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©2013 UpToDate ® Print Email Treatment of partial seizures including secondarily generalized Drugs Total daily adult dosage* Total daily pediatric dosage* Usual dosing interval Starting Maintenance Starting Maintenance Partial, including secondarily generalized Drugs of choice: Carbamazepine • 200-400 mg 800-1800 mg 10-20 mg/kg 10-30 mg/kg Bid/tid or Lamotrigine 12.5-50 mg Δ 100-700 mg Δ 0.15-0.6 mg/kg ◊ 1-15 mg/kg ◊ Bid or Oxcarbazepine 300-600 mg 900-2400 mg 8-10 mg/kg 6-51 mg/kg Bid or Levetiracetam § 500-1000 mg 1000-3000 mg 10-20 mg/kg 40-60 mg/kg Bid Some alternatives: Topiramate 25-50 mg 200-400 mg 1-3 mg/kg 5-9 mg/kg Bid Valproate • 500-1000 mg 1000-3500 mg 10-15 mg/kg 15-60 mg/kg Once/bid/tid¥ Gabapentin § 900-1200 mg 1800-6400 mg 10-15 mg/kg 25-40 mg/kg ������ Tid Zonisamide § 100 mg 100-600 mg 1-2 mg/kg ������ 6-8 mg/kg ������ Once/bid Phenytoin • 300-400 mg 300-400 mg** 5 mg/kg 4-8 mg/kg Once/bid Pregabalin § 150 mg 150-600 mg - - Bid/tid Absence Drugs of choice: Ethosuximide 500 mg 750-1500 mg 10-15 mg/kg 20-40 mg/kg Bid or Valproate • 500-1000 mg 1000-3500 mg 10-15 mg/kg 15-60 mg/kg Once/bid/tid ¥ Alternatives: Lamotrigine •• 12.5-50 mg Δ 100-700 mg Δ 0.15-0.6 mg/kg ◊ 1-15 mg/kg ◊ Bid Clonazepam 1.5 mg 1.5-8 mg 0.01-0.03 mg/kg 0.05-0.2 mg/kg Bid/tid Zonisamide •• 100 mg 100-600 mg 1-2 mg/kg ������ 6-8 mg/kg ������ Once/bid Levetiracetam •• 500-1000 mg 1000-3000 mg 10-20 mg/kg 40-60 mg/kg Bid * Dosage may need to be adjusted for renal or hepatic impairment, or concomitant use of other drugs. • Measurement of serum concentrations may be useful to guide therapy. Usual therapeutic serum concentrations are: carbamazepine 6-12 mcg/mL, phenobarbital 15-35 mcg/mL, phenytoin 10-20 mcg/mL, valproate 50-120 mcg/mL. Some patients achieve complete seizure control at lower concentrations, and occasional patients need higher concentrations. Δ Starting dosage is 25 mg every other day and maintenance dosage is 100 to 400 mg daily when given with valproate. ◊ Starting dosage is 0.15 mg/kg daily and maintenance dosage is 1 to 5 mg/kg daily when given with valproate. § Only FDA-approved for adjunctive therapy. ¥ Once daily for the extended-release formulation (Depakote ER). ‡ For children more than 5 years old, 25 to 35 mg/kg/day. For children 3-4 years old, 40 mg/kg/day. † Not FDA-approved for pediatric use. ** Adjustments in maintenance dosage above 300 mg/day for adults should usually be made in 25- or 30-mg increments because metabolism becomes saturated. •• Not FDA-approved for this indication.

* Dosage may need to be adjusted for renal or hepatic impairment, or concomitant use of other drugs. • Measurement of serum concentrations may be useful to guide therapy. Usual therapeutic serum concentrations are: carbamazepine 6-12 mcg/mL, phenobarbital 15-35 mcg/mL, phenytoin 10-20 mcg/mL, valproate 50-120 mcg/mL. Some patients achieve complete seizure control at lower concentrations, and occasional patients need higher concentrations. Δ Starting dosage is 25 mg every other day and maintenance dosage is 100 to 400 mg daily when given with valproate. ◊ Starting dosage is 0.15 mg/kg daily and maintenance dosage is 1 to 5 mg/kg daily when given with valproate. § Only FDA-approved for adjunctive therapy. ¥ Once daily for the extended-release formulation (Depakote ER). ‡ For children more than 5 years old, 25 to 35 mg/kg/day. For children 3-4 years old, 40 mg/kg/day. † Not FDA-approved for pediatric use. ** Adjustments in maintenance dosage above 300 mg/day for adults should usually be made in 25- or 30-mg increments because metabolism becomes saturated. •• Not FDA-approved for this indication. Reproduced with permission from: Drugs for Epilepsy. Treatment guidelines from The Medical Letter 2008; 6(70): 37-46. Copyright ©2008 The Medical Letter.