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Table 239. Guide to Pediatric Antiepileptic Drug (AED) Therapy.a

Drug/Target

Dose

Target

Serum

Levels

Idiosyncratic

Reactions

Dose-Related

Toxicity

Other Effects

Carbamazepine 412mcg/mL

Dermatologic (rash,including Stevens-

Johnson syndrome),

rare hematologic,hepatic

Vertigo, visualdisturbance

(diplopia), leukopenia

Hyponatremia inadults; leukopenia;

liver induction;

myoclonus inpatients with general

spike-wave

discharges, increased

bone metabolism

Adult: 1000

2000 mg/d

Pediatric: 1030mg/kg/d

Ethosuximide 40100

mcg/mL

Leukopenia, SLE,

nephrotic syndrome,rash

Sedation, GI upset Behavioral changes

Adult: 1000

mg/d

Pediatric: 1540

mg/kg/d

Felbamate 30100mcg/mL

Aplastic anemia(adults only?),

hepatic failure, rash

(rare)

Anorexia, insomnia,headache, irritability

Aplastic anemia(postpubertal?); drug

interactionsAdult: 2400

3600 mg/d

Pediatric: 4560

mg/kg/d; has

been used up to200 mg/kg/d

Gabapentin 420mcg/mL

Rash (rare) Somnolence,irritability, weight

gain

Renal excretion, nodrug interactionsAdult: 1800

3600 mg/d

Pediatric: 30100 mg/kg/d

Lamotrigine 320

mcg/mL

Rash,

hypersensitivity

reaction

Ataxia, diplopia, GI

upset, headache

Rash (probably 5%,

especially in

children), Stevens-

Johnson syndrome

Adult: 300500

mg/dPediatric: 115

mg/kg/d; dose

depends on

concomitantmedication

Levetiracetam 550 None reported to Somnolence, ataxia Agitation,


2/3

Adult: 1200

2400 mg/d

mcg/mL date aggression,

depression (510%?)

Pediatric: 40

100 mg/kg/d

Oxcarbazepine MHD:1045

mcg/mL

Rash (25% cross-reactivity with

carbamazepine)

CNS effects, diplopia Hyponatremia (3% ofadults) behavior,

?weight gainAdult: 1200

2400 mg/d


Phenobarbital 1540

mcg/mL

Rash, Stevens-

Johnson syndrome,

SLE

Somnolence,

irritability

Possible irreversible

cognitive effects,

liver induction,increased bone

metabolism

Adult: 60120

mg/d

Pediatric: 26

mg/kg/d

Phenytoin 1020

mcg/mL

Rash (510%),

hematologic,hepatic,

lymphadenopathy

others

Cosmetic, CNS,

ataxia, nystagmus

Elevated LFTs,

induction; reducedvitamin D levels;

?cerebellar

degeneration;increased bone

metabolism

Adult: 200600

mg/d

Pediatric: 48

mg/kg/d; mayneed higher does

in infants

Primidone 412mcg/mL

Rash Sedation, irritability,GI upset

Similar tophenobarbitalAdult: 750

2000 mg/d

Pediatric: 520

mg/kg/d

Tiagabine 570

mcg/mL

Psychiatric effects CNS, tremor,

weakness,

gastroesophagealreflux, gait difficulty

Adult: 3256

mg/d

Pediatric: 0.25

1.25 mg/kg/d

Topiramate 325

mcg/mL

Rash (rare), acute

glaucoma (rare)

Somnolence,

language disturbance,renal stones anorexia,

paresthesias

Language

disturbance(especially with

polytherapy); avoid

ketogenic diet;oligohidrosis

Adult: 100

400mg/d

Pediatric: 525

mg/kg/d; canincrease if side

effects are

tolerated


3/3

Valproic acid 50150

mcg/mL

Hepatic failure;

pancreatitis

Tremor, weight gain,

alopecia, sedation andcognitive changes,

thrombocytopenia,

prolonged bleeding

time

Hepatic failure (in

1:500 children < age2 y receiving

polytherapy),

elevated LFTs; GI

upset with syrup;incidence of PCOS

unknown, liverenzyme inhibition

Adult: 7501500 mg/d

Pediatric: 2060

mg/kg/d

Vigabatrin Visual field

constriction,

sedation, CNSeffects

Psychiatric symptoms

(rare), visual field

constriction

Especially effective

for infantile spasms

and tuberoussclerosis

Adult:

maximum 3000

mg/d

Pediatric: 40

150 mg/kg/d

Zonisamide 10

30mcg/mL

Rash, hematologic,hepatic

Renal stones,anorexia, somnolence

Oligohidrosis inchildren; cross-

sensitivity with sulfa

drugs

Adult: 200600

mg/d


Current pediatric diagnosis 19th

ed

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