Version June 2024
| Medication¶ | DoseΔ | Blood level | Monitoring◊ | ||
| Starting | Maintenance | Frequency | |||
| Brivaracetam (approved for use in patients ≥1 month old) |
| Adjust dose based on individual patient response and tolerability (gradual dose escalation not required). Maximum daily dose:
| In 2 divided doses per day | Not well established | Symptoms of depression and suicidality (eg, anxiety, irritability, insomnia, depression, behavior changes); growth parameters in pediatric patients (may cause decreased appetite). Routine lab tests not recommended. |
| Cannabidiol (approved for use in patients ≥1 year old) | 5 mg/kg/day | For Lennox-Gastaut syndrome or Dravet syndrome, maintenance dose 10 mg/kg/day (maximum 20 mg/kg/day). For tuberous sclerosis complex, maintenance dose 25 mg/kg/day. | In 2 divided doses per day | Not well established | Serum ALT, AST, and total bilirubin levels at baseline and at one, three, and six months after starting treatment, and periodically thereafter as clinically indicated, or within one month of change in cannabidiol dose or with changes in other medications that affect liver function. |
| Carbamazepine (CBZ) (approved for use in patients ≥1 year old) | 10 to 20 mg/kg/day | 10 to 35 mg/kg/day (maximum in children ≤15 years: Lower of 35 mg/kg or 1000 mg/day; maximum in >15 years: 1200 mg/day) | In 3 or 4 divided doses per day (for IR or oral suspension); 1 or 2 divided doses per day (for ER) | 4 to 12 mcg/mL (17 to 51 micromol/L) | HLA-B*1502 screening before starting if of Asian descent; CBC after four to six weeks, then as needed. If initial WBC low (particularly ANC), repeat as needed. CBZ level at three, six, and nine weeks; then at least every two months until stable. Serum sodium prior to initiation, at maintenance dose, and as needed in patients at risk for, or with symptoms of, hyponatremia. |
| Clobazam (approved for use in patients ≥2 years; used off-label in younger children and infants) | Children <2 years: 0.5 to 1 mg/kg/day (maximum: 5 mg/day) | Children <2 years: 0.5 to 1 mg/kg/day (maximum: 10 mg/day) | In 1 or 2 divided doses per day | Not useful | Routine lab tests not recommended. |
| Children 2 to 16 years: 5 mg/day | Children 2 to 16 years: 10 to 20 mg/day (maximum: 40 mg/day) | ||||
| Clonazepam (approved for use in patients ≥28 days old) | 0.01 to 0.03 mg/kg/day (maximum: Lower of 0.05 mg/kg/day or 1 mg/day) | 0.05 to 0.2 mg/kg/day (maximum: Lower of 0.2 mg/kg/day or 20 mg/day) | In 2 or 3 divided doses per day | Not useful | Routine lab tests not recommended. |
| Clorazepate (approved for use in patients ≥9 years old) | 0.3 mg/kg/day | 0.5 to 3 mg/kg/day (maximum in children 9 to 12 years: 60 mg/day; maximum in >12 years: 90 mg/day) | In 2 or 3 divided doses per day | Not useful | Routine lab tests not recommended. |
| Eslicarbazepine (approved for use in patients ≥4 years old) | Children 11 to 21 kg: 200 mg/day | Children 11 to 21 kg: Range 400 to 600 mg/day (titrate in 200 mg increments at intervals of seven days or more) | Dosed once daily | Not well established | Serum sodium prior to initiation, at maintenance dose, and as needed in patients at risk for, or with symptoms of, hyponatremia. Eslicarbazepine is structurally similar to carbamazepine and oxcarbazepine. However, role of HLA-B*1502 screening if of Asian descent is not yet established. |
| Children 22 to 31 kg: 300 mg/day | Children 22 to 31 kg: Range 500 to 800 mg/day (titrate in 300 mg increments at intervals of seven days or more) | ||||
| Children 32 to 38 kg: 300 mg/day | Children 32 to 38 kg: Range 600 to 900 mg/day (titrate in 300 mg increments at intervals of seven days or more) | ||||
| Children >38 kg: 400 mg/day | Children >38 kg: Range 800 to 1200 mg/day (titrate in 400 mg increments at intervals of seven days or more) | ||||
| Ethosuximide (approved for use in patients ≥3 years old) | 15 mg/kg/day (maximum: 500 mg/day) | 15 to 40 mg/kg/day (maximum: 1500 mg/day) | In 1 or 2 divided doses per day | 40 to 100 mcg/mL (280 to 700 micromol/L) | CBC/platelets after first one to two months, as needed thereafter; ethosuximide level at one to three weeks. |
| Felbamate (approved for use in patients ≥2 years old) | 15 mg/kg/day (maximum: 1200 mg/day) | 15 to 45 mg/kg/day (maximum: Lower of 45 mg/kg/day or 3600 mg/day) | In 3 or 4 divided doses per day | Not well established; 50 to 100 mcg/mL (210 to 420 micromol/L) has been proposed | CBC/platelets every two to four weeks; hepatic function tests every month. |
| Gabapentin (approved for use in patients ≥3 years old) | 10 to 15 mg/kg/day; may titrate to initial dose over three days (maximum: 900 mg/day) | 40 to 50 mg/kg/day (maximum: Lower of 70 mg/kg/day or 4800 mg/day) | In 3 divided doses per day (for IR) | Not useful | CBC/platelets every three months for first six months; chemical panel as needed (routine monitoring may not be necessary). |
| Lacosamide (approved for use in patients ≥28 days old) | Children <6 kg: 2 mg/kg/day | Children <6 kg: Range 7.5 to 15 mg/kg/day (titrate in 2 mg/kg/day increments at intervals of seven days or more) | In 2 divided doses per day | Not useful OR Not well established; 1.8 to 7.2 mcg/mL (10 to 40 micromol/L) has been proposed | Routine lab tests not recommended. In patients with cardiac conduction abnormalities or other significant heart disease, an electrocardiogram is recommended prior to starting lacosamide and after maintenance dose is reached. |
| Children 6 to 10 kg: 2 mg/kg/day | Children 6 to 10 kg: Range 6 to 12 mg/kg/day (titrate in 2 mg/kg/day increments at intervals of seven days or more) | ||||
| Children 11 to 29 kg: 2 mg/kg/day | Children 11 to 29 kg: Range 6 to 12 mg/kg/day (titrate in 2 mg/kg/day increments at intervals of seven days or more) | ||||
| Children 30 to 49 kg: 2 mg/kg/day | Children 30 to 49 kg: Range 4 to 8 mg/kg/day (titrate in 2 mg/kg/day increments at intervals of seven days or more) | ||||
| Children ≥50 kg: 50 mg twice daily | Children ≥50 kg:
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| Lamotrigine (approved for use in patients ≥2 years old; used off-label in younger children and infants) | Monotherapy: 0.3 mg/kg/day | 4.5 to 7.5 mg/kg/day (maximum: 300 mg/day) | In 2 divided doses per day (for IR) or once daily (for ER) | Not well established; 1.5 to 10 mcg/mL (5.85 to 39 micromol/L) has been proposed | CBC/platelets every three months for first six months; chemical panel as needed (routine monitoring may not be necessary). |
| Added to VPA: 0.15 mg/kg/day | 1 to 5 mg/kg/day (maximum: 200 mg/day) | ||||
| Added to inducer (PB, CBZ, PHT): 0.6 mg/kg/day | 5 to 15 mg/kg/day (maximum: 400 mg/day) | ||||
| Levetiracetam (approved for use in patients ≥28 days old) | 20 mg/kg/day (maximum: 1000 mg/day) | 40 to 60 mg/kg/day (maximum: 3000 mg/day) | In 2 divided doses per day (for IR) or once daily (for ER) | Not useful | Routine lab tests not recommended. |
ASMs: antiseizure medications; IR: immediate release; ER: extended release; CBC: complete blood count; WBC: white blood cell; ANC: absolute neutrophil count; VPA: valproate; PB: phenobarbital; PHT: phenytoin; US FDA: US Food and Drug Administration.
¶ Increased suicidality has been linked to several antiseizure medications. Patients taking antiseizure medications should be monitored for emergence or worsening of suicidal ideation or depression, and with routine screening of cognition, mood, and behavior.
Δ In general, the pediatric dose should not exceed the higher end of the adult dose range (shown in parentheses as the maximum dose). On a milligram per kilogram basis, doses of some of the antiseizure medications needed to obtain a similar blood concentration in children are greater than those for adolescents and adults.
◊ Additional laboratory monitoring recommendations may be contained in the approved product information in some countries; consult local product information.آیا می خواهید مدیلیب را به صفحه اصلی خود اضافه کنید؟
