due, just give your child the usual dose.
• If your child vomits within 30 minutes or so of taking a dose and you are able to see the squash or tablet in the vomit, then give the dose again. If you cannot see the blackcurrant squash or tablet, do not give it again.
• If your child has been taking the medicine regularly, do not stop it suddenly without advice. Your doctor may need to reduce the dose gradually.
• If your child stops using a medicine or it passed its expiry date, please return it to your pharmacist. Do not flush it down the toilet or throw it away.
• Always check that you have enough medicine and remember to order a new prescription in plenty of time.