Antiepileptics

CARBAMAZEPINE:

Indications: Complex-Partial Epilepsy, Epilepsy, Mixed Epilepsy, Tonic-Clonic Epilepsy, Trigeminal Neuralgia, Attention-Deficit Hyperactivity Disorder, Bipolar Disorder in Remission, Diabetes Insipidus, Manic Bipolar Disorder, Mixed Bipolar I Disorder, Neuralgia, Paroxysmal Choreoathetosis, Prevention of Seizures following Cranial Trauma or Surgery, Restless Legs Syndrome.

Contraindications: Ataxia, Blurred Vision, Diplopia, Dizziness, Drowsy, Impaired Cognition, Nausea, Nystagmus, Vomiting.

Dose and Administration: By mouth, epilepsy, initially, 100–200 mg 1–2 times daily, increased slowly (see notes above) to usual dose of 0.4–1.2 g daily in divided doses; in some cases 1.6–2 g daily may be needed; elderly reduce initial dose; child daily in divided doses, up to 1 year 100–200 mg, 1–5 years 200– 400 mg, 5–10 years 400–600 mg, 10–15 years 0.4–1 g. Trigeminal neuralgia, initially 100 mg 1–2 times daily (but some patients may require higher initial dose), increased gradually according to response; usual dose 200 mg 3–4 times daily, up to 1.6 g daily in some patients. Prophylaxis of bipolar disorder unresponsive to lithium, initially 400 mg daily in divided doses increased until symptoms controlled; usual range 400–600 mg daily; max. 1.6 g daily.

GABAPENTIN:

Indications: monotherapy and adjunctive treatment of partial seizures with or without secondary generalisation; peripheral neuropathic pain, trigeminal neuralgia.

Contraindications: Suicidal Ideation, Depression, And Renal Disease.

Dose and Administration: Epilepsy, 400 mg on day 1, then 400 mg twice daily on day 2, then 400 mg 3 times daily on day 3 or initially 400 mg 3 times daily on day 1; then increased according to response in steps of 400 mg daily (in 3 divided doses) every 2–3 days; usual dose 0.9–3.6 g daily in 3 divided doses; child 6–12 years (adjunctive therapy only) 10–15 mg/kg daily initially, then increased according to response over 3 days to usual maintenance dose 25– 35 mg/kg daily in 3 divided doses; max. 50 mg/kg daily in 3 divided doses. Neuropathic pain, adult over 18 years, 400 mg on day 1, then 400 mg twice daily on day 2, then 400 mg 3 times daily (approx. every 8 hours) on day 3 or initially 400 mg 3 times daily on day 1, then increased according to response in steps of 400 mg daily (in 3 divided doses) every 2–3 days to max. 3.6 g daily.

PREGABALIN:

Indications: peripheral and central neuropathic pain; adjunctive therapy for partial seizures with or without secondary generalisation; generalised anxiety disorder.

Contraindications: Rhabdomyolysis, Acutely Decompensated Chronic Heart Failure, Angioedema, Myopathy with CK Elevation, Renal Disease with Moderate to Severe Function Impairment, Suicidal Ideation.

Dose and Administration: Neuropathic pain, adult over 18 years, initially 150 mg daily in 2–3 divided doses, increased if necessary after 3–7 days to 300 mg daily in 2–3 divided doses, increased further if necessary after 7 days to max. 600 mg daily in 2–3 divided doses. Epilepsy, adult over 18 years, initially 25 mg twice daily, increased at 7-day intervals in steps of 50 mg daily to 300 mg daily in 2–3 divided doses, increased further if necessary after 7 days to max. 600 mg daily in 2–3 divided doses. Generalised anxiety disorder, adult over 18 years, initially 150 mg daily in 2–3 divided doses, increased if necessary at 7-day intervals in steps of 150 mg daily; max. 600 mg daily in 2–3 divided doses.

LAMOTRIGINE:

Indications: monotherapy and adjunctive treatment of partial seizures and primary and secondarily generalised tonic-clonic seizures; seizures associated with Lennox-Gastaut syndrome; trigeminal neuralgia.

Contraindications: Pregnancy and Suicidal Ideation.

Dose and Administration: Monotherapy, adult and child over 12 years, initially 25 mg once daily for 14 days, increased to 50 mg once daily for further 14 days, then increased by max. 50–100 mg daily every 7–14 days; usual maintenance 100–200 mg daily in 1–2 divided doses (up to 500 mg daily has been required). Adjunctive therapy with valproate, initially 25 mg every other day for 14 days then 25 mg once daily for further 14 days, thereafter increased by max. 25– 50 mg daily every 7–14 days; usual maintenance, 100–200 mg daily in 1–2 divided doses; child 2–12 years initially 150 micrograms/kg once daily for 14 days (those weighing under 13 kg may receive 2 mg on alternate days for first 14 days) then 300 micrograms/kg once daily for further 14 days, thereafter increased by max. 300 micrograms/kg daily every 7–14 days; usual maintenance 1–5 mg/kg daily in 1–2 divided doses (max. single dose 100 mg).

LEVETIRACETAM:

Indications: Complex-Partial Epilepsy, Myoclonic Epilepsy Adjunct Treatment, Simple-Partial Epilepsy, And Tonic-Clonic Epilepsy Treatment Adjunct.

Contraindications: Aggressive Behavior, Anxiety, Ataxia, Depersonalization, Depression, Drowsy, Fatigue, Feeling Agitated, Gait Abnormality, Hallucinations, Hostility, Indifference, Irritability, Mood Changes, Psychotic Disorder, Suicidal Ideation.

Dose and Administration: Monotherapy of partial seizures with or without secondary generalisation, by mouth, adult and child over 16 years, initially 250 mg twice daily increased according to response in steps of 250 mg twice daily every 2 weeks; max. 1.5 g twice daily. Adjunctive therapy of partial seizures with or without secondary generalisation, myoclonic seizures, and primarily generalised tonic-clonic seizures, by mouth, adult and child over 12 years, body-weight over 50 kg, initially 500 mg twice daily, adjusted in steps of 500 mg twice daily every 2 to 4 weeks; max. 1.5 g twice daily; child 4–18 years (12–18 years for myoclonic and tonic-clonic seizures), body-weight under 50 kg, initially 10 mg/kg twice daily, adjusted in steps not exceeding 10 mg/kg twice daily every 2 weeks; max. 30 mg/kg twice daily.

PHENOBARBITAL:

Indications: Epilepsy, Insomnia, Seizure Disorder, Simple-Partial Epilepsy, Status Epilepticus, And Tonic-Clonic Epilepsy.

Contraindications: Alcoholism, Lactating Mother, Phenobarbital Toxicity, Porphyria, Pregnancy, Severe Dyspnea, Severe Pain, Sleep Apnea, Chronic Pain, Depression, Hepatic Coma, Hepatic Encephalopathy, Hyperammonemia, Substance Abuse, Suicidal Ideation.

Dose and Administration: By mouth, 60–180 mg at night; child 5–8 mg/kg daily. Status epilepticus, by intravenous injection (dilute injection 1 in 10 with water for injections), 10 mg/kg at a rate of not more than 100 mg/min; max. 1 g.

PHENYTOIN:

Indications: Complex-Partial Epilepsy, Epilepsy, Prevention of Seizures following Cranial Trauma or Surgery, Seizures in Neurosurgery, Simple-Partial Epilepsy, Tonic-Clonic Epilepsy.

Contraindications: Pregnancy, Disease of Liver, Porphyria, And Suicidal Ideation.

Dose and Administration: By mouth, initially 3–4 mg/kg daily or 150–300 mg daily (as a single dose or in 2 divided doses) increased gradually as necessary (with plasma-phenytoin concentration monitoring); usual dose 200–500 mg daily (exceptionally, higher doses may be used); child initially 5 mg/kg daily in 2 divided doses, usual dose range 4–8 mg/kg daily (max. 300 mg daily).

TOPIRAMATE:

Indications: Complex-Partial Epilepsy, Lennox-Gastaut Epilepsy, Migraine Prevention, Simple-Partial Epilepsy, And Tonic-Clonic Epilepsy.

Contraindications: Concentration Difficulty, Decreased Sweating, Drowsy, Fatigue, Impaired Cognition, Memory Impairment, Metabolic Acidosis, Mood Changes, Narrow Angle Glaucoma, Renal Disease with Moderate to Severe Function Impairment, Suicidal Ideation.

Dose and Administration: Monotherapy, initially 25 mg at night for 1 week then increased in steps of 25–50 mg daily at intervals of 1–2 weeks taken in 2 divided doses; usual dose 100 mg daily in 2 divided doses; max. 400 mg daily; child 6–16 years, initially 0.5–1 mg/kg at night for 1 week then increased in steps of 0.5–1 mg/kg daily at intervals of 1–2 weeks taken in 2 divided doses; usual dose 3–6 mg/kg daily in 2 divided doses; max. 15 mg/kg daily. Adjunctive therapy, initially 25 mg at night for 1 week then increased in steps of 25–50 mg daily at intervals of 1–2 weeks taken in 2 divided doses; usual dose 200–400 mg daily in 2 divided doses; max. 800 mg daily; child 2–16 years, initially 25 mg at night for one week then increased in steps of 1–3 mg/kg daily at intervals of 1–2 weeks taken in 2 divided doses; recommended dose range 5–9 mg/kg daily in 2 divided doses; max. 15 mg/kg daily.

VALPROATE SODIUM:

Indications: all forms of epilepsy.

Contraindications: Acute Pancreatitis, Arginase Deficiency, Arginosuccinate Lyase Deficiency, Carbamyl Phosphate Synthetase Deficiency, Chronic Pancreatitis, Citrullinemia, Disease of Liver, Ornithine Carbamyltransferase Deficiency, Pregnancy, Valproic Acid Toxicity.

Dose and Administration: By mouth, initially 600 mg daily in 2 divided doses, preferably after food, increased by 200 mg daily every 3 days to max. 2.5 g daily, usual maintenance dose 1–2 g daily (20–30 mg/kg daily); child body-weight up to 20 kg, initially 20 mg/kg daily in divided doses, may be increased provided plasma concentration monitored (dose above 40 mg/kg daily also monitor clinical chemistry and haematological parameters); child under 12 years body-weight over 20 kg, initially 400 mg daily in divided doses increased according to response (usual range 20–30 mg/kg daily); max. 35 mg/kg daily.

CLONAZEPAM:

Indications: Absence Epilepsy, Atonic Seizures, Lennox-Gastaut Epilepsy, Myoclonic Epilepsy, and Panic Disorder.

Contraindications: respiratory depression; acute pulmonary insufficiency; sleep apnoea syndrome; marked neuromuscular respiratory weakness including unstable myasthenia gravis.

Dose and Administration: mg (elderly 500 micrograms) initially at night for 4 nights, increased according to response over 2–4 weeks to usual maintenance dose of 4–8 mg usually at night (may be given in 3–4 divided doses if necessary); child up to 1 year, initially 250 micrograms increased as above to usual maintenance dose of 0.5–1 mg, 1–5 years, initially 250 micrograms increased as above to 1–3 mg, 5–12 years, initially 500 micrograms increased as above to 3– 6 mg.

VIGABATRIN:

Indications: adjunctive treatment of partial seizures with or without secondary generalisation not satisfactorily controlled with other antiepileptics; monotherapy for management of infantile spasms (West’s syndrome).

Contraindications: Lactating Mother, Pregnancy, Reduced Visual Acuity, Renal Disease, Suicidal Ideation, and Visual Field Defect.

Dose and Administration: With current antiepileptic therapy, initially 1 g daily in single or 2 divided doses then increased according to response in steps of 500 mg at weekly intervals; usual range 2–3 g daily (max. 3 g daily); child initially 40 mg/kg daily in single or 2 divided doses then adjusted according to body-weight 10–15 kg, 0.5–1 g daily; body-weight 15–30 kg, 1–1.5 g daily; body-weight 30–50 kg, 1.5–3 g daily; body-weight over 50 kg, 2–3 g daily. Infantile spasms (West’s syndrome), monotherapy, 50 mg/kg daily, adjusted according to response over 7 days; up to 150 mg/kg daily used with good tolerability.