AED              (%protein-bound)	Kidney	Liver	Bone marrow	Heart	Comment
Carbamazepine (65-80%)	Hyponatremia		Leukopenia Anemia		Monitor cyclosporine level
Gabapentin (3%)	300 mg q.o.d. for severe renal failure300 mg after ~4 hrs hemodialysis		Useful during engraftment
Lamotrigine (55%)	T1/2 ~48 hrs during severe renal failureT1/2 ~12 hrs during hemodialysis	T1/2 ~110 hrs during severe hepatic failure			Serious rashes:~3/1000 adults~1/100 children
Levetiracetam (<10%)	Reduce dose during renal failure Supplemental dose after hemodialysis		Useful during engraftment
Oxcarbazepine (MHD is ~40%)	Hyponatremia	Liver converts to active MHD Not studied in severe failure	Avoid during engraftment		Both an inhibitor and inducer of CYP450 Monitor cyclosporine level
Phenobarbital (40-60%)	Sedating	Sedating	Useful during engraftment		Monitor cyclosporine level Steroid metabolism altered
Phenytoin (80-90%)	Use free phenytoin levels	Use free phenytoin levels	Avoid during engraftment	Use free phenytoin levels	Monitor cyclosporine level Steroid metabolism altered
Topiramate (~15%)	Clearance reduced ~50% in renal failure Need to adjust dose during hemodialysis				Kidney stone: ~1% incidence
Valproic acid (~95%)	Useful during hemodialysis because little is removed	Avoid during hepatic failure	Avoid during engraftment Thrombocytopenia at high concentrations		Severe hepatotoxicity or pancreatitis are rare Avoid in patients <2 yrs of age
Zonisamide (~40%)	Avoid in renal failure	Not studied in hepatic failure	Avoid during engraftment		A sulfonamide Kidney stone: ~4% incidence

MHD = monohydroxy derivative (active metabolite); T1/2 = terminal half-life.

From Epilepsy.com/professionals