| Medication |
Year approved |
Mechanism |
Uses |
Dosing |
Side Effects |
| Phenobarbital |
1912 |
GABA agonist |
status, neonatal seizures |
load 20 mg/kg; maint infants: 5-8 mg/kg/d; 1-5 yrs: 6-8 mg/kg/d; 5-12 yrs: 4-6 mg/kg/d |
Sedation, respiratory depression, lowered IQ |
| Dilantin (phenytoin) |
1938 |
inhibits Na+ channels |
Partial and generalized epilepsy, status |
load 20 mg/kg; begin 5 mg/kg/d div BID, increase up to 10 mg/kg/d under 3 yrs, 7 mg/kg/d 10-16 yrs |
ataxia, nystagmus, osteoporosis, gingival hyperplasia, N/V, rash, headache, vitamin K/folate deficiency; levels vary with albumin (corrected=measured/(0.2 x albumin +0.1)), drug interactions |
| Fosphenytoin |
|
? Na+ channels (phenytoin prodrug) |
Status |
load 20 mg/kg |
Can be infused quicker than dilantin |
| Zarontin (Ethosuximide) |
1957 |
unknown; may inhibit Na+ channels |
Absence seizures |
<6 yrs: 15-40 mg/kg/d div BID; >6 yrs: 250 mg BID, up to 1.5 g/d |
sedation, dizziness, lethargy |
| Tegretol (carbamazepine) |
1974 |
blocks Na+ channels |
Partial seizures: can worsen generalized seizures |
<6 yrs: start 10-20 mg/kg/d div TID, max 35 mg/kg/d; 6-12 yrs: 100 mg BID, max 1 g/d |
hyponatremia, dose-related dizziness, ataxia, idiosyncratic aplastic anemia, thrombocytopenia, agranulocytosis, Stevens-Johnson, rare hepatotoxicity |
| Trileptal (oxcarbamazepine) |
2000 |
? Na+ channels, analog of carbamazepine |
Partial seizures; can worsen generalized seizures |
10 mg/kg/d titrate to 30 |
Same as carbamazepine, but overall better tolerated with fewer idiosyncratic reactions |
| Lamictal (Lamotrigine) |
1994 |
inhibits Na+ channels, glutamate release |
partial, generalized, absence seizures, JME, Lennox-Gastuat |
0.15 mg/kg, increase q1-2 wks to 1-5 mg/kg |
Rash with rapid titration, may result in Stevens-Johnson, headache, ataxia, diplopia, GI disturbance, tremor |
| Keppra (levitiracetam) |
2000 |
unknown, may inhibit Ca++ release |
partial, generalized: GTCs, JME |
20-60 mg/kg/d div BID |
somnolence, behavioral, dizziness; Note: no drug interactions |
| Topamax (Topiramate) |
1996 |
multiple: inhibits Na+ channels,
? GABA,
? glutamate receptor |
Partial, generalized, Lennox-gastaut, infantile spasms, migraine |
Start 1-3 mg/kg/d, increase to 5-9 mg/kg/d div BID |
Ataxia, poor concentration anorexia, dizziness, paresthesias, somnolence, depression, nervousness, renal calculi |
| Depakote (Valproic acid) |
1978 |
? GABA synthesis,
? Na+ channels |
Generalized, partial epilepsies, absence seizures, JME, Lennox-gastaut, infantile spasms |
Start 10-15 mg/kg/d, increase to maintenance 30-60 mg/kg/d div BID or TID |
N/V, tremor, sedation, confusion, irritability, weight gain, hepatotoxicity, hyperammonemia, hypocarnitinemia, bone marrow suppression, pancreatitis |
| Benzodiazepines |
|
GABA agonist |
Status, generalized, partial epilepsies |
|
Sedation, respiratory depression, paradoxical reaction |
| Felbemate |
1993 |
inhibits glutamate |
Severe, refractory partial epilepsy; Lennox-gastaut |
2-14 yrs: begin 15 mg/kg/d, max 45 mg/kg/d |
insomnia, weight loss, nausea, dizziness, ataxia. Limited use now because associated with aplastic anemia, hepatic failure |
| Gabitril (Tiagabine) |
1997 |
blocks reuptake of GABA |
Partial, secondarily generalized; can worsen generalized epilepsy |
12-18 yrs: start 4 mg/day, increase to max 32 mg/day |
dizziness, asthenia, tremor, somnolence, overdose may cause status |
| Sabril (Vigabatrin) |
|
inhibits GABA metabolism |
Partial epilepsy, Infantile spasms |
start 40 mg/kg/day; infantile spasms: begin
50-100 mg/kg/day |
drowsiness, depression. Not available in the U.S.: causes peripheral retinal atrophy; can cause absence status |
| Neurontin (Gabapentin) |
1993 |
enhances GABA synthesis |
Partial seizures, modest efficacy; also pain, migraine |
3-12 yrs: start 10-15 mg/kg/d; >12 yrs: start 300 mg TID |
mild: somnolence, dizziness, ataxia, tremor, fatigue |
| Corticotropin (Acthar, ACTH) |
|
unknown, may suppress CRH |
Infantile spasms |
0.25 mg x 2 wks, then taper over 6 wks |
weight gain, hypertension, infection |
| Zonegran (Zonisamide) |
2000 |
inhibits Na+ channels, other mechanisms? |
Partial seizures, myoclonus, infantile spasms |
start 1-2 mg/kg/d, increase to 5-8 mg/kg/d; higher doses for infantile spasms |
Dizziness, anorexia, HA, ataxia, confusion, irritability, tremor, weight gain, idiosyncratic rashes, Note: a sulfa med |
