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.

Adapted from: Schachter SC. Treatment of seizures. In: Schachter SC, Schomer DL, eds. The comprehensive evaluation and treatment of epilepsy. San Diego, CA: Academic Press; 1997. p. 61-74.
With permission from Elsevier (www.elsevier.com).

Authored By: 
Steven C. Schachter MD
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