Anticonvulsants-Dosage (Part-IV)

In this article, we will discuss Anticonvulsants-Dosage (Part-IV). So, let’s get started.

Anticonvulsants

Lorazepam 0.05-0.1 mg/kg/dose (maximum 4 mg) over 2-5 min IV or IM, may repeat once after 10-15 min. Use 0.05 mg/kg/dose q 4-8 hr for sedation oral, IV or IM. The risk of hypotension and respiratory depression is low. The duration
of effect is longer as compared to diazepam.

Adult dose: For anxiety, 2-3 mg daily in divided doses, lot insomnia 1-2 mg at bedtime.

Indication: Uncontrolled status epilepticus, postanoxic myoclonus.

C/I: Narrow angle glaucoma, respiratory depression, and sleep apnea.

(Ativan, calmese, trapex, larpose, lorazine tabs 1 mg, 2 mg; inj calmese 2 mg per ml; inj loripam 10 mg/ml).

Midazolam Status epilepticus 0.2 mg/kg IV or IM bolus:ventilation, 0.05-0.15 mg/kg/dose q 1-2 hr or continuous followed by 0.1-0.2 mg/kg/hr. For sedation during mechanical infusion at a rate of 0.2-1.0 μg/kg/min for neonates and 0.5-3.0 μg/kg/min for infants and children. For sedation,
0.05-0.1 mg/kg over 2 min, may repeat 0.05 mg/kg in 2-3 min intervals up to a total dose of 0.2 mg/kg. Onset of action
within 1-5 min. Intranasal 0.3 mg/kg (5 mg/ml IV preparation), buccal route 0.3 mg/kg may be used for acute seizure control till intravenous access is established. For other details, refer to section on Tranquillisers, Hypnotics, Sedatives and Anti-depressants.

Adult dose: 0.07-0.08 mg/kg IM and 0.01-0.07 mg/kg IV.

C/I: Respiratory depression, shock, coma, and acute narrow angle glaucoma.

Caution: Avoid co-administration with erythromycin which may increase the depth and duration of sedation.

(Fulsed, mezolam, midosed, shortal 1 mg/ml in 5 ml and 10 ml vials and 5 mg/ml in 1 ml ampoule, zapiz 0.25 mg and 0.5 mg sublingual tabs, insed nasal spray or atomizer provides 0.5 mg midazolam per metered dose, midacip provides 1.25 mg/metered dose).

Nitrazepam 0.25-10 mg/kg/day q 12 hr or single dose oral.

Adult dose: 5-10 mg at bedtime.

C/I: Myasthenia gravis, porphyria, and acute narrow angle glaucoma.

Indication: Myoclonus, partial epilepsy, infantile spasms and insomnia.

(Nitravet, nitravan tabs 2.5 mg, 5 mg, 10 mg; nitrosun, nipan tabs 5 mg, 10 mg; hypnotex caps 5 mg, 10 mg).

Oxcarbazepine It is a keto analogue of carbamazepine. Start at 8-10 mg/kg/day b.d. to a maximum dose of 30 mg/kg/day (up to 1800 mg/day). Increase by increments of 10 mg/kg weekly.

Adult dose: Initially 300 mg q 12 hr, increase weekly by 600 mg/day. Usual dose is 600-2400 mg per day.

Indication: It is a first line drug for treatment of simple and complex partial seizures. Add-on drug for partial and generalized tonic-clonic seizures.

Caution: Avoid <6 yr age; use half of initial dose in renal failure.

Side Effects: Fatigue, headache, dizziness, ataxia, hyponatremia, and skin rashes.

(Oxcarb, trioptal, oxep, oxrate, zenoxa, oleptal, oxetol, selzic, vinlep tabs 150 mg, 300 mg, 450 mg, 600 mg; syrup selzic and oxeptal 300 mg/5 ml).

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