Supplements and antiepileptic drugs.
Older antiepileptic drugs (phenytoin, carbamazepine, valproate) are strong inducers or inhibitors of CYP enzymes. Newer ones (lamotrigine, levetiracetam) less so. Supplements that share those CYP substrates can shift blood levels in either direction, with seizure-control implications.
The headline exclusion is St John’s Wort: CYP3A4 induction reduces blood levels of most antiepileptics and can break seizure control. Folate is the other side of the same coin: long-term valproate depletes folate, which is associated with elevated homocysteine and (in pregnancy) neural tube defect risk; supplementation is standard. Vitamin D and calcium are flagged on long-term antiepileptic use for bone health (enzyme-inducing AEDs increase vitamin D clearance).
Something missing?
If a supplement or medication you take isn't in our autocomplete, tell us and we'll add it in the next quarterly update.