In this article, we will discuss Anticonvulsants-Dosage (Part-II). So, let’s get started.
Anticonvulsants
Diazepam In status epilepticus above one month of age: 0.2-0.5 mg/kg/dose IV, may be repeated at 3-5 minute intervals. May administer IM if IV administration not possible but its efficacy is diminished and absorption is erratic. Maximum total dose <5 yr: 5 mg, >5 yr: 10 mg per-rectal dose 0.3-0.5 mg/kg/dose. Rapid IV bolus may cause apnea. For symptomatic relief of anxiety, sedation and muscle relaxation, oral dose 0.1-0.3 mg/kg/day q 48 hr adjusted to clinical response. For neonatal tetanus, 0.5-5.0 mg/kg IV every 2 to 4 hours.
Adult dose: 5–50 mg/day in divided doses.
Caution: Flumazenil, a benzodiazepine antagonist, can reverse sedation but it may not reverse respiratory depression.
Indication: Status epilepticus, muscle spasms due to tetanus, febrile seizures, and anxiety states.
C/I: Myasthenia gravis, acute narrow angle glaucoma, and paralytic ileus.
(Valium, placidox, anaxol tabs 2 mg, 5 mg, 10 mg; calmod, paxum tab 5 mg; calmpose tabs 5 mg, 10 mg; susp calmpose 2 mg per 5 ml; inj calmpose, paxum 10 mg per 2 ml ampoule; Direc 2 rectal diazepam 2 mg/ml; Rec-DZ rectal solution 2 mg/25 ml and 5 mg/5 ml).
Ethosuximide 15 mg/kg/day q 12 hr. The dose is increased every week till control of absence seizures is achieved. Usual maintenance dose 20-40 mg/kg/day q 12 hr, maximum dose <6 yr: 500 mg/day and >6 yr: 1500 mg/day.
Adult dose: Initial dose 500 mg daily, increase by 250 mg every 4-7 days to a maximum dose of 1.0-1.5 gm daily.
Indication: Absence attacks.
(Zarontin tab 250 mg; syrup 250 mg per 5 ml).
Fosphenytoin sodium It is a water-soluble prodrug of phenytoin and 1.5 mg fosphenytoin is equivalent to 1.0 mg phenytoin (expressed as phenytoin equivalents, PE).
Loading dose is 15-20 mg/kg IV. Maintenance 4-6 mg/kg/day IV/IM. Maximum IV infusion rate 3 mg/kg/min.
Adult dose: 15 mg/kg IV at a rate of 100-150 mg/min.
Indication: Status epilepticus, tonic-clonic seizures, and partial seizures.
C/I: Porphyria.
(Inj fosolin 2 ml ampoule, 10 ml vial; inj fosphen 2 ml ampoules containing 50 mg phenytoin equivalent per ml).