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 ( | 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 | |
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.
Adapted from: Cruz-Martinez E and Gilmore RL. Transplantation and seizures. In: Ettinger AB and Devinsky O, eds. Managing epilepsy and co-existing disorders. Boston: Butterworth-Heinemann; 2002;75-82.
With permission from Elsevier (www.elsevier.com).
Reviewed By:
Steven C. Schachter MD
on:
Monday, March 1, 2004