Depending on the drug: In adolescents 12 to 18 years of age, the initial tiagabine dose is 4 mg once daily. Valproic acid, package insert. Because of the bitter taste, tablets should not be broken. By mouth , intramuscular , intravenous , sublingual.
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There is a difference in drug handbooks. With an A to Z organization, no other drug handbook helps you access reliable drug information quicker. But perhaps best of all, this full-color handbook gives you extensive drug information for over 5, generic and trade-name drugs — including uses, side effects, interactions, and pharmacokinetics. This reference also includes key nursing considerations to help you assess, administer, evaluate, and teach your patients, as well as instructions for giving drugs by various routes e.
With an A to Z organization, no other drug handbook helps you access My library Help Advanced Book Search. Elsevier Health Sciences Amazon. Elsevier Health Sciences , Jun 11, - Medical - pages. This e-book allows users to quickly find important information with custom navigation. Search and find drugs by Generic and Trade names. Also included is a linked, comprehensive list of all drugs found in the book.
Linked index allows users to click on a link and go straight to monographs quickly. Oxcarbazepine 10,dihydrooxo-5H-dibenz[ b,f ]aze-pinecarboxamide has a molecular weight of Oxcarbazepine is used as monotherapy for adults and in children 4 to 16 years of age with partial seizures and as adjunctive therapy for children 2 years of age and older and for adults and children 2 to 16 years of age with partial seizures.
The precise mechanism by which oxcarbazepine and MHD exert their antiseizure effects is unknown. Preclinical evidence had indicated that they produce blockade of voltage-sensitive sodium channels, thereby stabilizing hyperexcited neural membranes, inhibiting repetitive neuronal firing, and diminishing the propagation of synaptic impulses. These actions are thought to be important in preventing the spread of seizures in the intact brain.
Oxcarbazepine is available as , , and mg film-coated tablets for oral administration. The concomitant AED should be completely withdrawn over three to six weeks, and the maximum oxcarbazepine dose should be reached in about two to four weeks. This AED may be completely withdrawn over a period of three to six weeks, whereas the oxcarbazepine dose may be increased.
Patients who are not currently receiving another AED may try monotherapy. For further details, please see Appendix A on page Ethosuximide is an antiseizure succinimide, chemically designated as alpha-ethyl-alpha methyl-succinimide. Ethosuximide is indicated for controlling absence petit mal epilepsy. It suppresses the paroxysmal three-cycles-per-second 3-Hz spike-and-wave activity associated with lapses of consciousness, which are common in absence seizures.
The frequency of epileptiform attacks is reduced, apparently by depression of the motor cortex and elevation of the threshold of the CNS to convulsive stimuli. Ethosuximide is given orally. The initial dose for patients three to six years of age is one mg capsule per day; for patients six years of age and older, the dose is two mg capsules per day.
The dose should be augmented in small increments. One useful method is to increase the daily dose by mg every four to seven days until seizure control is achieved with minimal side effects. Subsequent dose schedules can be based on effectiveness and plasma concentration determinations. Ethosuximide may be given in combination with other AEDs when other forms of epilepsy coexist with absence epilepsy.
Additional details are listed in Appendix A on page Zonisamide 1,2-benzisoxazolemethanesulfonamide is an antiseizure sulfonamide, but it is not related to other AEDs. Zonisamide is indicated as adjunctive therapy for treating partial seizures in adults. Its precise mechanism of action is unknown, but the agent may produce its effects through action at sodium and calcium channels. It does not appear to potentiate the synaptic activity of GABA. The initial dose should be mg daily.
Additional details are presented in Appendix A on page Phenobarbital tablets and elixir are given orally and are classified as Schedule IV controlled substances. Barbiturates are substituted pyrimidine derivatives in which the basic structure common to these drugs is barbituric acid, which has no CNS activity. The chemical name is 5-ethylphenylpyrim-idine-2,4,6 1 H ,3 H ,5 H -trione. Phenobarbital is often used to treat seizures that occur in neonates and in the first year of life.
The drug potentiates inhibitory neurotransmission by increasing the duration of time that GABA-mediated chloride channels remain open and reduces neurotransmitter release from nerve terminals, probably through its effect on calcium channels. In status epilepticus, it is imperative to achieve therapeutic phenobarbital blood levels as rapidly as possible, because a barbiturate-induced depression may occur along with postictal depression after the seizures are controlled. It is therefore important to use the minimal amount of drug required and to wait for the antiseizure effect to develop before a second dose is given.
For adults, as a daytime sedative, 30 to mg is given orally daily in two or three divided doses. As a bedtime hypnotic agent, the dose is to mg. As an AED, the dose is 50 to mg two to three times daily. More information is provided in Appendix A on page Primidone 5-ethyldihydrophenyl-4,6[1H, 5H]-pyrim-idinedione is used alone or together with other AEDs. Primidone is indicated for controlling psychomotor, focal epileptic, and grand mal seizures as well as grand mal seizures that have not responded to another AED.
It raises electroshock or chemoshock seizure thresholds and may alter seizure patterns in experimental animals. The antiseizure mechanism is unknown. Patients eight years of age and older who have received no previous treatment may start with either mg or scored mg primidone tablets: For most adults and children eight years of age and older, the usual maintenance dosage is three or four mg primidone tablets daily in divided doses, taken as mg three or four times daily.
If necessary, the dose may be increased to five or six mg tablets daily, but daily doses should not exceed mg four times daily. For patients already receiving another AED, primidone should be started at to mg at bedtime and gradually increased to the maintenance concentration as the dose of the other drug is gradually decreased. This regimen should be continued until a satisfactory dosage level is achieved for the combination or until the other medication is completely withdrawn.
When therapy with primidone alone is the objective, the transition from concomitant therapy should not be completed in less than two weeks. Children younger than eight years of age may receive 50 mg at bedtime from days 1 to 3; 50 mg twice daily from days 4 to 6; mg twice daily from days 7 to 9; and mg to mg three times daily on day 10 to the maintenance dose.
The mechanism by which felbamate exerts its antiseizure activity is unknown. Protection against maximal electroshock-induced seizures suggests that felbamate may reduce the spread of seizures, an effect possibly predictive of efficacy in generalized tonic—clonic or partial seizures. Felbamate may increase the seizure threshold, and it has weak inhibitory effects on GABA-receptor binding. Felbamate has been studied as monotherapy and as adjunctive therapy in adults and as adjunctive therapy in children with seizures associated with Lennox—Gastaut syndrome.
Felbamate has not been systematically evaluated as initial monotherapy. The dose of the concomitant AED is reduced by one-third when felbamate therapy is initiated. Further reductions of the concomitant AED dosage may be necessary in order to minimize adverse effects resulting from drug interactions. Most adverse effects observed during felbamate adjunctive therapy resolve as the dose of any concomitant AEDs is decreased.
Levetiracetam, a single enantiomer, is not chemically related to existing AEDs. Levetiracetam is indicated as adjunctive therapy for 1 partial-onset seizures and epilepsy in adults and children four years of age and older; 2 myoclonic seizures in adults and adolescents 12 years of age and older with juvenile myoclonic epilepsy; and 3 primary generalized tonic—clonic seizures in adults and children six years of age and older with idiopathic generalized epilepsy.
Levetiracetam may selectively prevent hypersynchronization of epileptiform burst firing and propagation of seizure activity. Patients weighing 20 kg or less should receive the oral solution. Patients weighing more than 20 kg can receive either the tablets or the oral solution. For more details, please see Appendix A on page The chemical name of tiagabine HCl is - - R [4,4-bis 3-methylthienyl butenyl]nipecotic acid HCl. Tiagabine is indicated as adjunctive therapy in adults and children 12 years of age and older with partial seizures.
The precise mechanism by which tiagabine exerts its antiseizure effect is unknown, although it is believed to be related to its ability to enhance the activity of GABA, the major inhibitory neurotransmitter in the CNS. Tiagabine binds to recognition sites associated with the GABA uptake carrier, suggesting that this activity blocks GABA uptake into presynaptic neurons and thus permitting more GABA to be available for receptor binding on the surfaces of postsynaptic cells.
The drug is administered orally and is taken with food. A loading dose, a rapid escalation, and large dose increments of tiagabine should not be used. For adults and adolescents 12 years of age or older, certain recommendations apply if patients are already taking an enzyme-inducing AED e. In adolescents 12 to 18 years of age, the initial tiagabine dose is 4 mg once daily. Modification of the concomitant AED dosage is not necessary unless clinically indicated.
The total daily dose may be increased by 4 mg at the beginning of week 2. The total daily dose should be given in two to four divided doses. In adults, the initial tiagabine dose is 4 mg once daily. Dose adjustments of concomitant AEDs are not necessary unless clinically indicated. The chemical name for gabapentin is 1- aminomethyl cyclohexaneacetic acid.
Gabapentin is an adjunctive therapy for patients older than 12 years of age with partial seizures with and without secondary generalization and as an adjunctive therapy for pediatric patients three to 12 years of age with partial seizures. Gabapentin does not exhibit affinity for benzodiazepine, glutamate, NMDA, quisqualate, kainate, strychnine-insensitive or strychnine-sensitive glycine; alpha 1 , alpha 2 , or beta-adrenergic, adenosine A 1 or A 2 , cholinergic muscarinic or nicotinic, dopamine D 1 or D 2 ; histamine H 1 ; serotonin S 1 ,or S 2 ; or voltage-sensitive, calcium-channel receptor sites.
The starting dose is mg three times per day. The maximum time between doses in the three-times-daily schedule should not exceed 12 hours. The effective dose is reached by upward titration over a period of approximately three days. Additional details are provided in Appendix A on page The formula for clonazepam is 5- 2-chlorophenyl -1,3-dihydronitro-2H-1,4-benzodiazepinone.
A benzodiazepine derivative, clonazepam is useful alone or as an adjunctive therapy in Lennox—Gastaut syndrome petit mal variant , akinetic seizures, and myoclonic seizures. In patients with absence petit mal seizures who have not responded to succinimides, clonazepam may be useful. In some cases, a dosage adjustment may re-establish efficacy. The precise mechanism by which clonazepam exerts its antiseizure and antipanic effects is unknown, although it is believed to be related to its ability to enhance the activity of GABA, the major inhibitory neurotransmitter in the CNS.
For adults, the initial clonazepam dose is divided into three doses. The total dose should not exceed 1. The dose may be titrated upward in increments of 0. The maintenance dose must be individualized for each patient, depending upon the response. The maximum recommended daily dose is 20 mg. This consequence should be considered before clonazepam is added to an existing antiseizure regimen. In children, clonazepam is administered orally. In order to minimize drowsiness, the initial dose for infants and children, including those up to 10 years of age or who weigh 30 kg, should be between 0.
The dose should be increased by no more than 0. When possible, the daily dose should be divided into three equal doses. If doses are not equally divided, the largest dose should be given before the patient retires to bed. Vigabatrin is indicated as adjunctive therapy for adults with refractory complex partial seizures who have responded inadequately to alternative treatments and for whom the potential benefits outweigh the risk of vision loss.
It is also approved as monotherapy for children one month to two years of age with infantile spasms when the potential benefits outweigh the potential risk of vision loss. The disorder can be difficult to treat because of the frequency of seizures. The precise mechanism of the antiseizure effect is unknown, but it is believed to result from its action as an irreversible inhibitor of GABA transaminase GAB A -T , the enzyme responsible for the metabolism of the inhibitory neurotransmitter GABA.
No direct correlation between vigabatrin plasma concentration and efficacy has been established. For refractory complex partial seizures in adults, vigabatrin oral mg tablets are taken twice daily with or without food. Vigabatrin is eliminated primarily via the kidneys. Vigabatrin is not available in pharmacies because of the high risk of vision loss associated with the drug. It can be ordered directly only from Lundbeck Research in Deerfield, Illinois.
There are no contraindications, but there is a boxed warning. Further details are given in Appendix A on page Pregabalin, S aminomethyl methylhexanoic acid , has a molecular weight of Pregabalin is indicated as an adjunctive therapy in the treatment of partial-onset epileptic seizures in adults. It binds with high affinity to the alpha 2 -delta site an auxiliary subunit of voltage-gated calcium channels in CNS tissues.
However, in cultured neurons, the prolonged application of pregabalin increases the density of GABA transporter protein and increases the rate of functional GABA transports. Both the efficacy and adverse-event profiles of pre-gabalin are dose-related. In general, it is recommended that patients begin with a total daily dose no greater than mg 75 mg two times per day, or 50 mg three times per day. Because pregabalin is eliminated primarily by renal excretion, the dose should be adjusted in patients with reduced kidney function.
Pregabalin is a controlled substance Schedule V. Lacosamide is composed of functional amino acids. Lacosamide tablets are indicated as adjunctive therapy for patients 17 years of age and older with partial-onset seizures. The precise mechanism by which the drug exerts antiepileptic effects in humans has not been fully elucidated. In vitro electrophysiological studies show that lacosamide selectively enhances slow inactivation of voltage-gated sodium channels, resulting in stabilization of hyperexcitable neuronal membranes and inhibition of repetitive neuronal firing.
Lacosamide can be initiated with either oral or IV administration. In clinical trials, mg daily was not more effective than mg daily and was associated with a substantially higher rate of adverse reactions. When patients switch from the oral to the IV route, the initial total daily IV dose should be equivalent to the total daily dose and frequency of oral lacosamide and should be infused over a period of 30 to 60 minutes. Twice-daily IV infusion has been performed for up to five days.
At the end of the IV treatment period, patients may be switched from the IV to the oral route at the daily dose and frequency equivalent to the IV administration. Lacosamide is a Schedule V controlled substance. A triazole derivative, rufinamide is structurally unrelated to currently marketed AEDs. The chemical name is 1-[ 2,6-difluorophenyl methyl]-1H-1,2,3-triazole-4 carboxamide. Rufinamide is indicated for the adjunctive treatment of seizures associated with Lennox—Gastaut syndrome in adults and children four years of age and older.
The precise mechanism by which rufinamide exerts its antiepileptic effect is unknown. In vitro studies suggest that rufinamide modulates the activity of sodium channels and, in particular, prolongs the inactive state of the channel. At a concentration of 1M or greater, rufinamide significantly slowed sodium channel recovery from inactivation after a prolonged prepulse in cultured cortical neurons and limited sustained repetitive firing of sodium-dependent action potentials EC 50 of 3.
It is not known whether doses lower than the target doses are effective. Known as ESL, this drug is a derivative of carbamazepine. The chemical formula is [ S - - acetoxy,dihydro-5H-dibenz[ b,f ]azepinecarboxamide. It is intended as adjunctive treatment in adults with refractory, partial-onset seizures. ESL acts as a voltage-gated sodium-channel blocker, inhibiting sodium channel-dependent release of neurotransmitter with a potency similar to that of carbamazepine and oxcarbazepine.
The drug is an active metabolite of oxcarbazepine and has the same mechanism of action as carbamazepine. Ultimately, results from ongoing studies will reveal the clinical utility of this agent as adjunctive therapy for partial-onset seizures. In a phase 3 clinical trial, once-daily ESL in doses of mg, mg, or 1, mg was administered to patients with partial seizures. The daily dose was titrated upward weekly by mg to reach the maintenance dose. The frequency of seizures was significantly lower in patients receiving 1, and mg than in the placebo group.
Contraindications and warnings have not been published. Adverse effects include abnormal coordination, dizziness, somnolence, headache, nausea, diplopia, and vomiting. A first-in-its-class neuronal potassium-channel opener, retigabine is in late-stage development as an adjunctive therapy for partial-onset seizures. In phase 3 trials, retigabine was efficacious and reduced monthly seizure rates compared with placebo.
The drug is currently under review by the FDA for approval. Clobazam Lundbeck is being studied for the treatment of Lennox—Gaustaut syndrome, and perampanel E, Eisai is being developed as a possible adjunctive therapy for patients with partial-onset seizures. Table 4 lists experimental agents in various stages of clinical development 50 — 54 and their structural relationship to FDA-approved AEDs. Surgery should be considered when seizures remain uncontrolled with optimal medical management and when they disrupt quality of life.
Some patients with refractory seizures experience little disability, whereas others find their lives severely compromised by infrequent attacks. Few patients benefit from further efforts at medical treatment if seizures have not been controlled after two trials of high-dose monotherapy with two appropriate AEDs and one trial of combination therapy. If the seizure is caused by an underlying correctable brain condition, surgery may be a worthwhile option.
Both new and earlier AEDs are generally equally effective in new-onset epilepsy. Newer drugs tend to have fewer adverse effects. Guidelines of the American Academy of Neurology were based on a careful critique of the current clinical data and were designed to provide a strategy for decision making in patient care; they are not intended to exclude any other reasonable alternative treatments.
For children with newly diagnosed absence seizures, lamotrigine can be included in the options. For children with refractory partial seizures, the summary of evidence-based guidelines for refractory epilepsy suggests gabapentin, lamotrigine, oxcarbazepine, and topiramate. In a previous guideline, neurology experts found that felbamate, another new AED, was also effective for partial seizures.
However, felbamate has special risks that should be considered before practitioners prescribe it. When considering which newer drugs were effective as monotherapy for partial seizures, the neurologists concluded that oxcarbazepine, topiramate, and possibly lamotrigine were effective in preventing refractory partial seizures. When the experts studied the data on generalized epilepsy that was refractory to other drug therapies, only topiramate was noted to be effective.
Studies have not been conducted with the other AEDs. The group also recommended that lamotrigine and topiramate be used to treat drop attacks associated with the Lennox—Gastaut syndrome in adults and children. AEDs can enhance quality of life and can help to reduce the number of seizures. Although all medications have some side effects, the choice of which drug and which side effects can be tolerated depends on each individual.
AED therapy is the primary treatment for most patients with epilepsy. Early diagnosis and treatment of seizure disorders with a single appropriate therapeutic agent offer the best prospect of achieving prolonged seizure-free periods with the lowest risk of toxicity. The overall goals are to prevent seizures entirely with a minimum of adverse events and to provide a dosage schedule that is easy to follow. An attempt should be made to determine the cause of the epilepsy with the intention of finding a correctable lesion, either structural or metabolic.
Such a finding is more likely in very young patients or in patients whose first seizure appears during adulthood. After a decision is made to use drugs to control seizures—and this is often the case even if a specific etiologic mechanism is found—the goal of therapy is to keep the patient free of seizures without interfering with normal functioning.
In most cases, the regimen is started with a single drug. Classifying the seizure is an important element in treatment plan decisions, because some AEDs act differently against various seizure types. After the drug is selected, the initial dosage is usually expected to provide a plasma drug concentration during the plateau state, at least in the lower part of the range associated with clinical efficacy.
However, to reduce the risk of dose-related adverse events, some drugs are initiated at a reduced dose and titrated upward to the lowest effective therapeutic dose. A loading dose is used only if the urgency to control seizures surpasses the risk of adverse events during initial therapy. Health care professionals should assess the initial results by recognizing the time needed to reach the plateau state and the usual variability of incidence of seizures, and they should expect that some tolerance ordinarily develops to the sedative and minor adverse events associated with these AEDs.
It is customary for the dose to be raised at suitable intervals in order to control seizures or as restricted by toxicity, and such change is preferably aided by monitoring plasma drug concentrations. If a single drug does not sufficiently control seizures with the maximal tolerated dose and if patient compliance has been confirmed, another drug should be substituted.
Unless serious adverse events direct otherwise, the dose should always be reduced slowly when a drug is being withdrawn to minimize the risk of precipitating status epilepticus. If a second drug proves to be inadequate in eliminating seizures, many physicians substitute another agent before instituting a combined-drug regimen. If two or more drugs do not control seizures, it is possible that the patient is experiencing more than one type of seizure.
Newer AEDs are more expensive than the older drugs; this is clearly a problem for some individuals who must pay for their own medications. Common older drugs include valproic acid, phenytoin, carbamazepine, primidone, ethosuximide, clonazepam, and phenobarbital. Newer agents are gabapentin, lamotrigine, topiramate, tiagabine, levetiracetam, zonisamide, oxcarbazepine, pregabalin, eslicarbazepine, vigabatrin, lacosamide, and rufinamide.
Felbamate, approved in , is now rarely used because of its potential for serious adverse effects. Because more monitoring of blood tests is required with earlier AEDs, this tends to puts newer drugs at an advantage. Older drugs are also associated with the potential to cause birth defects. Unfortunately, there is no certainty that new drugs are better in this regard, although there is promise.
The newer drugs have not been clearly associated with birth defects, but data are insufficient to confirm that they are safe in pregnancy. Patients are encouraged not to settle for unsatisfactory outcomes; instead, they should work with an informed physician to find a suitable treatment. Individuals starting on medication for the first time should discuss the relative advantages and disadvantages of the different choices.
The author reports no financial or commercial relationships in regard to this article. National Center for Biotechnology Information , U. Journal List P T v. His e-mail address is moc. Accepted Mar This article has been cited by other articles in PMC. Important epilepsy syndromes include the following: EEG features showing slow below 3 cycles per second [hertz, Hz] spike-and-wave discharges and other abnormalities. Selection of Antiepileptic Therapy The ideal AED should suppress all seizures without causing any unwanted adverse effects.
Indication and Mechanism of Action 19 Valproic acid has been effective in partial and generalized seizures and is indicated as monotherapy and adjunctive therapy for complex partial seizures, which begin in a limited area of the brain. Dosage and Administration 19 Monotherapy. Contraindications, Warnings, and Adverse Effects 19 A boxed warning mentions hepatotoxicity, teratogenicity, and pancreatitis.
Indication and Mechanism of Action 21 Lamotrigine is indicated as an adjunctive therapy for partial seizures, primary generalized tonic—clonic seizures, and generalized seizures of Lennox—Gastaut syndrome in patients two years of age or older. Contraindications, Warnings, and Adverse Effects 21 A boxed warning mentions hepatotoxicity, teratogenicity, and pancreatitis.
Indication and Mechanism of Action 24 Topiramate is an adjunctive therapy for adult and pediatric patients 2 to 16 years of age with partial-onset seizures or primary generalized tonic—clonic seizures in patients two years of age and older with seizures associated with Lennox—Gastaut syndrome. Dosage and Administration 24 Topiramate is available as , , , and mg round tablets for oral administration. Contraindications, Warnings, and Adverse Effects 24 There are no contraindications.
Indication and Mechanism of Action 25 Carbamazepine is indicated for use as an anticonvulsant drug. Contraindications, Warnings, and Adverse Effects 25 A boxed warning is included for carbamazepine. Indication and Mechanism of Action 26 Phenytoin is indicated for controlling generalized tonic—clonic grand mal and complex partial psychomotor, temporal lobe seizures and for preventing and treating seizures occurring during or following neurosurgery.
Dosage and Administration 26 Patients who have not received previous treatment may begin with one mg extended phenytoin capsule three times daily. Contraindications, Warnings, and Adverse Effects 26 There are no contraindications. Indication and Mechanism of Action 27 Oxcarbazepine is used as monotherapy for adults and in children 4 to 16 years of age with partial seizures and as adjunctive therapy for children 2 years of age and older and for adults and children 2 to 16 years of age with partial seizures.
Dosage and Administration 27 Oxcarbazepine is available as , , and mg film-coated tablets for oral administration. Pediatric Patients Adjunctive Therapy. Indication and Mechanism of Action 28 , 29 Ethosuximide is indicated for controlling absence petit mal epilepsy. Dosage and Administration 28 Ethosuximide is given orally. Indication and Mechanism of Action 30 Zonisamide is indicated as adjunctive therapy for treating partial seizures in adults.
Dosage and Administration 30 The initial dose should be mg daily. Contraindications, Warnings, and Adverse Effects. Indication and Mechanism of Action 31 — 33 Phenobarbital is often used to treat seizures that occur in neonates and in the first year of life. Indication and Mechanism of Action 35 Primidone is indicated for controlling psychomotor, focal epileptic, and grand mal seizures as well as grand mal seizures that have not responded to another AED.
Dosage and Administration 35 Patients eight years of age and older who have received no previous treatment may start with either mg or scored mg primidone tablets: Dosage and Administration 36 Felbamate has been studied as monotherapy and as adjunctive therapy in adults and as adjunctive therapy in children with seizures associated with Lennox—Gastaut syndrome.
Indication and Mechanism of Action 37 Levetiracetam is indicated as adjunctive therapy for 1 partial-onset seizures and epilepsy in adults and children four years of age and older; 2 myoclonic seizures in adults and adolescents 12 years of age and older with juvenile myoclonic epilepsy; and 3 primary generalized tonic—clonic seizures in adults and children six years of age and older with idiopathic generalized epilepsy.
Indication and Mechanism of Action 38 Tiagabine is indicated as adjunctive therapy in adults and children 12 years of age and older with partial seizures. Dosage and Administration 38 The drug is administered orally and is taken with food. Indication and Mechanism of Action 39 Gabapentin is an adjunctive therapy for patients older than 12 years of age with partial seizures with and without secondary generalization and as an adjunctive therapy for pediatric patients three to 12 years of age with partial seizures.
Indication and Mechanism of Action 40 A benzodiazepine derivative, clonazepam is useful alone or as an adjunctive therapy in Lennox—Gastaut syndrome petit mal variant , akinetic seizures, and myoclonic seizures. Dosage and Administration 40 , 41 For adults, the initial clonazepam dose is divided into three doses. Indication and Mechanism of Action 42 Vigabatrin is indicated as adjunctive therapy for adults with refractory complex partial seizures who have responded inadequately to alternative treatments and for whom the potential benefits outweigh the risk of vision loss.
Dosage and Administration 42 For refractory complex partial seizures in adults, vigabatrin oral mg tablets are taken twice daily with or without food. Contraindications, Warnings, and Adverse Effects 42 There are no contraindications, but there is a boxed warning. Indication and Mechanism of Action 43 Pregabalin is indicated as an adjunctive therapy in the treatment of partial-onset epileptic seizures in adults.
Indication and Mechanism of Action 44 Lacosamide tablets are indicated as adjunctive therapy for patients 17 years of age and older with partial-onset seizures.