Suggested Adult Antiseizure Medication Dosing TABLE 10-3

Initial target total daily dose;

Antiseizure Starting total daily usual maximal dose (for some
medication dose Titration antiseizure medications)a
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Brivaracetam 50-100 mg 50 mg as needed 100 mg; maximum 200 mg

Carbamazepine 200 mg 200 mg every 3 days 400-800 mg

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Cannabidiol 5 mg/kg Increase by 5 mg/kg every week as needed 10 mg/kg; maximum 20 mg/kg

Cenobamate 12.5 mg Increase to 25 mg after 2 weeks, 50 mg 100-200 mg; maximum 400 mg

2 weeks later, then by 50 mg/2 wk

Clobazam 10 mg 10 mg/2 wk as needed 20-40 mg

Eslicarbazepine 400 mg 400 mg/wk as needed 800-1200 mg; maximum

acetate 1600 mg

Ethosuximide 500 mg 250 mg/wk as needed 750 mg; maximum 1500 mg

Felbamate 1200 mg 600-1200 mg/wk 3600 mg

Gabapentin 300-400 mg 300-400 mg/d 1200 mg; maximum 4800 mg

Lacosamide 100 mg 100 mg/wk as needed 200 mg; maximum 600 mg

Lamotrigine Monotherapy for Monotherapy for weeks 3 and 4: 50 mg; then 200-300 mg
weeks 1 and 2: increase by 50 mg every 1-2 weeks
25 mg

Levetiracetam 500 mg 500 mg/wk as needed 1000 mg; maximum 4000 mg

Oxcarbazepine 300-600 mg 300 mg/wk as needed 600-1200 mg; maximum

2400 mg

Perampanel 2 mg 2 mg/3 wk 4 mg; maximum 8 mg

Phenobarbital 30-60 mg 30-60 mg every 1-2 wk as needed 120-180 mg

Phenytoin 200-400 mg No titration needed, dose adjustment with 30- to 200-400 mg

60-mg increments as needed for seizure control

Pregabalin 75-150 mg 75-150 mg/wk as needed 300 mg; maximum 600 mg

Primidone 50-125 mg 50-125 mg every 3-7 days 750-1000 mg

Rufinamide 400 mg 400 mg every 2 days 3200 mg

Tiagabine 4 mg 4 mg/wk 24 mg; maximum 56 mg

Topiramate 25 mg 25 mg/wk 100 mg; maximum 400 mg BNF = 500

Valproate 500 mg 250-500 mg/wk as needed 1000-2000 mg

Vigabatrin 1000 mg 500 mg/wk as needed 3000 mg; maximum 6000 mg

Zonisamide 100 mg 100 mg/1-2 wk as needed 200 mg; maximum 600 mg

a
The schedule depends on the formulation used and the half-life of the antiseizure medication.

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 ANTISEIZURE MEDICATIONS

TABLE 10-4 Suggested Pediatric Antiseizure Medication Dosinga

Antiseizure Starting total daily Target total daily dose; usual

medication dose Titration maximal effective dose
Brivaracetamb 1-2 mg/kg/d Dose adjustment based on 1-5 mg/kg/d (pediatric patients weighing
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response >50 kg [110 lb]: initial dose of 50-100 mg/d

with maximum dose of 200 mg/d)
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Carbamazepine 10-20 mg/kg/d Increase weekly using 100-mg 20 mg/kg/d; usually <35 mg/kg/d
increments

Cannabidiol 5 mg/kg/d Increase by 5 mg/kg/d every 20 mg/kg/d

week as needed

Clobazam 0.1 mg/kg/d Increase by 0.1 mg/kg/d every 0.5-1.0 mg/kg/d

week as needed

Eslicarbazepine 10-20 mg/kg/d 200-400 mg/wk as needed 20-60 mg/kg/d (400-1200 mg/d
acetate (200-400 mg/d depending on weight)
depending on weight)

Ethosuximide 10-15 mg/kg/d 5 mg/kg/d every week as 20-30 mg/kg/d; up to 40 mg/kg/d

needed

Felbamate 15 mg/kg/d 15 mg/kg/d every week 45 mg/kg/d

Fenfluramine 0.2 mg/kg/d Increase weekly as needed 0.7 mg/kg/d; maximum of 26 mg/d
0.4 mg/kg/d in presence of stiripentol
and clobazam; maximum 17 mg/d

Gabapentin 10-15 mg/kg/d 10 mg/kg/d every day 40 mg/kg/d; up to 50 mg/kg/d

Lacosamideb 2 mg/kg/d 2 mg/kg/d every week 4-8 mg/kg/d

6-12 mg/kg/d for patients weighting
<30 kg (66 lb)

Lamotrigine Monotherapy for Monotherapy for weeks 3 and 4: Maintenance dose for monotherapy:
weeks 1 and 0.6 mg/kg/d; week 5 and on: 4.5-7.5 mg/kg/d
2: 0.3 mg/kg/d increase by 0.6 mg/kg/d every
1-2 weeks

With valproate for With valproate for weeks 3 and 4: With valproate: 1-5 mg/kg/d
weeks 1 and 2: 0.3 mg/kg/d; week 5 and on:
0.15 mg/kg/d increase by 0.3 mg/kg/d every
1-2 weeks

With enzyme inducer With enzyme-inducer for weeks With enzyme inducers: 5-15 mg/kg/d
for weeks 1 and 2: 3 and 4: 1.2 mg/kg/d; week 5 and
0.6 mg/kg/d on: increase by 1.2 mg/kg/d
every 1-2 weeks

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 CONTINUED FROM PAGE 508

Antiseizure Starting total daily Target total daily dose; usual

medication dose Titration maximal effective dose
Levetiracetam 20 mg/kg/d (infants 10 mg/kg/d every 1-2 weeks Children 4 years to <16 years: 60 mg/kg/d;
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1 month to <6 months children 6 months to <4 years: 50 mg/kg/d;

of age: 14 mg/kg/d) infants 1 month to <6 months: 42 mg/kg/d
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Oxcarbazepine 8-10 mg/kg/d 5-10 mg/kg/d every 3-7 days as 30-50 mg/kg/d; usually <60 mg/kg/d
needed

Perampanel 2 mg/d Increase by 2 mg as needed, no 8-12 mg/d

more frequently than weekly

Phenobarbital 1-3 mg/kg/d 1 mg/kg/d every 1-2 weeks 3 mg/kg/d; up to 8 mg/kg/d

Phenytoin 5-7 mg/kg/d No titration needed 6-8 mg/kg/d; up to 10 mg/kg/d (may be

guided by serum concentration)

Pregabalin 2.5 mg/kg/d if patient Increase by 2.5 mg/kg/d weekly 10 mg/kg if patient weighs ≥30 kg (66 lb)
weighs ≥30 kg (66 lb) as needed
14 mg/kg if patient weighs <30 kg (66 lb)
3.5 mg/kg/d if patient
weighs <30 kg (66 lb)

Rufinamide 10 mg/kg/d Increase by 10 mg/kg/d every 45 mg/kg/d

other day

With valproate, the With valproate, titration rate With valproate, target dose should be
starting dose should be should be ~5 mg/kg/d every 20-30 mg/kg/d
~5 mg/kg/d other day

Stiripentol 50 mg/kg/d - 3000 mg/d

Topiramate 1-3 mg/kg/d 1-3 mg/kg/d every 1-2 weeks 5-9 mg/kg/d

Valproate 15 mg/kg/d 5-10 mg/kg/d every week 30 mg/kg/d; up to 60 mg/kg/d with

enzyme-inducing antiseizure medications

Vigabatrin 20 mg/kg/d 20 mg/kg/d every week as 40-60 mg/kg/d

needed

Infantile spasms: Infantile spasms: increase to Infantile spasms: 100 mg/kg/d; maximum
50 mg/kg/d 100 mg/kg/d after 5 days 150 mg/kg/d

Zonisamidec 1 mg/kg/d 2 mg/kg/d every 2 weeks as Usual dose of 4-8 mg/kg/d; with
needed maximum dose of 12 mg/kg/d

a
Generally applicable to children younger than 12 years of age; pediatric dosing may vary depending on the patient’s weight. The dosing is provided
for antiseizure medications that have at least been tested in children.
b
Applicable to children weighing 11-50 kg (24-110 lb).
c
Not US Food and Drug Administration (FDA)-approved for children.

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