In this article, we will discuss Anticonvulsants-Dosage (Part-III). So, let’s get started.
Anticonvulsants
Gabapentin Initial dose 15 mg/kg/day q 8 hr, increase over several days to 30-60 mg/kg/day q 8 hr.
Adult dose: Initially 300 mg once daily on day 1, 300 mg q 12 hr on day 2, 300 mg q 8 hr on day 3, then increase by 300 mg increments in 3 divided doses; maximum dose is 800 mg q 8 hr.
Indication: Add on therapy for partial seizures, diabetic neuropathy and postherpetic neuralgia. Avoid below 12 years.
(Gabapin, neurontin caps 300 mg, 400 mg).
Lacosamide Starting dose 1 mg/kg/day q 12 hr. Usual maintenance dose 2-12 mg/kg/day q 12 hr.
Adult dose: Initial dose 50 mg twice daily, with weekly increments of 100 mg/day. The usual maintenance dose is 200 to 400 mg/day.
Indication: Adjunctive therapy for refractory partial-onset seizures and diabetic neuropathy.
Side Effects: Dizziness, headache, nausea, vomiting, ataxia, tremors, diplopia, fatigue, and somnolence.
(Lacasa, lacosam, lacoset tablets, 50 mg, 100 mg, 150 mg, 200 mg)
Lamotrigine Start with a low dose and increase gradually. Slow dose titration is necessary to reduce incidence of skin rash. Without sodium valproate or other enzyme inducers, 5–10 mg/kg/day q 12 hr p.o., with sodium valproate 0.5-5 mg/kg/day q 24 hr oral; with enzyme inducing antiepileptic drugs start with 2 mg/kg/day and increase to 5-15 mg/kg/day q 12 hr. Maximum dose 15 mg/kg/day or 400 mg/day.
Adult dose: As a monotherapy 25 mg once daily for 2 weeks, then 50 mg daily for 2 weeks, then increase by 50-100 mg every 1-2 weeks till seizures are controlled; usual dose is 100-200 mg/day. Co-administration with valproate; initially 25 mg on alternate days for 2 weeks then 25 mg daily, then increase by 25-50 mg every 1-2 weeks till response occurs, usual dose 100-200 mg per day. When co-administered with enzyme inducing drugs, initial dose is 50 mg daily for 2 weeks then 50 mg q 12 hr for 2 weeks, then increase by up to 100 mg every 1-2 weeks till response occurs; usually 200-400 mg daily q 12 hr. Maximum dose 800 mg/day.
C/I: Significant hepatic disease.
Side Effects: Life-threatening hypersensitivity skin rash, dizziness,
diplopia and aseptic meningitis.
Indication: Add-on therapy for partial seizures, Lennox-Gastaut syndrome (LGS), generalized seizures, atypical absence attacks, atonic seizures and myoclonic seizures. It may be used as a first line drug for treatment of absence seizures (Loose syndrome). It is useful for prevention of mood swings in bipolar disorder in adults.
(Lametec tabs 5 mg, 25 mg; lamitor tabs 25 mg, 50 mg, 100 mg).
Levetiracetam Start with 10 mg/kg/day q 12 hr, increase by 10 mg/kg every 2 weeks up to 60 mg/kg/day. It can be given to newborn babies.
Adult dose: 1-3 gm/day q 12 hr.
Adverse effects: Dizziness, drowsiness, tiredness, weakness, skin rash, anorexia, stuffy nose, irritable, depression, suicidal tendencies.
Indication: Add-on therapy for refractory partial seizures, generalized tonic clonic seizures, absence attacks and astatic myoclonic seizures (Loose syndrome).
(Levroxa, levera, levecetam, levilex, keppra tabs 250 mg, 500 mg, 750 mg; torleva, levipil, elepsia, levilex tabs 250 mg, 500 mg, 750 mg, 1000 mg; syrup levroxa, levilex, keppra 100 mg/ml).