Anticonvulsants: Doses for children

 

(Prepared by Dr Veena V Nair and Dr Abhishek Kulkarni)

 

Drug

Dose and Route

Remarks

Carbamazepine (Tegratol)

Tab -100,200,400mg

Syrup-100mg/5ml

Start at 10 mg/kg/day PO three divided doses, increase to 20-30 mg/kg/day in three divided doses

S/E- Steven Johnson syndrome

Clobazam ( Frisium)

Tab 5,10,20mg

0.25-1mg/kg PO in 2-3 divided doses

S/E- sedation

Clonazepam ( Rivotril, Lonazep)

Tab- 0.5, 2 mg

<30 kg start with 0.05 mg/kg/day, increase by 0.05 mg/kg/week (max 0.2 mg/kg/day 2-3 divided doses)

>30 kg 1.5 mg/kg/day PO in three divided doses (max- 20 mg/day)

S/E- bronchorrhea

Diazepam ( Calmpose, Valium)

T.2,5,10mg Syp.2mg/5ml

IV- 0.2-0.3 mg/kg/dose slowly (1mg/mt)

PO- 0.5 mg/kg/day ( max 2 mg/kg/day) TDS

Rectal- 0.2-1 mg/kg/dose

S/E- sedation, resp.depression

Ethosuximide (Zarontin)

Cap 250mg, Syp.50mg/5ml

Start with 20 mg/kg/day, increase to max 40 mg/kg/day or 1.5 g/day whichever is less PO

S/E vomiting

Fosphenytoin

IV/IM-15-20 mg Phenytoin equivalent/kg/dose (3 mg/kg/mt)

Less hypotension

Gabapentine (Gabantin, Neurontin) Cap.300,400mg

Children 20-50 mg/kg/day PO three divided doses

Adolescence 900-3600 mg/day TDS

S/E- ataxia, weight gain, nystagmus

Lamotrigine (Lamitor)

Tab.5,25,50,100mg

Start with 2 mg/kg/day, increase to 5-15mg/kg/day PO.

With Valproate start with0.5 mg/kg/day, increase to a maximum of 1-5 mg/kg/day

S/E- skin rash, ataxia, diplopia

Levetiracetam (Torleva)

Tab-250-1000mg

Syp-100mg/5ml

10 mg/kg/dose PO BD , increase every week to a maximum of 30 mg/kg/dose BD

S/E- somnolence, vomiting

Lorazepam (Ativan)

Tab 1,2mg

IV- 0.05-0.1mg/kg over 5-10 minutes

Repeat after 15-30 minutes

Longer duration of action

Less respiratory depression

Midazolam

IV-0.05-0.2 mg/kg/dose

IM-0.1-0.2 mg/kg/dose

Buccal-0.1-0.2 mg/kg/dose

Maintenance infusion- 1-5 ug/kg/mt

S/E- respiratory depression

Nitrazepam (Nitravit)

Tab 5,10mg

0.2 mg/kg/day , slowly increase to 1 mg/kg/day PO three divided doses

S/E- hallucination

Oxcarbazepine (Oxitol)

T. 150,300,600mg

4-5 mg/kg/dose PO BD

Increase wkly by 5 mg/kg/dose to 15 mg/kg/dose ( max 25mg/kg/dose)

S/E- vomiting, hyponatremia

Caution renal impairement

Phenobarbitone(Gardenal)

Syrup-20mg/5ml

Tab-30,60mg

IV loading 20 mg/kg (20-30 mg/kg in neonate)

PO 3-5 mg/kg/day 2 divided doses

S/E hyperactivity

Phenytoin

Syp Eptoin 30mg/5ml

Syp Dilantin- 25mg/5ml

Tab 100mg, Cap 25, 100

 

IV loading dose 20 mg/kg

PO- 3-9 mg/kg/day 2 divided doses

S/E- gum hyperplasia, cognitive decline

Primidone (Mysoline)

T.250mg

<8yrs : 10-25 mg/kg/day 3-4 divided doses

>8yrs: 750-1500 mg/day 3-4 divided doses

S/E- sedation, hyperactivity

Topiramate (Topamac)

T.25,50mg

PO- 1-9 mg/kg/day 2 divided doses

S/E- renal stones

Tiagabine (Gabitril)

Average dose 6 mg in 3 divided doses

S/E tremor

Sodium Valproate

(Encorate/ Valparin)

T.200mg, Syp.200mg/5ml

PO- begin with10 mg/kg/day, increase by 5-10 mg/kg/wk to 30-60 mg/kg/day 3-4 divided doses

Rectal valproic acid- 20 mg/kg/dose diluted1:1 with sterile water

S/E impaired LFT

Vigabatrin (Sabril)

T.500mg

PO- 30 mg/kg/day 1-2 divided doses to begin with.

Maintenance- 30-100 mg/kg/day divided once or twice daily

Visual field defect, optic atrophy, optic neuritis

Zonisemide (Zonegran)

Cap 100mg

PO- Start with 2-4 mg/kg/day, slowly increase to 4-20 mg/kg/day

S/E- sedation, rash, renal stones