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LOADING AND MAINTENANCE OF ANTIEPILEPTIC DRUGS

 

barbiturates: primidone (Mysoline), phenobarbital

IV loading dose Oral loading and maintenance doses
phenobarbital: 90-120 mg every 10-15 min as needed,to maximum of 1000 mg 1-5 mg/kg/day

 

carbamazepine (Tegretol, Tegretol-XR, Carbatrol)

IV loading dose Oral loading and maintenance doses
n/a Start at 2-3 mg/kg/day. Increase dose every 3-5 days to 10 mg/kg/day.
Dose may need to be further increased to 15-20 mg/kg/day after 2-3 months
because of hepatic autoinduction.

 

ethosuximide (Zarontin)

IV loading dose Oral loading and maintenance doses
n/a 20-40 mg/kg/day in 1-3 divided doses

 

felbamate (Felbatol)

Felbamate is recommended for use only by patients who respond inadequately to alternative treatments and whose epilepsy is so severe that a substantial risk of aplastic anemia, liver failure, or both is deemed acceptable in light of the benefits of its use.

IV loading dose Oral loading and maintenance doses
n/a Start at 1200 mg/day in three divided doses.
Increase by 600-1200 mg/day every 2 weeks
to recommended maximum of 3600 mg/day.

 

gabapentin (Neurontin)

IV loading dose Oral loading and maintenance doses
n/a 300 mg first day, 300 mg bid second day, 300 mg tid third day.
Increase as needed to 1800 mg/day in three divided doses.

 

lamotrigine (Lamictal)

IV loading dose Oral loading and maintenance doses
n/a For patients taking an enzyme-inducing AED: 25 mg bid,
titrated upward by 50-mg increments every 1-2 weeks as needed.
For patients taking valproate: 25 mg every other day,
with increases of 25 to 50 mg every 2 weeks as needed, to a
maximum of 300 to 500 mg/day.
The maximum dosage used in US open-label drug trials is 700 mg/day.

 

phenytoin (Dilantin, Phenytek)

IV loading dose Oral loading and maintenance doses
15 mg/kg (not more than 50 mg/min) 15 mg/kg in three divided doses over 9-12 hours.
5 mg/kg/day maintenance.

 

valproate (Depakote, Depakote ER, Depakene, valproic acid)

IV loading dose Oral loading and maintenance doses
n/a 15 mg/kg/day in three divided doses.
Increase by 5 to 10 mg/kg/day every week as needed.

From Epilepsy.com/professionals