ࡱ> z|yg bjbjVV .r<r<n,PPPPPdddd$Ld.%0. q$s$s$s$s$s$s$$^&)$QP$PP$ PPq$ q$ =#`#3%1I #]$$0.%#,)I p)##8)P $Tr ab$$ .%) : Patient Information on FDA Approved Antiepileptic Medications (last edited May 2010) Drug (brand name in parenthesis)IndicationCommon dosesCommon Side EffectsSignificant Drug InteractionsOver the Counter, herbal, food interactionsCarbamazepine (Tegretol) Partial seizures with complex symptoms, generalized tonic-clonic seizures (grand mal) and mixed seizures< 6 years old 10-20mg/kg/day* 6-12 years old 100mg twice daily > 12 years old 800-1200mg/day in divided dosesDizziness, drowsiness, headache, nausea, vomiting, muscle pain, infection, and tinglingAdditive effects with other CNS depressants and alcohol. May diminish effect of acetaminophenAvoid alcohol, grapefruit juice, evening primrose, valerian, St. Johns wort, kava kava, gota kolaEthosuximide (Zarontin) absence seizures (petit mal)3-6 years old 15-40mg/kg/day* in 2 doses > 6 years old 20-40mg/kg/day* in 2 divided doses Dizziness, drowsiness, fatigue, headache, nausea, diarrheaAdditive effects with other CNS depressants and alcohol.Avoid alcohol, St. Johns wortFelbamate (Felbatol) Not first line antiepileptic (used in patients who have failed alternative therapies), has orphan drug status for partial and generalized seizures associated with Lennox-Gastaut syndrome in childrenDosage is started low and titrated up over 3 weeks to therapeutic range of 2400-3600mg/day in divided doses (other antiepileptic medication doses are reduced as Felbamate is increased)Headache, fever, dizziness, nausea, vomiting, constipationAdditive effects with other CNS depressants and alcohol. Oral contraceptive failure is possibleAvoid alcohol, evening primroseGabapentin (Neurontin) Partial seizures with or without secondary generalization in patients > 12 years old, partial seizures in 3-12 year olds3-12 years old 10 to 40mg/kg/day* in 3 divided doses, > 12 years old up to 1800mg/day in 3 divided dosesDrowsiness, dizziness, fatigue, viral infection, fever, tremor, diarrhea, nausea, vomiting (also hostility in 3-12 year olds)Additive effects with other CNS depressants and alcohol. Ketorolac and mefloquine may diminish effect.Avoid alcohol, evening primrose, valerian, St. Johns wort, kava kava, gotu kolaLacosamide (Vimpat)Adjunctive therapy in treatment of partial-onset seizuresInitial: 50 mg twice daily; may increase to 100mg/day at weekly intervals Maintenance dose: 200-400mg/dayNausea, vomiting, dizziness, headache, loss of ability to control muscle movement, double vision, fatigue Carbamazepine, fosphenytoin, phenobarbital and phenytoin may decrease serum concentration of lacosamideAvoid alcoholLamotrigine (Lamictal) Generalized seizures of Lennox-Gastaut syndrome, partial seizures patients 2 years or olderDose is titrated depending on the combination therapy and age of the individual patient. Max for 2-12 year olds is 400mg/day and over 12 years old max dose is 700mg/dayHeadache, dizziness, drowsiness, nausea, visual disturbances, runny nose, allergic rash (in some cases rash is severe)Additive effects with other CNS depressants and alcohol. Oral contraceptive may diminish effect. Barbiturates may increase the metabolismAvoid alcohol and evening primroseLevetiracetam (Keppra) Adjunct therapy in treatment of partial onset, myoclonic, and/or primary generalized tonic-clonic seizures. 4-15 years old 10 to 30mg/kg/day* in 2 doses, over 15 year olds max dose of 3000mg/day in 2 divided dosesBehavioral symptoms (agitation, aggression, anger, anxiety, nervousness etc.) drowsiness, headache, vomiting, runny nose, anorexia, cough, accidental injuryAdditive effects with other CNS depressants and alcohol. Ketorolac and mefloquine may diminish effect.Avoid alcoholOxcarbazepine (Trileptal) Partial seizures in patients 2 years or older with epilepsyDosage is highly variable based on combination therapy, patients age and patients weight Dose for adults can reach 2400mg/day but most patients will not be able to tolerate due to side effects Dizziness, drowsiness, headache, fatigue, vertigo, vomiting, nausea, abdominal pain, visual disturbances May decrease metabolism of oral contraceptive. Contraceptive failure is possible.Avoid alcohol, evening primrose, valerian, St. Johns wort, kava kava, gotu kola Phenobarbital Generalized tonic-clonic (grand mal) and partial seizuresInfants to age 12 with seizures receive 4 to 8mg/kg/day* in 1 or 2 doses > 12 years old receive 1 to 3mg/kg/day * in divided doses of 50-100mg/dose Drowsiness, dizziness, confusion, agitation, nervousness, headache, insomnia, nightmares, hallucinations, anxiety, rash, nausea, vomiting, constipationAdditive effects with other CNS depressants and alcohol. May diminish effect of acetaminophen. Contraceptive failure is possible. May increase warfarin metabolism. Avoid alcohol, evening primrose, valerian, St. Johns wort, kava kava, gotu kola. Phenobarbital may reduce vitamin D and calcium levels.Phenytoin (Dilantin) Generalized tonic-clonic (grand mal), complex partial seizures, seizures following head trauma/neurosurgeryA one time loading dose of 15-20mg/kg* for patients less than 16 years of age and 15 to 20mg/kg* for 16 years and older is given. Maintenance dose for 6 month olds to 16 years range between 6 and 10mg/kg/day* in 2 or 3 divided doses. Age16 or older dose is 5 to 6mg/kg/day* in 2 or 3 divided doses. Swollen gums, dizziness, drowsiness, blurred vison, slurred speech, headache, insomnia rash, nausea, vomiting, constipationAdditive effects with other CNS depressants and alcohol. May diminish effect of acetaminophen. Contraceptive failure is possible.Do not take within 2 hours before or after food, do not give 2 within 2 hours before or after enteral nutrition. Calcium, folic acid, vitamin D levels may be reduced with Phenytoin use. Avoid alcohol, evening primrose, valerian, St. Johns wort, kava kava, gota kolaPregabalin (Lyrica) Partial onset seizures in adults150mg/day in 2 or 3 divided doses (max dose is 600mg/day)Swollen legs, Dizziness, drowsiness, blurred vision, weight gainAdditive effects with other CNS depressants (opiods, ethanol, other sedatives), weight gain may be additive with pioglitazone or rosiglitazone Avoid alcohol, valerian, St. Johns wort, kava kava, gotu kolaPrimidone (Mysoline) Grand mal, psychomotor, focal seizuresChildren less than 8 years old 10 to 25mg/kg/day* in 3 or 4 doses, > 8 years of age 750 to 1500mg/day in 3 to 4 divided dosesDrowsiness, visual disturbances, headache, dizziness, nausea, vomitingAdditive effects with other CNS depressants and alcohol. Ketorolac and mefloquine may diminish effect. Folic acid may decrease concentration.Avoid alcohol, valerian, St. Johns wort, kava kava,gota kola. Patient needs to maintain a protein rich diet while taking PrimidoneRufinamide (Banzel) Partial onset seizures, Lennox-Gastaut syndromeChildren e"4 years: Oral: Initial: 10 mg/kg/day in 2 equally divided doses; increase dose by ~10 mg/kg/day every other day to a target dose of 45 mg/kg/day or 3200 mg/day (whichever is lower) in 2 equally divided dosesHeadache, dizziness, fatigue, blurred vision, nausea, vomiting, constipation, rashAdditive effects with other CNS depressants and alcohol. May decrease concentrations of Estradiol. Avoid alcohol , evening primroseStiripentol (Diacomit) Severe myoclonic epilepsy of infancy (Dravets syndrome)50 to 100mg/kg/day* in 2 or 3 divided doses with meals (max dose is 4gm per day)Nausea and/or vomiting (especially when given with sodium valproate)None knownAvoid evening primrose, ginkgoTiagabine (Gabitril) Adjunctive therapy in adults and children e"12 years of age in the treatment of partial seizures Dosing regime based on liver function Confusion, difficulty speaking/stuttering, drowsiness, tingling sensation in hands/feetAdditive effects with other CNS depressants and alcohol. Ketorolac and mefloquine may diminish effect.Avoid alcohol, St Johns wort, valerian, kava kava, gotu kolaTopiramate (Topamax) Partial onset seizures, primary generalized tonic-clonic seizures, seizures associated with Lennox-Gastaut syndromeChildren 10 years or younger max of 400mg/day in 2 doses. Adolescents and adults usual maintenance dose is 400mg/day in 2 doses. Dizziness, drowsiness, nervousness, memory and speech problems, fatigue, difficulty concentrating, depression, confusion, decreased serum bicarbonate levels, nausea, weight loss, anorexiaAdditive effects with other CNS depressants and alcohol. Ketorolac and mefloquine may diminish effect. Contraceptive failure is possibleAvoid alcohol, evening primrose. Patients on ketogenic diet may have increased possibility of acidosis.Valproic Acid and derivatives (Depakene, Depakote) Complex partial seizures, simple and complex absence seizures, mixed seizure types that include absence seizuresPatients 10 years or older 30-60mg/kg/day* in 1 to 3 divided doses. Headache, drowsiness, dizziness, pain, nausea, vomiting, diarrhea, weight loss, hair loss, insomnia, nervousness, tremor, abdominal pain, visual disturbancesAdditive effects with other CNS depressants and alcohol. Aspirin causes an increase in concentrations of Valproic Acid. Some antibiotics lead to an increase in concentrations of Valproic Acid.Avoid alcohol, carbonated beverages and evening primrose.Vigabatrin (Sabril)Complex partial seizure, refractory seizureChildren: 40 mg/kg/day divided twice daily; maintenance dosages based on patient weight. Adults: 500 mg twice daily and increase daily dose by 500 mg at weekly intervals to a target dose of 3g/day. Note: only available through a restricted distribution program called SHARERash, increased weight, viral disease, joint pain, confusion, dizziness, headache, sleepiness, memory impairment, tremorAdditive effects with other CNS depressants and alcohol. Ketorolac and mefloquine may diminish effect. Droperidol and methotrimeprazine may enhance CNS depressant effect. Vigabatrin may increase serum concentration of phenytoin and fosphenytoin. Avoid alcohol, evening primrose, valerian, St. Johns wort, kava kava, and gotu kola.Zonisamide (Zonegran) Partial seizures in patients 16 years or older100 to 400mg/day is the normal dose range. Max is 600mg/day but doses above 300mg/day have increased side effects.Drowsiness, dizziness, weight loss, headache, irritability/agitationAdditive effects with other CNS depressants and alcohol. Ketorolac and mefloquine may diminish effectAvoid alcohol.  * To calculate dose take the patients weight in pounds and divide by 2.2 to get the patients weight in kilograms. References. Lacy CF, Armstrong LL, Goldman MP, Lance LL. Drug Information Handbook: A Comprehensive Resource for all Clinicians and Healthcare Professionals. Edition #14. Hudson, OH: Lexi-Comp; 2006. Woelfel JA. Comparison of FDA-Approved Antiepileptic Drugs. 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