Patient Information on FDA Approved Antiepileptic Medications (Last Edited May 2010)

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

Drug (brand Indication Common doses Common Side Significant Drug Over the name in Effects Interactions Counter, parenthesis) herbal, food interactions Carbamazepin Partial seizures with < 6 years old Dizziness, Additive effects Avoid alcohol, e (Tegretol) complex symptoms, 10- drowsiness, with other CNS grapefruit generalized tonic- 20mg/kg/day* headache, nausea, depressants and juice, evening clonic seizures (grand 6-12 years old vomiting, muscle alcohol. May primrose, mal) and mixed 100mg twice pain, infection, and diminish effect of valerian, St. seizures daily tingling acetaminophen John’s wort, > 12 years old kava kava, 800- gota kola 1200mg/day in divided doses Ethosuximide absence seizures 3-6 years old Dizziness, Additive effects Avoid alcohol, (Zarontin) (petit mal) 15- drowsiness, fatigue, with other CNS St. John’s 40mg/kg/day* headache, nausea, depressants and wort in 2 doses diarrhea alcohol. > 6 years old 20- 40mg/kg/day* in 2 divided doses Felbamate Not first line Dosage is Headache, fever, Additive effects Avoid alcohol, (Felbatol) antiepileptic (used in started low and dizziness, nausea, with other CNS evening patients who have titrated up over vomiting, depressants and primrose failed alternative 3 weeks to constipation alcohol. Oral therapies), has therapeutic contraceptive orphan drug status range of 2400- failure is possible for partial and 3600mg/day in generalized seizures divided doses associated with (other Lennox-Gastaut antiepileptic syndrome in children medication doses are reduced as Felbamate is increased) Gabapentin Partial seizures with 3-12 years old Drowsiness, Additive effects Avoid alcohol, (Neurontin) or without secondary 10 to dizziness, fatigue, with other CNS evening generalization in 40mg/kg/day* viral infection, depressants and primrose, patients > 12 years in 3 divided fever, tremor, alcohol. Ketorolac valerian, St. old, partial seizures doses, > 12 diarrhea, nausea, and mefloquine John’s wort, in 3-12 year olds years old up to vomiting (also may diminish kava kava, 1800mg/day in hostility in 3-12 effect. gotu kola 3 divided doses year olds) Lacosamide Adjunctive therapy in Initial: 50 mg Nausea, vomiting, Carbamazepine, Avoid alcohol (Vimpat) treatment of partial- twice daily; dizziness, fosphenytoin, onset seizures may increase to headache, loss of phenobarbital and 100mg/day at ability to control phenytoin may weekly muscle movement, decrease serum intervals double vision, concentration of fatigue lacosamide Maintenance dose: 200- 400mg/day Lamotrigine Generalized seizures Dose is titrated Headache, Additive effects Avoid alcohol (Lamictal) of Lennox-Gastaut depending on dizziness, with other CNS and evening syndrome, partial the drowsiness, nausea, depressants and primrose seizures patients 2 combination visual disturbances, alcohol. Oral years or older therapy and runny nose, allergic contraceptive may age of the rash (in some cases diminish effect. individual rash is severe) Barbiturates may patient. Max increase the for 2-12 year metabolism olds is 400mg/day and over 12 years old max dose is 700mg/day Levetiracetam Adjunct therapy in 4-15 years old Behavioral Additive effects Avoid alcohol (Keppra) treatment of partial 10 to symptoms with other CNS onset, myoclonic, 30mg/kg/day* (agitation, depressants and and/or primary in 2 doses, aggression, anger, alcohol. Ketorolac generalized tonic- over 15 year anxiety, and mefloquine clonic seizures. olds max dose nervousness etc.) may diminish of 3000mg/day drowsiness, effect. in 2 divided headache, doses vomiting, runny nose, anorexia, cough, accidental injury Oxcarbazepine Partial seizures in Dosage is Dizziness, May decrease Avoid alcohol, (Trileptal) patients 2 years or highly variable drowsiness, metabolism of oral evening older with epilepsy based on headache, fatigue, contraceptive. primrose, combination vertigo, vomiting, Contraceptive valerian, St. therapy, nausea, abdominal failure is possible. John’s wort, patient’s age pain, visual kava kava, and patient’s disturbances gotu kola weight Dose for adults can reach 2400mg/day but most patients will not be able to tolerate due to side effects Phenobarbital Generalized tonic- Infants to age Drowsiness, Additive effects Avoid alcohol, clonic (grand mal) 12 with dizziness, with other CNS evening and partial seizures seizures confusion, depressants and primrose, receive 4 to agitation, alcohol. May valerian, St. 8mg/kg/day* in nervousness, diminish effect of John’s wort, 1 or 2 doses headache, acetaminophen. kava kava, > 12 years old insomnia, Contraceptive gotu kola. receive 1 to nightmares, failure is possible. Phenobarbital 3mg/kg/day * hallucinations, May increase may reduce in divided anxiety, rash, warfarin vitamin D and doses of 50- nausea, vomiting, metabolism. calcium 100mg/dose constipation levels. Phenytoin Generalized tonic- A one time Swollen gums, Additive effects Do not take (Dilantin) clonic (grand mal), loading dose of dizziness, with other CNS within 2 complex partial 15-20mg/kg* drowsiness, blurred depressants and hours before seizures, seizures for patients vison, slurred alcohol. May or after food, following head less than 16 speech, headache, diminish effect of do not give 2 trauma/neurosurgery years of age insomnia rash, acetaminophen. within 2 and 15 to nausea, vomiting, Contraceptive hours before 20mg/kg* for constipation failure is possible. or after 16 years and enteral older is given. nutrition. Maintenance Calcium, folic dose for 6 acid, vitamin month olds to D levels may 16 years range be reduced between 6 and with 10mg/kg/day* Phenytoin in 2 or 3 use. Avoid divided doses. alcohol, Age16 or older evening dose is 5 to primrose, 6mg/kg/day* in valerian, St. 2 or 3 divided John’s wort, doses. kava kava, gota kola Pregabalin Partial onset seizures 150mg/day in 2 Swollen legs, Additive effects Avoid alcohol, (Lyrica) in adults or 3 divided Dizziness, with other CNS valerian, St. doses (max drowsiness, depressants John’s wort, dose is blurred vision, (opiods, ethanol, kava kava, 600mg/day) weight gain other sedatives), gotu kola weight gain may be additive with pioglitazone or rosiglitazone Primidone Grand mal, Children less Drowsiness, visual Additive effects Avoid alcohol, (Mysoline) psychomotor, focal than 8 years disturbances, with other CNS valerian, St. seizures old 10 to headache, depressants and John’s wort, 25mg/kg/day* dizziness, nausea, alcohol. Ketorolac kava in 3 or 4 doses, vomiting and mefloquine kava,gota > 8 years of age may diminish kola. Patient 750 to effect. Folic acid needs to 1500mg/day in may decrease maintain a 3 to 4 divided concentration. protein rich doses diet while taking Primidone Rufinamide Partial onset Children ≥4 Headache, Additive effects Avoid (Banzel) seizures, Lennox- years: Oral: dizziness, fatigue, with other CNS alcohol , Gastaut syndrome Initial: 10 blurred vision, depressants and evening mg/kg/day in 2 nausea, vomiting, alcohol. May primrose equally divided constipation, rash decrease doses; increase concentrations of dose by ~10 Estradiol. 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 Severe myoclonic 50 to Nausea and/or None known Avoid evening (Diacomit) epilepsy of infancy 100mg/kg/day* vomiting (especially primrose, (Dravet’s syndrome) in 2 or 3 when given with ginkgo divided doses sodium valproate) with meals (max dose is 4gm per day) Tiagabine Adjunctive therapy in Dosing regime Confusion, difficulty Additive effects Avoid alcohol, (Gabitril) adults and children based on liver speaking/stuttering, with other CNS St John’s ≥12 years of age in function drowsiness, tingling depressants and wort, the treatment of sensation in alcohol. Ketorolac valerian, kava partial seizures hands/feet and mefloquine kava, gotu may diminish kola effect.

Topiramate Partial onset Children 10 Dizziness, Additive effects Avoid alcohol, (Topamax) seizures, primary years or drowsiness, with other CNS evening generalized tonic- younger max of nervousness, depressants and primrose. clonic seizures, 400mg/day in 2 memory and alcohol. Ketorolac Patients on seizures associated doses. speech problems, and mefloquine with Lennox-Gastaut Adolescents fatigue, difficulty may diminish ketogenic diet syndrome and adults concentrating, effect. may have usual depression, Contraceptive increased maintenance confusion, failure is possible possibility of dose is decreased serum acidosis. 400mg/day in 2 bicarbonate levels, doses. nausea, weight loss, anorexia Valproic Acid Complex partial Patients 10 Headache, Additive effects Avoid alcohol, and derivatives seizures, simple and years or older drowsiness, with other CNS carbonated (Depakene, complex absence 30- dizziness, pain, depressants and beverages Depakote) seizures, mixed 60mg/kg/day* nausea, vomiting, alcohol. Aspirin and evening seizure types that in 1 to 3 diarrhea, weight causes an increase primrose. include absence divided doses. loss, hair loss, in concentrations seizures insomnia, of Valproic Acid. nervousness, Some antibiotics tremor, abdominal lead to an increase pain, visual in concentrations disturbances of Valproic Acid. Vigabatrin Complex partial Children: 40 Rash, increased Additive effects Avoid alcohol, (Sabril) seizure, refractory mg/kg/day weight, viral with other CNS evening seizure divided twice disease, joint pain, depressants and primrose, daily; confusion, alcohol. Ketorolac valerian, St. maintenance dizziness, and mefloquine John’s wort, dosages based headache, may diminish kava kava, on patient sleepiness, memory effect. Droperidol and gotu kola. weight. impairment, tremor and Adults: 500 mg methotrimeprazine twice daily and may enhance CNS increase daily depressant effect. dose by 500 mg Vigabatrin may at weekly increase serum intervals to a concentration of target dose of phenytoin and 3g/day. fosphenytoin. Note: only available through a restricted distribution program called SHARE

Zonisamide Partial seizures in 100 to Drowsiness, Additive effects Avoid alcohol. (Zonegran) patients 16 years or 400mg/day is dizziness, weight with other CNS older the normal loss, headache, depressants and dose range. irritability/agitation alcohol. Ketorolac Max is and mefloquine 600mg/day but may diminish doses above effect 300mg/day have 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.

Click here for Anti-Seizure Medication and Their Side Effects