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©2013 UpToDate ® Print Email Drug therapy for seizures in children Drug Dose Blood level Laboratory Starting Maintenance Carbamazepine 10-20 mg/kg/day 10-35 mg/kg/day 4-12 mcg/mL CBC after initial 4-6 weeks, then prn. If initial WBC low (particularly AMC) repeat as needed Clobazam Children <2 y.o. 0.5-1 mg/kg/day 0.5-1 mg/kg/day (max 40 mg/day) Not established Routine lab tests not recommended Children 2-16 y.o. 5 mg/day Clonazepam 0.01-0.03 mg/kg/day 0.1-0.2 mg/kg/day Not used If clinically indicated (bruising, unexplained fevers, etc) Clorazepate 0.3 mg/kg 0.5-3.0 mg/kg Not used Not required Ethosuximide 15 mg/kg/day 15-40 mg/kg/day 40-100 mcg/mL (any increase to 150) CBC/plts after first 1-2 months, prn thereafter Felbamate 15 mg/kg/day 15-45 mg/kg/day 50-100 mcg/mL CBC/plts every 2-4 weeks, hepatic function tests every month Gabapentin 10-15 mg/kg/day 40-50 mg/kg/day Not established (probably 7-12 mcg/mL) CBC/plts every 3 months for first 6 months, chemical panel prn (routine monitoring may not be necessary) Lamotrigine+ Monotherapy 0.3 mg/kg/day 4.5-7.5 mg/kg/day 4-15 mcg/mL CBC/plts every 3 months for first 6 months, chemical panel prn (routine monitoring may not be necessary) Add to VPA 0.15 mg/kg/day 1-5 mg/kg/day Add to inducer (PB, CBZ, PHT) 0.6 mg/kg/day 5-15 mg/kg/day Levetiracetam 20 mg/kg/day 40-60 mg/kg/day Not established Routine lab tests not recommended +: dosing for children 2-12 years of age; AMC: absolute monocyte count; CBC: complete blood count; CBZ: carbamezepine; max: maximum; PB: phenobarbital; PHT: phenytoin; plts: platelets; VPA: valproate; y.o.: years old

©2013 UpToDate ® Print Email Drug therapy for seizures in children Drug Dose Blood level Laboratory Starting Maintenance Carbamazepine 10-20 mg/kg/day 10-35 mg/kg/day 4-12 mcg/mL CBC after initial 4-6 weeks, then prn. If initial WBC low (particularly AMC) repeat as needed Clobazam Children <2 y.o. 0.5-1 mg/kg/day 0.5-1 mg/kg/day (max 40 mg/day) Not established Routine lab tests not recommended Children 2-16 y.o. 5 mg/day Clonazepam 0.01-0.03 mg/kg/day 0.1-0.2 mg/kg/day Not used If clinically indicated (bruising, unexplained fevers, etc) Clorazepate 0.3 mg/kg 0.5-3.0 mg/kg Not used Not required Ethosuximide 15 mg/kg/day 15-40 mg/kg/day 40-100 mcg/mL (any increase to 150) CBC/plts after first 1-2 months, prn thereafter Felbamate 15 mg/kg/day 15-45 mg/kg/day 50-100 mcg/mL CBC/plts every 2-4 weeks, hepatic function tests every month Gabapentin 10-15 mg/kg/day 40-50 mg/kg/day Not established (probably 7-12 mcg/mL) CBC/plts every 3 months for first 6 months, chemical panel prn (routine monitoring may not be necessary) Lamotrigine+ Monotherapy 0.3 mg/kg/day 4.5-7.5 mg/kg/day 4-15 mcg/mL CBC/plts every 3 months for first 6 months, chemical panel prn (routine monitoring may not be necessary) Add to VPA 0.15 mg/kg/day 1-5 mg/kg/day Add to inducer (PB, CBZ, PHT) 0.6 mg/kg/day 5-15 mg/kg/day Levetiracetam 20 mg/kg/day 40-60 mg/kg/day Not established Routine lab tests not recommended +: dosing for children 2-12 years of age; AMC: absolute monocyte count; CBC: complete blood count; CBZ: carbamezepine; max: maximum; PB: phenobarbital; PHT: phenytoin; plts: platelets; VPA: valproate; y.o.: years old Drug therapy for seizures in children (continued) Drug Dose Blood level Laboratory Starting Maintenance Oxcarbazepine 8-10 mg/kg/day 30-40 mg/kg/day 8-35 mcg/mL CBC/plts every 3 months for first 6 months, chemical panel prn (routine monitoring may not be necessary) Phenytoin, fosphenytoin (intravenous) 5 mg/kg/day 4-8 mg/kg/day (older children, adolescents 300 mg/day) 10-20 mcg/mL Routine lab tests not recommended Status elilepticus 20 mg/kg (fosphenytoin) Phenobarbital 3-4 mg/kg/day Infants 5-6 mg/kg/day 10-40 mcg/mL Routine lab tests not recommended Children 1-5 y.o. 6-8 mg/kg/day Primidone 1-2 mg/kg/day 10-25 mg/kg/day 5-12 mcg/mL (phenobarbital level 1.2 x higher) Routine lab tests not recommended Rufinamide 10 mg/kg/day 45 mg/kg/day Not established Routine lab tests not recommended Topiramate 1-3 mg/kg/day 5-9 mg/kg/day 5-20 mcg/mL CBC/plts, hepatic function tests, serum K when maximum dose reached or at 3-6 months Tiagibine <12 years 0.5 mg/kg/day

1-2 mg/kg/day 10-25 mg/kg/day 5-12 mcg/mL (phenobarbital level 1.2 x higher) Routine lab tests not recommended Rufinamide 10 mg/kg/day 45 mg/kg/day Not established Routine lab tests not recommended Topiramate 1-3 mg/kg/day 5-9 mg/kg/day 5-20 mcg/mL CBC/plts, hepatic function tests, serum K when maximum dose reached or at 3-6 months Tiagibine <12 years 0.5 mg/kg/day Weekly increase 0.5-1 mg/kg/day with max 4-8 mg/kg/day (3-4 divided daily doses) Not established Routine lab tests not recommended >12 years 4 mg/day Increase 4 mg/week to max 32 mg/day (2-4 divided daily doses) Valproate 10-15 mg/kg/day 30-60 mg/kg/day 50-150 mcg/mL Hepatic function tests every 1-2 months Zonisamide 1-2 mg/kg/day 5-8 mg/kg/day 10-40 mcg/mL Serum electrolytes when maximum dose is reached or at 3-6 months CBC: complete blood count; max: maximum; plts: platelets; y.o.: years old