Version May 2024
| Medication¶ | DoseΔ | Blood level | Monitoring◊ | ||
| Starting | Maintenance | Frequency | |||
| Oxcarbazepine (IR approved for use in patients ≥2 years; ER approved for use in patients ≥6 years) | 8 to 10 mg/kg/day (maximum 600 mg/day) | 30 to 40 mg/kg/day (maximum 2100 mg/day if ≤16 years old or 2400 mg/day if >16 years old as monotherapy) | In 2 divided doses per day (for IR) or once daily (for ER) | Not well established; 8 to 35 mcg/mL has been proposed | HLA-B*1502 screening before starting if of Asian descent; CBC/plts every 3 months for first 6 months. Serum sodium prior to initiation, at maintenance dose, and as needed in patients at risk for, or with symptoms of, hyponatremia. |
| Phenytoin (approved for use in infants and children) | 5 mg/kg/day (maximum 300 mg/day) | 4 to 8 mg/kg/day (300 mg/day for older children, adolescents; maximum 600 mg/day) | In 2 or 3 divided doses per day(for IR) or 1 or 2 divided doses per day (for ER) | 10 to 20 mcg/mL (40 to 80 micromol/L) | Routine lab tests not recommended. |
| Phenobarbital | 3 to 4 mg/kg/day | Infants and children ≤5 years: 3 to 5 mg/kg/day | In 1 to 2 divided doses per day | 10 to 40 mcg/mL (43 to 172 micromol/L) | Routine lab tests not recommended. |
| Children >5 years: 2 to 3 mg/kg/day | |||||
| Primidone (approved for use in children) | 1 to 2 mg/kg/day (maximum 125 mg/day) | 10 to 25 mg/kg/day (maximum 2000 mg/day) | Starting dose given at bedtime; maintenance dose in 3 to 4 divided doses per day | 5 to 12 mcg/mL (23 to 55 micromol/L) (monitor both primidone and phenobarbital level, which is 1.2 times higher) | Routine lab tests not recommended. |
| Rufinamide (approved for use in patients ≥1 year) | 10 mg/kg/day (maximum 400 mg/day) | 45 mg/kg/day (maximum 3200 mg/day) | In 2 divided doses per day | Not well established; 3 to 30 mcg/mL has been proposed | Routine lab tests not recommended. |
| Tiagabine§ (doses based on combination with enzyme-inducing ASM; approved for use in patients ≥12 years) | <12 years: 0.25 mg/kg/day (maximum 4 mg/day) | Weekly increase by 0.5 to 1 mg/kg/day to maximum 32 mg/day | In 3 to 4 divided doses per day | Not useful | Routine lab tests not recommended. |
| ≥12 years: 4 mg/day | ≥12 years: Weekly increase by 4 to 8 mg/day to maximum 32 mg/day | In 2 to 4 divided doses per day | |||
| Topiramate (approved for use in patients ≥2 years) | 1 to 3 mg/kg/day (maximum 25 mg/day) | 5 to 9 mg/kg/day (usual maximum 400 mg/day; higher doses in adults have not provided added benefit) | In 2 divided doses per day (for IR) or once daily (for ER) | 5 to 20 mcg/mL (15 to 59 micromol/L) | Serum electrolytes, CBC/plts, and hepatic transaminases when maximum dose reached or at 36 months. |
| Valproate (approved for use in patients ≥10 years; increased risk of hepatotoxicity in younger children, especially <2 years) | 10 to 15 mg/kg/day | 30 to 60 mg/kg/day | In 3 divided doses per day (for IR), or 2 divided doses per day (for enteric coated), or once daily (for ER) | 50 to 125 mcg/mL (346 to 875 micromol/L) | VPA level 1 to 2 weeks after initial dose; hepatic transaminases every 1 to 2 months. Recommendations for baseline metabolic screening if used in children <3 years are provided in accompanying text. |
| Zonisamide (approved for use in patients >16 years) | <5 years: 1 to 2 mg/kg/day ≥5 years: 0.5 to 1 mg/kg/day (maximum 100 mg/day) | 5 to 8 mg/kg/day (usual maximum 500 mg/day; higher doses in adults have not provided added benefit) | In 1 or 2 divided doses per day | Not well established; 10 to 20 mcg/mL has been proposed | Serum electrolytes at baseline and when maximum dose is reached or at 3 to 6 months. |
IR: immediate release; ER: extended release; CBC: complete blood count; plts: platelets; VPA: valproate.
¶ 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 ASMs 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.
§ Tiagabine dose recommendations are based on US available product and limited experience in children <12 years old. Tiagabine preparations available in countries other than the US are labeled differently and recommendations may not be comparable; consult local product information.آیا می خواهید مدیلیب را به صفحه اصلی خود اضافه کنید؟
