Seizure Medications Flashcards
Levetiracetam/Keppra uses
Go-to, used in all seizure types
Keppra dosing
500mg BID, titrate q2w until at max recommended dose of 1.5g BID
Keppra side effects
Well tolerated, some weight gain
Keppra monitoring
Dose adjust based on GFR- watch renal function
Keppra enhances what drugs?
CNS depressants
Oxcarbazepine uses
Adjunctive therapy in partial seizure treatment in children 6+
Initial oxcarbazepine dosing
5mg/kg/day, weekly increments of 5mg/kg/day
Target oxcarbazepine dosing
30-50mg/kg/day
Dosing frequency of oxcarbazepine
BID
Oxcarbazepine side effects
Most common in children: somnolence, HA, dizziness, N/V, rash is potentially fatal but reversible
Oxcarbazepine monitoring
Sodium, hepatic function
Get baseline electrolytes and hepatic enzymes
Oxcarbazepine and drug interactions
Lower potential for drug interactions because of low protein binding, hepatic enzyme induction, MHD eliminated by the kidneys
Lamotrigine uses
Partial onset seizures
Initial lamotrigine dose
0.5mg/kg/day divided BID x2 weeks, then 1mg/kg/day x2 weeks, then increase 1mg/kg/day q2w until response
Maintenance lamotrigine dose
5-15mg/kg/day div BID
MDD of lamotrigine
400mg/day
When does the dose of lamotrigine need to be decreased?
Patients taking VPA
Lamotrigine side effect
SJS! More likely to occur with fast titration
Other info about lamotrigine
Broad spectrum of activity, low teratogenic potential, nonsedative
Gabapentin uses
Partial seizures, also useful in comorbid neuropathic pain/mood stabilization in BPD
Initial gabapentin dosing
30mg/kg/day
Max gabapentin dosing
1800mg/day
Dosing frequency of gabapentin
TID
Gabapentin side effects
Somnolence, dizziness, ataxia, weight gain with higher doses
Lower incidence of neurotoxic side effects
That one weird fact about gabapentin
Doses 2-3x higher often necessary to achieve max benefits
With a higher dose, lower % is absorbed
Gabapentin interactions with other drugs
No PK interactions, pure renal elimination and no binding to serum proteins
Phenytoin use
Generalized seizures