Which seizure meds cause hair loss? A guide to pharmacologic alopecia

October 8, 2025 •

4 min read

According to a 2012 study, hair loss is one of the leading reasons why patients choose to discontinue their antiseizure medications (ASMs). While highly effective for controlling seizures, some of these drugs can cause alopecia, a potentially distressing cosmetic side effect. Understanding which seizure meds cause hair loss and the potential underlying mechanisms is crucial for managing this side effect and ensuring treatment adherence.

Quick Summary

This article explores the link between antiseizure medications and hair loss, detailing specific drugs that can cause alopecia. It covers proposed mechanisms, such as nutrient deficiencies and hormonal changes, and outlines practical strategies for management. Key drugs discussed include valproate, lamotrigine, and levetiracetam.

Key Points

Valproate (Valproic Acid) is a major culprit: It is most frequently associated with hair loss among ASMs, with incidence rates varying significantly depending on dosage.
Hair loss is typically reversible: In most cases of drug-induced hair loss, hair regrowth occurs after the medication is discontinued or the dosage is lowered under a doctor's supervision.
Zinc and biotin deficiencies are implicated: For valproate and potentially levetiracetam, hair loss may be linked to depleted levels of zinc and biotin, essential for hair growth.
Telogen effluvium is the common cause: The hair loss is typically a diffuse, non-scarring type where hair follicles prematurely enter a resting phase.
Consult your doctor before any change: Never stop or change your seizure medication dosage on your own, as this can have serious health consequences. Work with your healthcare provider to explore safe alternatives.
Other medications pose a risk: While less common, drugs like lamotrigine, levetiracetam, carbamazepine, topiramate, and gabapentin can also cause alopecia.

Antiseizure Medications (ASMs) Commonly Linked to Hair Loss

Not all antiseizure medications carry the same risk of causing hair loss. A significant body of research highlights certain drugs more frequently associated with this side effect than others. Hair loss from ASMs typically presents as diffuse, non-scarring alopecia, also known as telogen effluvium, where hair follicles prematurely enter the resting phase. For many patients, the hair loss is reversible upon discontinuation or dosage adjustment of the medication.

Valproate (Valproic Acid)

Valproate is frequently cited as one of the most prominent ASMs associated with hair loss. Incidence rates vary significantly across studies, ranging from 0.5% to as high as 28%. Hair loss with valproate is often dose-dependent, with higher blood levels linked to a greater risk. It typically occurs within the first few months of starting the medication.

Lamotrigine

Though less frequently implicated than valproate, lamotrigine is also associated with hair loss. The estimated incidence is lower, around 0.8%, but for some, it can be a significant side effect impacting treatment adherence.

Levetiracetam (Keppra)

Hair loss is a rare side effect of levetiracetam, with a prevalence reported at around 0.4% in some studies. Case reports show that hair loss with this drug is also reversible upon dose reduction or discontinuation.

Carbamazepine

Carbamazepine is another ASM linked to alopecia, with reported incidences ranging from 0.3% to 6%. Hair loss may occur a few months into treatment and can be reversed by adjusting the dose.

Other medications

Less common ASMs that have been anecdotally or rarely linked to hair loss include topiramate, gabapentin, phenytoin, and pregabalin. In the case of phenytoin, other cosmetic side effects like hirsutism (excessive hair growth) or gingival hyperplasia (gum overgrowth) are more commonly reported.

Possible Mechanisms of ASM-Induced Hair Loss

The exact mechanisms by which ASMs cause hair loss are not fully understood, but several hypotheses have been proposed:

Telogen Effluvium: This is the most common suspected mechanism. The drug can cause a premature shift of a large number of hair follicles from the active growth phase (anagen) to the resting phase (telogen), leading to excessive shedding.
Nutrient Deficiencies: Some ASMs, particularly valproate, are thought to interfere with the body's absorption or metabolism of key nutrients for hair growth. Valproate can chelate essential minerals like zinc and selenium and has been linked to decreased serum biotinidase activity, suggesting deficiencies in biotin.
Hormonal Changes: Valproate's effect on androgen levels is another proposed mechanism, especially in women, where increased androgen activity can lead to a type of hair loss known as androgenic alopecia.
Genetic Predisposition: Individual susceptibility may play a role. Some people may be more genetically predisposed to experiencing hair loss as a side effect from certain medications.

Managing Hair Loss from Seizure Medications

If you experience hair loss while on an ASM, consulting your healthcare provider is the crucial first step. Never stop a seizure medication abruptly without medical guidance, as this could trigger life-threatening seizures. A doctor may recommend one or more of the following management strategies:

Medication Review: Your doctor may evaluate if a lower dose is possible, or if switching to an alternative ASM with a lower risk of alopecia is appropriate. Newer generation ASMs often have more favorable side effect profiles.
Nutritional Support: For valproate-induced hair loss linked to deficiencies, supplementation with zinc and biotin may be recommended. The efficacy of supplementation can be variable and should be discussed with your doctor.
Topical Treatments: Products like minoxidil, available over-the-counter, can help stimulate hair growth and may be used in combination with other strategies.
Scalp Health: Gentle hair care techniques, such as using soft brushes and mild shampoos, and avoiding heat-styling tools or harsh dyes, can help protect and strengthen existing hair.

Comparison of ASMs and Associated Hair Loss


Seizure Medication	Associated Hair Loss Risk	Proposed Mechanism(s)	Management Options
Valproate (VPA)	High risk (incidences 0.5-28%)	Telogen effluvium, zinc/biotin deficiency, hyperandrogenism	Dose adjustment, switching meds, zinc/biotin supplementation
Lamotrigine (LTG)	Moderate to low risk (approx. 0.8%)	Telogen effluvium	Dose adjustment, switching medications
Carbamazepine (CBZ)	Moderate to low risk (incidences 0.3-6%)	Telogen effluvium	Dose adjustment, switching medications
Levetiracetam (LEV)	Low risk (approx. 0.4%)	Telogen effluvium, potential zinc depletion	Dose adjustment, zinc supplementation, switching medications
Topiramate (TPM)	Low risk (approx. 1-1.7%)	Reversible upon discontinuation	Dose adjustment, switching medications
Phenytoin (PHT)	Low risk (approx. 0.3%)	Potential autoimmune response (rarely), hirsutism is more common	Switching medications, managing other cosmetic effects

Conclusion: Navigating Hair Loss as a Side Effect

Hair loss resulting from antiseizure medication can be a difficult experience, but it is a manageable one. Awareness of which seizure meds cause hair loss, and the fact that most cases are reversible, is an empowering first step. Close collaboration with your healthcare team is essential to determine the best course of action. This might involve adjusting your current regimen, exploring alternative medications, or using supplements like zinc and biotin to address potential deficiencies. With a proactive approach, it is possible to find a balance that effectively controls seizures while minimizing the impact of cosmetic side effects. Resources like the Epilepsy Foundation can provide additional support and guidance for patients facing these challenges.

Disclaimer: This information is for educational purposes only and does not constitute medical advice. Consult with a qualified healthcare professional regarding any medical concerns or before making any changes to your medication plan.

Frequently Asked Questions

Valproate (valproic acid) is consistently reported as one of the most common antiseizure medications to cause hair loss, with varying incidence rates, sometimes associated with higher dosages.

No, hair loss caused by antiseizure medication is generally not permanent. It is often a form of telogen effluvium that is reversible, and hair regrowth typically occurs after the medication is stopped or adjusted.

Management is best discussed with your doctor. Options may include adjusting your medication dosage, switching to a different drug, or using nutritional supplements like zinc and biotin, especially if a deficiency is suspected.

Hair loss is a rare, but documented, side effect of levetiracetam. It typically appears within a few months of starting the treatment and is usually reversible if the dose is reduced or stopped.

The mechanism is not fully clear, but hypotheses include telogen effluvium, hormonal imbalances (hyperandrogenism), and deficiencies in key minerals and vitamins like zinc, selenium, and biotin due to chelation.

For hair loss associated with valproate, some studies suggest that supplementing with zinc and biotin might help. However, effectiveness varies, and it's essential to discuss the approach with your doctor to determine if it is appropriate for you.

The most important step is to talk to your neurologist. They can assess your overall health, confirm if the medication is the cause, and work with you to develop a management plan that safely controls your seizures while addressing the hair loss.