Ketogenic dietary therapy (KDT) guidance on low carbohydrate medications

This leaflet is intended for families and carers of children and young people who have been diagnosed with drug-resistant epilepsy, have attended a ketogenic assessment clinic and are following, or are considering, ketogenic dietary therapy (KDT).

KDT is a very low carbohydrate medical therapy for children and young people with drug-resistant epilepsy. Most of our carbohydrate intake comes from starchy, sweet and milky foods and drinks. However, medications (both prescribed and over-the- counter) can also contain a significant amount of carbohydrate; we should try to avoid this where possible when following KDT.

When a child or young person is starting KDT, their care team will check that current medications are prescribed in an appropriate low-carbohydrate form. Likewise, the care team should also check any new medications introduced while on the diet.

Medicinal formulations

Preferred option:

• Tablets
• Granules
• Capsules

Sometimes suitable:

• Powdered drugs
• Sugar-free oral solutions / suspensions

Unsuitable:

• Sugary syrups

Tablets, granules and capsules

The best medication forms are tablets, granules and capsules as these are the lowest in carbohydrate content.

Sugar-free liquids and powdered medications

Many powdered drugs and sugar-free liquids are suitable for children on KDT, but the list of extra ingredients, sometimes referred to as ‘excipients’, should always be checked carefully to be sure.

Sugary syrups and suspensions

Sugary syrups and sugar-containing suspensions should be avoided on KDT, where possible. Speak with your pharmacist or doctor about suitable alternatives. Very occasionally, there is no alternative. In this situation, we recommend getting expert advice from your care team.

Checking medication labels for carbohydrate contents

The ingredients of medications can be found in the patient information leaflet issued with the medicine. We recommend that you retain that information for future reference.

Suitability of ingredients

Suitable

• ✔ Erythritol
• ✔ Inulin
• ✔ Stevia
• ✔ Acesulfame K
• ✔ Aspartame
• ✔ Saccharine
• ✔ Sucralose
• ✔ Glycerol
• ✔ Sorbitol
• ✔ Isomalt
• ✔ Mannitol

Unsuitable (avoid)

• ❌ Syrup
• ❌ Sugar (sucrose)
• ❌ Glucose
• ❌ Maltose
• ❌ Dextrose
• ❌ Maltodextrin
• ❌ Molasses
• ❌ Honey
• ❌ Lactose
• ❌ Maltitol
• ❌ Frucose
• ❌ Galactose
• ❌ Xylitol
• ❌ Maize starch

Example 1: This is the ingredients list on a bottle of Tegretol liquid.

Example 2: This is the ingredients list on a bottle of Epilim syrup:

Examples of suitable medications

Remember: the dosage always needs to be checked for your child.

Pain relief

Hay fever

Oral rehydration

Some of the sweeteners in this product are not suitable. In this instance, you should speak with your pharmacist or doctor about suitable alternatives. Examples of low carbohydrate over-the-counter medications (however: remember the dosage always needs to be checked for your child).

Summary

Always check the ingredients list when buying/ taking new medications (both prescribed medications and medications available over the counter) whilst following a ketogenic diet. When a new medication is prescribed, confirm that the prescriber is aware that the medication needs to be suitable for the ketogenic diet.

If you or the prescribing healthcare professional are unsure whether a medication can be taken alongside a ketogenic diet, contact the Ketogenic team via email or telephone on 01223 216655.