Patient Information on FDA Approved Antiepileptic ...



Patient Information on FDA Approved Antiepileptic Medications (last edited May 2010)

|Drug (brand name in |Indication |Common doses |Common Side Effects |Significant Drug |Over the Counter, |

|parenthesis) | | | |Interactions |herbal, food |

| | | | | |interactions |

|Carbamazepine |Partial seizures with complex |< 6 years old |Dizziness, drowsiness, |Additive effects with other |Avoid alcohol, |

|(Tegretol) |symptoms, generalized |10-20mg/kg/day* |headache, nausea, vomiting, |CNS depressants and alcohol.|grapefruit juice, |

| |tonic-clonic seizures (grand |6-12 years old 100mg |muscle pain, infection, and |May diminish effect of |evening primrose, |

| |mal) and mixed seizures |twice daily |tingling |acetaminophen |valerian, St. John’s |

| | |> 12 years old | | |wort, kava kava, gota|

| | |800-1200mg/day in | | |kola |

| | |divided doses | | | |

|Ethosuximide (Zarontin)|absence seizures (petit mal) |3-6 years old |Dizziness, drowsiness, |Additive effects with other |Avoid alcohol, St. |

| | |15-40mg/kg/day* in 2 |fatigue, headache, nausea, |CNS depressants and alcohol.|John’s wort |

| | |doses |diarrhea | | |

| | |> 6 years old | | | |

| | |20-40mg/kg/day* in 2 | | | |

| | |divided doses | | | |

|Felbamate (Felbatol) |Not first line antiepileptic |Dosage is started low |Headache, fever, dizziness, |Additive effects with other |Avoid alcohol, |

| |(used in patients who have |and titrated up over 3 |nausea, vomiting, |CNS depressants and alcohol.|evening primrose |

| |failed alternative therapies), |weeks to therapeutic |constipation |Oral contraceptive failure | |

| |has orphan drug status for |range of | |is possible | |

| |partial and generalized |2400-3600mg/day in | | | |

| |seizures associated with |divided doses (other | | | |

| |Lennox-Gastaut syndrome in |antiepileptic | | | |

| |children |medication doses are | | | |

| | |reduced as Felbamate is| | | |

| | |increased) | | | |

|Gabapentin (Neurontin) |Partial seizures with or |3-12 years old 10 to |Drowsiness, dizziness, |Additive effects with other |Avoid alcohol, |

| |without secondary |40mg/kg/day* in 3 |fatigue, viral infection, |CNS depressants and alcohol.|evening primrose, |

| |generalization in patients > 12|divided doses, > 12 |fever, tremor, diarrhea, |Ketorolac and mefloquine may|valerian, St. John’s |

| |years old, partial seizures in |years old up to |nausea, vomiting (also |diminish effect. |wort, kava kava, gotu|

| |3-12 year olds |1800mg/day in 3 divided|hostility in 3-12 year olds) | |kola |

| | |doses | | | |

|Lacosamide (Vimpat) |Adjunctive therapy in treatment|Initial: 50 mg twice |Nausea, vomiting, dizziness, |Carbamazepine, fosphenytoin,|Avoid alcohol |

| |of partial-onset seizures |daily; may increase to |headache, loss of ability to |phenobarbital and phenytoin | |

| | |100mg/day at weekly |control muscle movement, |may decrease serum | |

| | |intervals |double vision, fatigue |concentration of lacosamide | |

| | | | | | |

| | |Maintenance dose: | | | |

| | |200-400mg/day | | | |

|Lamotrigine (Lamictal) |Generalized seizures of |Dose is titrated |Headache, dizziness, |Additive effects with other |Avoid alcohol and |

| |Lennox-Gastaut syndrome, |depending on the |drowsiness, nausea, visual |CNS depressants and alcohol.|evening primrose |

| |partial seizures patients 2 |combination therapy and|disturbances, runny nose, |Oral contraceptive may | |

| |years or older |age of the individual |allergic rash (in some cases |diminish effect. | |

| | |patient. Max for 2-12 |rash is severe) |Barbiturates may increase | |

| | |year olds is 400mg/day | |the metabolism | |

| | |and over 12 years old | | | |

| | |max dose is 700mg/day | | | |

|Levetiracetam (Keppra) |Adjunct therapy in treatment of|4-15 years old 10 to |Behavioral symptoms |Additive effects with other |Avoid alcohol |

| |partial onset, myoclonic, |30mg/kg/day* in 2 |(agitation, aggression, |CNS depressants and alcohol.| |

| |and/or primary generalized |doses, over 15 year |anger, anxiety, nervousness |Ketorolac and mefloquine may| |

| |tonic-clonic seizures. |olds max dose of |etc.) drowsiness, headache, |diminish effect. | |

| | |3000mg/day in 2 divided|vomiting, runny nose, | | |

| | |doses |anorexia, cough, accidental | | |

| | | |injury | | |

|Oxcarbazepine |Partial seizures in patients 2|Dosage is highly |Dizziness, drowsiness, |May decrease metabolism of |Avoid alcohol, |

|(Trileptal) |years or older with epilepsy |variable based on |headache, fatigue, vertigo, |oral contraceptive. |evening primrose, |

| | |combination therapy, |vomiting, nausea, abdominal |Contraceptive failure is |valerian, St. John’s |

| | |patient’s age and |pain, visual disturbances |possible. |wort, kava kava, gotu|

| | |patient’s weight | | |kola |

| | |Dose for adults can | | | |

| | |reach 2400mg/day but | | | |

| | |most patients will not | | | |

| | |be able to tolerate due| | | |

| | |to side effects | | | |

|Phenobarbital |Generalized tonic-clonic |Infants to age 12 with |Drowsiness, dizziness, |Additive effects with other |Avoid alcohol, |

| |(grand mal) and partial |seizures receive 4 to |confusion, agitation, |CNS depressants and alcohol.|evening primrose, |

| |seizures |8mg/kg/day* in 1 or 2 |nervousness, headache, |May diminish effect of |valerian, St. John’s |

| | |doses |insomnia, nightmares, |acetaminophen. Contraceptive|wort, kava kava, gotu|

| | |> 12 years old receive |hallucinations, anxiety, |failure is possible. May |kola. Phenobarbital |

| | |1 to 3mg/kg/day * in |rash, nausea, vomiting, |increase warfarin |may reduce vitamin D |

| | |divided doses of |constipation |metabolism. |and calcium levels. |

| | |50-100mg/dose | | | |

|Phenytoin (Dilantin) |Generalized tonic-clonic (grand|A one time loading dose|Swollen gums, dizziness, |Additive effects with other |Do not take within 2 |

| |mal), complex partial seizures,|of 15-20mg/kg* for |drowsiness, blurred vison, |CNS depressants and alcohol.|hours before or after|

| |seizures following head |patients less than 16 |slurred speech, headache, |May diminish effect of |food, do not give 2 |

| |trauma/neurosurgery |years of age and 15 to |insomnia rash, nausea, |acetaminophen. |within 2 hours before|

| | |20mg/kg* for 16 years |vomiting, constipation |Contraceptive failure is |or after enteral |

| | |and older is given. | |possible. |nutrition. Calcium, |

| | |Maintenance dose for 6 | | |folic acid, vitamin D|

| | |month olds to 16 years | | |levels may be reduced|

| | |range between 6 and | | |with Phenytoin use. |

| | |10mg/kg/day* in 2 or 3 | | |Avoid alcohol, |

| | |divided doses. Age16 or| | |evening primrose, |

| | |older dose is 5 to | | |valerian, St. John’s |

| | |6mg/kg/day* in 2 or 3 | | |wort, kava kava, gota|

| | |divided doses. | | |kola |

|Pregabalin (Lyrica) |Partial onset seizures in |150mg/day in 2 or 3 |Swollen legs, Dizziness, |Additive effects with other |Avoid alcohol, |

| |adults |divided doses (max dose|drowsiness, blurred vision, |CNS depressants (opiods, |valerian, St. John’s |

| | |is 600mg/day) |weight gain |ethanol, other sedatives), |wort, kava kava, gotu|

| | | | |weight gain may be additive |kola |

| | | | |with pioglitazone or | |

| | | | |rosiglitazone | |

|Primidone (Mysoline) |Grand mal, psychomotor, focal |Children less than 8 |Drowsiness, visual |Additive effects with other |Avoid alcohol, |

| |seizures |years old 10 to |disturbances, headache, |CNS depressants and alcohol.|valerian, St. John’s |

| | |25mg/kg/day* in 3 or 4 |dizziness, nausea, vomiting |Ketorolac and mefloquine may|wort, kava kava,gota |

| | |doses, > 8 years of age| |diminish effect. Folic acid |kola. Patient needs |

| | |750 to 1500mg/day in 3 | |may decrease concentration. |to maintain a protein|

| | |to 4 divided doses | | |rich diet while |

| | | | | |taking Primidone |

|Rufinamide (Banzel) |Partial onset seizures, |Children ≥4 years: |Headache, dizziness, fatigue,|Additive effects with other |Avoid alcohol , |

| |Lennox-Gastaut syndrome |Oral: Initial: 10 |blurred vision, nausea, |CNS depressants and alcohol.|evening primrose |

| | |mg/kg/day in 2 equally |vomiting, constipation, rash |May decrease concentrations | |

| | |divided doses; increase| |of Estradiol. | |

| | |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 doses | | | |

|Stiripentol (Diacomit) |Severe myoclonic epilepsy of |50 to 100mg/kg/day* in|Nausea and/or vomiting |None known |Avoid evening |

| |infancy (Dravet’s syndrome) |2 or 3 divided doses |(especially when given with | |primrose, ginkgo |

| | |with meals (max dose is|sodium valproate) | | |

| | |4gm per day) | | | |

|Tiagabine (Gabitril) |Adjunctive therapy in adults |Dosing regime based |Confusion, difficulty |Additive effects with other |Avoid alcohol, St |

| |and children ≥12 years of age |on liver function |speaking/stuttering, |CNS depressants and alcohol.|John’s wort, |

| |in the treatment of partial | |drowsiness, tingling |Ketorolac and mefloquine may|valerian, kava kava, |

| |seizures | |sensation in hands/feet |diminish effect. |gotu kola |

|Topiramate (Topamax) |Partial onset seizures, primary|Children 10 years or |Dizziness, drowsiness, |Additive effects with other |Avoid alcohol, |

| |generalized tonic-clonic |younger max of |nervousness, memory and |CNS depressants and alcohol.|evening primrose. |

| |seizures, seizures associated |400mg/day in 2 doses. |speech problems, fatigue, |Ketorolac and mefloquine may|Patients on ketogenic|

| |with Lennox-Gastaut syndrome |Adolescents and adults |difficulty concentrating, |diminish effect. |diet may have |

| | |usual maintenance dose |depression, confusion, |Contraceptive failure is |increased possibility|

| | |is 400mg/day in 2 |decreased serum bicarbonate |possible |of acidosis. |

| | |doses. |levels, nausea, weight loss, | | |

| | | |anorexia | | |

|Valproic Acid and |Complex partial seizures, |Patients 10 years or |Headache, drowsiness, |Additive effects with other |Avoid alcohol, |

|derivatives (Depakene, |simple and complex absence |older 30-60mg/kg/day* |dizziness, pain, nausea, |CNS depressants and alcohol.|carbonated beverages |

|Depakote) |seizures, mixed seizure types |in 1 to 3 divided |vomiting, diarrhea, weight |Aspirin causes an increase |and evening primrose.|

| |that include absence seizures |doses. |loss, hair loss, insomnia, |in concentrations of | |

| | | |nervousness, tremor, |Valproic Acid. Some | |

| | | |abdominal pain, visual |antibiotics lead to an | |

| | | |disturbances |increase in concentrations | |

| | | | |of Valproic Acid. | |

|Vigabatrin (Sabril) |Complex partial seizure, |Children: 40 mg/kg/day |Rash, increased weight, viral|Additive effects with other |Avoid alcohol, |

| |refractory seizure |divided twice daily; |disease, joint pain, |CNS depressants and alcohol.|evening primrose, |

| | |maintenance dosages |confusion, dizziness, |Ketorolac and mefloquine may|valerian, St. John’s |

| | |based on patient |headache, sleepiness, memory |diminish effect. Droperidol |wort, kava kava, and |

| | |weight. |impairment, tremor |and methotrimeprazine may |gotu kola. |

| | |Adults: 500 mg twice | |enhance CNS depressant | |

| | |daily and increase | |effect. Vigabatrin may | |

| | |daily dose by 500 mg at| |increase serum concentration| |

| | |weekly intervals to a | |of phenytoin and | |

| | |target dose of 3g/day. | |fosphenytoin. | |

| | |Note: only available | | | |

| | |through a restricted | | | |

| | |distribution program | | | |

| | |called SHARE | | | |

|Zonisamide (Zonegran) |Partial seizures in patients 16|100 to 400mg/day is the|Drowsiness, dizziness, weight|Additive effects with other |Avoid alcohol. |

| |years or older |normal dose range. Max |loss, headache, |CNS depressants and alcohol.| |

| | |is 600mg/day but doses |irritability/agitation |Ketorolac and mefloquine may| |

| | |above 300mg/day have | |diminish effect | |

| | |increased side effects.| | | |

* To calculate dose take the patients weight in pounds and divide by 2.2 to get the patients weight in kilograms.

References.

1. 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.

2. Woelfel JA. Comparison of FDA-Approved Antiepileptic Drugs. Pharmacist’s letter/Prescriber’s Letter. Stockton, CA: Therapeutic Research Center; 2004: detail-document #201213.

Note: This table should be used for informational purposes only.  For recommended dosage, interactions, precautions, and other items related to these drugs, please consult your health care professional.

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